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Retinoblastoma (Eye Cancer) Treatment in India

Retinoblastoma

Retinoblastoma is a rare type of eye cancer that usually develops in early childhood, typically before the age of 5. This form of cancer develops in the retina, which is the specialized light-sensitive tissue at the back of the eye that detects light and color.

In most children with retinoblastoma, the disease affects only one eye. However, one out of three children with retinoblastoma develops cancer in both eyes. The most common first sign of retinoblastoma is a visible whiteness in the pupil called “cat’s eye reflex” or leukocoria. This unusual whiteness is particularly noticeable in photographs taken with a flash. Other signs and symptoms of retinoblastoma include crossed eyes or eyes that do not point in the same direction (strabismus); persistent eye pain, redness, or irritation; and blindness or poor vision in the affected eye(s).

Types of Retinoblastoma

Unilateral Retinoblastoma : This type of retinoblastoma accounts for almost 75% of cases and it usually affects only one eye. Unilateral retinoblastoma can be either sporadic or hereditary. Sporadic generally happens in those children who are over age 1 and accounts for almost 75-80% of unilateral retinoblastoma cases.

Bilateral Retinoblastoma : Bilateral retinoblastoma is an indication of a genetic influence and it affects not one but both the eyes. This disease can be inherited from a parent who are having it but at the same time does not show any symptoms. This condition can be diagnosed early at a young age as compared to unilateral disease.

Trilateral Retinoblastoma : Intracranial tumor also develops in those children who have inherited retinoblastoma. This tumor originates in primitive nerve cells and is considered as rare that accounts for only 5% of patients having bilateral retinoblastoma.

Causes of Eye Cancer

It’s not clear exactly why this occurs, but the following factors may increase the risk of it happening:

  • lighter eye colour – if you have blue, grey or green eyes, you have a higher risk of developing eye melanoma compared with people who have brown eyes
  • white or pale skin – eye melanoma mostly affects white people and is more common in those with fair skin
  • unusual moles – if you have irregularly shaped or unusually coloured moles, you’re more at risk of developing skin cancer and eye melanoma
  • use of sunbeds – there’s some evidence to suggest that exposing yourself to ultraviolet (UV) radiation from sunbeds, for example, can increase your risk of eye melanoma
  • overexposure to sunlight – this increases your risk of skin cancer, and may also be a risk factor for eye melanoma

Symptoms

Symptoms of eye cancer can include:

  • shadows, flashes of light, or wiggly lines in your vision
  • blurred vision
  • a dark patch in your eye that’s getting bigger
  • partial or total loss of vision
  • bulging of one eye
  • a lump on your eyelid or in your eye that’s increasing in size
  • pain in or around your eye, although this is rare

Stages of Retinoblastoma

  • Intraocular. This means that cancer occurs in one or both eyes, but has not spread into surrounding tissues or other parts of the body.
  • Extraocular. The cancer has spread to tissues around the eye or to other parts of the body.
  • Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis

Diagnosis of Retinal Cancer

  • Ultrasound. An ultrasound uses sound waves to create pictures of the internal organs. A transmitter that emits sound waves is moved over the child’s body. A tumor generates different echoes of the sound waves than normal tissue does, so when the waves are bounced back to a computer and changed into images, the doctor can locate a mass inside the body. The procedure is painless.
  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the child’s body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the brain and spinal column. MRI can also be used to measure the tumor’s size.
  • MRI or CT scan of the brain. These tests may be recommended to find out if there is an abnormality of the pineal gland, which is a small gland in the brain that regulates the body’s response to light
  • Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor takes a sample of cerebral spinal fluid (CSF) to look for cancer cells, blood, or tumor markers, which are substances found in higher than normal amounts in the blood, urine, or body tissues of people

·        Bone marrow aspiration and biopsy. These two procedures are performed to determine if any retinoblastoma cells have spread to the bone marrow and are often done at the same Treatment of Retinoblastoma Cancer

Treatment of Retinoblastoma Cancer

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery to remove the eye is called enucleation. A surgeon removes the eyeball and places an eye implant into the eye socket. This eye implant is then attached with the eye muscles. The implanted eyeball will be moved by the eye muscles just like it moves the natural eye. This implanted eye cannot see. The placement of a custom-made artificial eye is done on the eye implant after some weeks of the surgery. This artificial eye is matched with the healthy eye of a child. Gradually, it sits at the back of the eyelids and is clipped on the eye implant. When the eye implant is moved by the eye muscles then it will look as if the child is moving this artificial eye.

Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, plaques, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated

Cryotherapy

Cryosurgery, also called cryotherapy or cryoablation, uses liquid nitrogen to freeze and kill cells. More than one freezing may be needed.

Laser therapy

Laser therapy uses heat in the form of a laser to shrink a smaller tumor. It may be called thermotherapy or TTT for transpupillary thermotherapy. It may be used alone or in addition to cryotherapy or radiation therapy

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide and may be used to shrink an eye tumor. The injection of these drugs is done into a vein that travels in the entire body. It also helps in shrinking the tumor of retinoblastoma that has spread to the other areas of the body or outside the eyeball.