Intraocular Tumours

Ocular oncology encompasses the management of all tumours involving the eye, eyelid, orbit and tear, or lacrimal, glands. Intraocular tumours affect adults and children, and tumours may occur in one eye or may involve both eyes.

Primary eye cancers are rare. They can occur within the eye, on the eye’s surface, in the skin cells around the eye, or in your glands that produce tears.

Secondary eye cancers occur more frequently. These are tumours from other parts of the body that have spread to the eye.

Common intraocular tumours include:

Choroidal melanoma is the most common primary intraocular tumour in adults. It arises from the pigmented cells of the choroid of the eye and is not a tumour that started somewhere else and spread to the eye. A choroidal melanoma is malignant, meaning that the cancer may metastasize and eventually spread to other parts of the body.

A choroidal haemangioma is comprised of blood vessels that may grow within the choroid (the blood vessel layer beneath the retina). These are not cancers and never metastasize. However, if the haemangioma is located in the area of central vision of the eye it can leak fluid. That may cause a retinal detachment and visual function may be affected.

Many choroidal haemangiomas can be safely monitored by your eye doctor without the need of further treatment. Treatment options may include laser photocoagulation to decrease the amount of fluid leakage or low doses of external beam radiation therapy.

Choroidal Metastasis are malignant tumours from other parts of the body can spread in and around the eye. Metastatic cancers that appear in the eye usually come from a primary cancer of the breast in women and the lungs in men. Other less common sites of origin include the prostate, kidneys, thyroid, and the gastrointestinal tract. Blood cell tumours (lymphomas and leukaemia) also can spread to the eye. Patient care will be coordinated between the eye cancer specialist, medical oncologist, and radiation oncologist. Treatment options may include chemotherapy, external beam radiation therapy, or, more rarely, enucleation.

A choroidal nevus looks like a raised freckle on the skin and can occur inside the eye. A choroidal freckle can become malignant, so should be closely monitored and examined by an ophthalmologist every four to six months to check if the pigmentation, size or characteristics of the nevus has changed. In most cases, the only treatment recommended is close observation and monitoring by an ocular oncologist.

Iris tumours can grow within and behind the iris (the coloured portion of the eye that controls the amount of light entering the eye). Though many iris tumours are cysts or a nevus, malignant melanomas can occur in this area. Most pigmented iris tumours do not grow. They are photographed and monitored with a special slit lamp and high frequency ultrasound to establish a baseline for future comparisons. When an iris tumour is documented to grow, treatment is recommended. Most small iris melanomas can be surgically removed. Radiation plaque therapy or enucleation may be considered for larger iris tumours.

Retinoblastoma is the most common intraocular cancer in children. It is extremely rare in adults.

Lymphoma tumours can appear in the eyelid tissue, lacrimal (tear) gland and the orbit. Treatment involves a multi-disciplinary approach with haematology/oncology and/or radiation oncology. The oculoplastic surgeon aids in diagnosis of the condition and monitors the patient for recurrence and ophthalmic side effects of treatment.

Tests

An eye cancer specialist can determine if you have an eye cancer by performing a complete clinical examination. The examination may include asking questions about your medical history, examining both eyes, looking into the eye at the tumour, doing an ultrasound examination, CT scan, MRI, obtaining specialized photographs and sometimes a biopsy is necessary.

Your doctor may request that you have a complete physical examination and specific tests depending upon what he sees inside your eye. Tests may include chest x-ray, complete blood count, MRI or CT scan