Eye cancer is a condition when cells in the eye organs or surrounding tissues grow rapidly, are uncontrollable, are malignant, and can spread to other parts or organs of the body. As they grow and spread, these cancer cells can damage normal cells in and around the eye.
Eye cancer is a rare disease. However, eye cancer can attack the three main parts of the eye, namely the eyeball, the tissue surrounding the eyeball (orbita), and the eye accessories (eyebrows, tear glands, and eyelids).
Eye cancer can originate from eye cells or from cancer in other organs or body parts that spread to the eye. Eye cancer that originates from the eye is called primary eye cancer. Meanwhile, eye cancer from cancer in other organs is called secondary eye cancer.
Types of Eye Cancer
Based on the tissue of origin, eye cancer can be divided into several types, namely:
Intraocular melanoma
Intraocular melanoma is the most common type of eye cancer. Melanoma generally develops from pigment-producing cells or melanocytes located in the uveal tissue. Intraocular melanoma most often occurs in the choroid, but can also occur in the iris.
Intraocular lymphoma
Intraocular lymphoma is a type of eye cancer that originates in the cells in the lymph nodes inside the eye. Intraocular lymphoma belongs to the class of non-Hodgkin lymphoma .
Patients with intraocular lymphoma generally have diseases that weaken the immune system, such as HIV/AIDS . Intraocular lymphoma also often appears together with lymphoma in the central nervous system, which is called primary central nervous system lymphoma (PCNSL).
Retinoblastoma
Retinoblastoma is an eye cancer that generally affects children. This eye cancer arises due to mutations (changes) in genes in the retina that cause retinal cells to divide rapidly and spread to eye tissue and other parts of the body. Retinoblastoma can occur in one or both eyes.
In addition to the three types of eye cancer above that occur in the eyeball, eye cancer can also occur in the orbits and accessory parts of the eye. Several types of cancer in the orbital tissue and accessory tissue of the eye, namely:
- Eyelid cancer, which is a variant of skin cancer, such as basal cell carcinoma or squamous cell carcinoma
- Orbital cancer, which is cancer that occurs in the muscles that move the eyeball and the connective tissue around the eyeball ( rhabdomyosarcoma )
- Conjunctival melanoma, which is cancer that occurs in the membrane that lines the eyelids and eyeball (conjunctiva), usually this cancer looks like a black spot in the eye
- Tear gland cancer ( malignant mixed epithelial tumor ), which is cancer that originates from the cells of the tear glands
Causes of Eye Cancer
The cause of eye cancer is not known with certainty. However, this condition is thought to arise due to gene mutations in eye tissue, especially genes that regulate cell growth.
Although the cause is unknown, there are factors that can increase the risk of developing eye cancer, namely:
- Over the age of 50 years
- White or pale skin
- Have a bright eye color, such as blue or green
- Have a family history of eye cancer
- Suffer from a disorder or a history of certain disorders, such as having many moles ( dysplastic nevus syndrome ) or black spots on the eyes ( nevus of Ota )
Several studies suspect that exposure to sunlight and exposure to ultraviolet lamps are also associated with the occurrence of eye cancer. In addition, several types of work, such as a welder, are also thought to increase a person's risk of developing melanoma. However, these assumptions need to be investigated further.
Symptoms of Eye Cancer
Symptoms of eye cancer vary, depending on the type of cancer suffered. Symptoms can mimic those of other eye conditions or diseases. Sometimes, eye cancer may not cause any symptoms at first.
However, in general there are several symptoms that can indicate eye cancer, namely:
- Impaired vision
- Visual field narrowing
- Floaters , namely objects, lines or spots that appear to be flying on sight
- The flash of light on sight
- Dark spot on the iris
- Changes in pupil size and shape
- Strabismus or squint
- One eye looks more prominent
- Lumps on the surface of the eye, eyelid, or around the eye
- Red or irritated eyes
- Pain in the eyes
- Conjunctivitis
In children who have retinoblastoma, you will see a picture like a cat's eyes reflecting light or white spots when the eyes are exposed to light.
When to see a doctor
Some of the symptoms of eye cancer are non-specific and can mimic the symptoms of other eye diseases. Therefore, check with your doctor if you experience the symptoms mentioned above, especially if they don't subside after 2 weeks.
