Eye cancer

Disease Description (Causes and Symptoms)

• Summary of definition: Eye cancer refers collectively to malignant and benign tumors occurring in the eyeball and surrounding tissues, including the eyelid, conjunctiva, sclera, choroid, retina, and orbit. Major types include choroidal melanoma, conjunctival and eyelid tumors (such as basal cell carcinoma, squamous cell carcinoma, and conjunctival melanoma), and retinoblastoma.
• Causes and pathophysiology:
  • Choroidal melanoma: A malignant tumor arising from pigment cells in the mammalian eye. Some cases may be associated with genetic predisposition, fair skin, and long-term ultraviolet exposure.
  • Retinoblastoma: Genetic factors, such as abnormalities in the RB1 gene, account for a substantial proportion of cases (approximately 40%), and the disease occurs in children.
  • Conjunctival and eyelid carcinomas: Associated with chronic ultraviolet exposure, older age, and skin characteristics.
  • Depending on the tumor’s location and growth pattern, decreased vision may occur due to optic nerve compression, retinal detachment, or vascular changes. Some tumors metastasize; for example, choroidal melanoma tends to metastasize to the liver.
• Main symptoms:
  • Redness of the eye, swelling or detection of a lump at the tumor site
  • Proptosis of one eye, limitation of eye movement
  • Decreased vision, visual field defects, floaters, photopsia
  • Children (retinoblastoma): leukocoria (white pupil/white reflex), abnormal eye appearance (strabismus), visual abnormalities
  • Conjunctival melanoma and similar conditions: Changes in the size, color, or shape of a spot-like pigmented lesion, chronic redness

Treatment Methods (Standard Treatment · Medications · Procedures/Surgery · Lifestyle Management · Precautions)

• Diagnosis-based treatment selection: This varies depending on the type, location, and size of the tumor, the patient’s age, and whether metastasis is present.
• Local treatment:
  • Surgery
    • Enucleation: Performed when the tumor is very large or the eye cannot be preserved with other treatments.
    • Eyelid tumors: Wide excision plus reconstruction (plastic reconstruction) is recommended.
  • Local ablation/cryotherapy: Cryotherapy is applied to small conjunctival and eyelid lesions.
  • Local laser/photothermal therapy: Used selectively for small choroidal lesions (e.g., TTT).
• Radiation therapy:
  • Local radiation (brachytherapy/plaque brachytherapy, e.g., I-125), linear accelerator, or proton beam therapy: Used to preserve the eye in conditions such as choroidal melanoma. Proton therapy has the advantage of reducing damage to surrounding normal tissue.
• Systemic and local chemotherapy:
  • Retinoblastoma: Systemic chemotherapy, selective intra-arterial chemotherapy, and intravitreal or local injection treatment may be used.
  • For some conjunctival lesions, topical anticancer eye drops (e.g., Mitomycin C, 5-FU) or interferon alpha injections may be used.
  • In cases of choroidal metastatic cancer or systemic metastasis, systemic chemotherapy, targeted therapy, or immunotherapy may be considered, depending on the type.
• Preservation and rehabilitation:
  • A treatment plan prioritizing vision preservation, followed by insertion of an ocular prosthesis and oculoplastic reconstruction after enucleation.
  • Pain management, cosmetic and emotional support, and rehabilitation (including low-vision aids and coordination with hearing-aid services).
• Complications and precautions:
  • Possible complications include vision loss, retinal detachment, radiation retinopathy, infection, and damage to surrounding tissues after treatment.
  • Because choroidal melanoma carries a risk of metastasis, particularly to the liver, regular surveillance for metastasis is necessary.
  • Because enucleation can have significant cosmetic and psychological effects, thorough preoperative counseling and a postoperative rehabilitation plan are necessary.
• Prognosis (for reference): The 5-year survival rate for choroidal melanoma is approximately 65%, and the 10-year survival rate is approximately 50% (with substantial variation depending on tumor characteristics and the presence of metastasis).

Checklist Before an Outpatient Visit (Recommended Items · Information for Medical History · Example Questions)

• Recommended items to bring
  • List of medications currently being taken, including eye drops, and allergy records
  • Original copies or CDs of previous ophthalmologic/systemic test results or imaging (CT/MRI/ultrasound/fundus photographs, etc.)
  • Photos showing when symptoms began and how they have progressed (visible lesions, leukocoria, etc.)
  • Family history (especially a family history of retinoblastoma and genetic history in children)
  • Notes on physical symptoms that may suggest metastasis, such as weight loss or right upper abdominal pain
• Main information that medical staff will check during the outpatient visit
  • When symptoms began and factors that worsen or improve them
  • Changes in vision (measurements and whether eye contact is possible), presence of pain, eye discharge or bleeding
  • Systemic diseases (such as immunosuppression or a history of cancer) and history of smoking and ultraviolet exposure
• Precautions before examinations
  • Because driving may be difficult after a dilated-eye examination, confirm transportation home in advance.
  • If surgery is planned, prior consultation is necessary regarding currently used anticoagulants and antiplatelet agents.

General Example Questions to Ask the Doctor

• "What is the exact diagnosis and location of my tumor (inside or outside the eyeball, and which layer)?"
• "What treatment options do you recommend, and what are the expected benefits and side effects of each?"
• "What is the likelihood of preserving vision with treatment, and what is the prognosis?"
• "What will the follow-up schedule be after treatment, including imaging and blood tests?"
• "Are there any activities I should avoid or special precautions I should follow in daily life?"

Examples of Disease-Specific Questions (1–2)

• Choroidal melanoma (adults)
  • "How is the risk of metastasis from this tumor assessed, and how often should I undergo testing for metastasis, particularly to the liver?"
  • "Given my situation, which option do you recommend: eye-preserving treatment (e.g., brachytherapy or proton therapy) or enucleation?"
• Retinoblastoma (children)
  • "Is testing for hereditary disease (RB1 testing) recommended, and how should genetic testing or follow-up be handled for siblings?"
  • "What is the possibility of local treatment for eye preservation (local chemotherapy, laser, cryotherapy, etc.), and what is the long-term visual prognosis?"

(If necessary, please discuss a more specific diagnosis and treatment plan with the treating medical staff based on additional imaging findings, past medical history, and family history.)