Routine examinations to the doctor are highly recommended if you have factors that can increase the risk of developing eye cancer. Examination should be done once a year so that eye cancer can be detected as early as possible. The earlier cancer is detected, the greater the chances of successful treatment.
Diagnosis of Eye Cancer
The doctor will conduct questions and answers regarding the patient's complaints, including when the symptoms appeared, what can trigger or relieve symptoms, as well as the patient's general medical history.
The doctor will also do an eye examination with the help of an ophthalmoscope , slit lamp , and lens gonioscopy. This examination aims to determine the ability of eye vision, movement of the eyeball, and the condition of the eye blood vessels.
If the results of the examination indicate the possibility of eye cancer, the doctor will carry out several supporting examinations to confirm the diagnosis, namely:
- Scans, such as eye ultrasound , CT scan, or MRI, to determine the location and size of cancer cells, and detect the spread of cancer cells to other organs
- Biopsy , to take samples of eye tissue suspected of having cancer for further examination in the laboratory
- Lumbar puncture , to detect whether intraocular lymphoma cancer has spread to the brain or spinal cord
Eye Cancer Treatment
The chance of cure for eye cancer depends on the size and location of the tumor, the severity of the condition, and how fast the cancer is growing. In some cases, eye cancer can also recur after the patient has undergone treatment and is declared cured.
Treatment of eye cancer aims to maintain eye function, prevent the spread of cancer cells to other parts of the body, and prevent recurrence after treatment. Some of the methods that can be done include:
1. Operation
The type of surgery performed depends on the location and size of the cancerous tissue present. During surgery, the patient is usually given general anesthesia. Specifically, the types of surgery that can be done to treat cancer are:
- Iridectomy, which is the removal of part of the iris of the eye to treat small iris melanoma
- Iridotrabulectomy, which is the removal of part of the iris along with a little outside of the eyeball to treat melanoma on the iris
- Iridocyclotomy, which is the removal of part of the iris and part of the ciliary body to treat iris melanoma
- Transcleral resection, which is the removal of melanoma cancer that occurs in the choroid or ciliary body
- Enucleation, which is the removal of the entire eyeball in melanomas that cause pain and are large, or in patients who have lost their sight
- Exenteration of the eye, which is the removal of the eyeball and several other parts around it, such as the eyelids, muscles, nerves, and other tissues in the eye socket
2. Radiotherapy
Radiotherapy is a treatment that is carried out by shooting high-energy X-rays at cancer tissue. The risk of loss or damage to the eyeball and vision loss can be reduced by this method of treatment.
Two types of radiotherapy that can be given are:
- Brachytherapy , which is performed by inserting small radioactive plates in the area around the eye close to the cancerous tissue
- External radiotherapy, which is done by shooting X-rays into the eye, but carries the risk of damaging other healthy tissue around the cancer
3. Laser therapy
Laser therapy functions to destroy cancerous tissue using infrared light. One form of laser therapy is gamma knife surgery ( gamma knife surgery ).
Laser therapy is usually used in patients with intraocular melanoma and small retinoblastoma, but is not recommended in patients with intraocular lymphoma.
4. Chemotherapy
Chemotherapy is a method of treating eye cancer using drugs. Chemotherapy can be injected into certain parts of the body, given through an IV, or taken by mouth.
5. Drugs
Some immunotherapy drugs and targeted therapy drugs can be a treatment option, especially if chemotherapy drugs are not effective for the type of eye cancer being treated. Immunotherapy drugs, such as nivolumab, pembrolizumab, and ipilimumab, have been shown to treat melanoma.
6. Cryotherapy
Cryotherapy is a method of treating cancer by freezing cancer tissue. Cryotherapy can be given to small retinoblastoma sufferers.
Eye Cancer Complications
Complications that can occur from eye cancer include:
- Glaucoma
- Loss of sight or blind
- Spread of cancer cells to other parts of the body ( metastasis )
Prevention of Eye Cancer
Eye cancer is difficult to prevent, because not all eye cancers have a known cause. The best effort that can be done is to avoid factors that can increase the risk of this condition, including by:
- Avoid exposure to sunlight or ultraviolet rays by wearing UV - protected glasses when the sun is hot
- Preventing HIV infection, one of the factors that can increase the risk of intraocular lymphoma
- Undergo eye examinations early on in children if there are family members who have a history of retinoblastoma
- Undergo routine eye examinations at least 1 time in 1 year