Eye cancer is a disease where cells onorgan eye or surrounding tissue grows rapidly, uncontrollably, is malignant, and can spread to other parts or organs of the body. SAs they grow and spread, these cancer cells can damage the normal cells around them.
Eye cancer is a rare disease. Eye cancer can occur in three main parts of the eye, namely the eyeball (Fig.globe), orbit (tissue surrounding the eyeball), and eye accessories (eyebrows, tear glands, and eyelids).
Eye cancer can originate from the cells of the eye or from cancer in other organs or body parts that spreads to the eye. Eye cancer originating from the eye is called primary eye cancer, while eye cancer from 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 (dye) or melanocytes located in the uveal tissue. Intraocular melanoma most commonly occurs in the choroid, but can also occur in the iris (rainbow membrane) tissue.
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 non-Hodgkin lymphoma group.
Patients with intraocular lymphoma generally have a disease that causes a weakened immune system, such as HIV/AIDS. Intraocular lymphoma also often co-occurs with lymphoma of the central nervous system called primary central nervous system lymphoma (PCNSL).
Retinoblastoma
Retinoblastoma is eye cancer in children. Retinoblastoma arises due to mutations in a gene in the retina that causes retinal cells to divide rapidly and spread to eye tissue and other body parts. 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 orbit and eye accessories. Several types of cancer in the orbital tissue and eye accessory tissues, including:
- 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 conjunctival membrane that lines the eyelids and eyeball, usually this cancer looks like a black spot on the eye
- tear gland cancer (malignant mixed epithelial tumor), namely tear gland cancer that originates from gland cells that can spread to other parts of the body
Causes of Eye Cancer
The exact cause of eye cancer is not known. However, eye cancer is suspected 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 50 years old
- Fair skin
- Have a bright eye color, such as blue or green
- Have a family history of intraocular melanoma
- Have 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 have shown that exposure to harmful chemicals, exposure to sunlight, or exposure to ultraviolet light is also associated with eye cancer. In addition, certain types of work, such as welding, are also thought to increase a person's risk of developing melanoma.
Symptoms of Eye Cancer
Symptoms of eye cancer vary, depending on the type of cancer suffered. Symptoms can resemble those of another eye condition or disease. Sometimes, eye cancer may not cause any symptoms at first.
However, in general there are several symptoms that can indicate eye cancer, namely:
- There are dark spots on the iris
- Visual disturbance
- Narrowing of the field of view
- Seeing things like flying (floaters), stripes, or spots
- Seeing flashes of light
- Changes in pupil size and shape
- Strabismus or squint
- One eye looks more prominent
- A lump appears on the surface of the eye, eyelid, or around the eye
- Pain in the eye
- Red or irritated eyes
- Conjunctivitis
In children who have retinoblastoma, it will look like a "cat's eye" or white patches when the eyes are exposed to light.
When to go to the doctor
Since the symptoms of eye cancer are non-specific and can mimic those of other eye conditions or diseases, it is advisable to see a doctor if you experience any of the symptoms mentioned above, especially if the symptoms do not subside after 2 weeks.
Regular check-ups with your doctor are highly recommended if you have factors that can increase your risk of developing eye cancer. Examination should be done once a year, so eye cancer can be detected as early as possible.
Eye Cancer Diagnosis
The doctor will ask and answer questions about the complaints and symptoms experienced by the patient, including when the symptoms have appeared and what can trigger or relieve symptoms, as well as the patient's general medical history.
Then, the doctor will also perform an eye examination with the help of tools, such as an ophthalmoscope, slit lamp (slit lamp), and lens gonioscopy, to see eye conditions. This examination aims to determine the ability of eye vision, eye movement, and the condition of the eye blood vessels.
If the results of the examination indicate the possibility of eye cancer, several investigations can be carried out to confirm the diagnosis, including:
- Scans, such as an eye ultrasound, CT scan, or MRI to determine the location and size of cancer cells
- Biopsy, to take a sample of eye tissue suspected of having cancer for examination in the laboratory
- Lumbar puncture, to detect whether intraocular lymphoma cancer has spread to the brain or spinal cord
Eye Cancer Treatment
Chances of curing eye cancer depend on the size of the tumor, the severity of the condition, and the area and part of the eye that has cancer. In some patients, recurrence can also occur after treatment and declared cured.
Eye cancer treatment 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 performed to treat cancer are:
- Iridectomy, which is the removal of part of the iris of the eye to treat melanoma of the small iris
- Iridotrabulectomy, which is the removal of part of the iris along with a small part of the outside of the eyeball to treat melanoma of the iris
- Iridocycletomi, 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 large melanomas or in patients who have lost vision
- Exenteration of the eye, which is the lifting of the eyeball and some other parts around it, such as the eyelids, muscles, nerves, and other tissues in the eye socket
2. Radiotherapy
Radiotherapy is a treatment that involves shooting high-energy X-rays at cancerous tissue. With radiotherapy the risk of loss or damage to the eyeball and vision loss can be reduced. Two types of radiotherapy that can be given are:
- Brachytherapy, this procedure is done by inserting a small radioactive plate in the area around the eye that is close to the cancerous tissue
- External radiotherapy, this procedure is done by shooting X-rays into the eye, but there is a risk of damaging other healthy tissue around the cancer
3. Laser therapy
Laser therapy works to destroy cancerous tissue using a laser beam. Laser therapy is usually used in patients with small intraocular melanoma and retinoblastoma, but is not recommended for patients with intraocular lymphoma.
4. Chemotherapy
Chemotherapy is a method of treating eye cancer using chemical drugs. Chemotherapy can be injected directly into the eye area (intraocular), into the cerebrospinal fluid (intrathecal), or given through an IV. Chemotherapy can be given to patients with retinoblastoma, or intraocular lymphoma.
5. Drugs
Some immunotherapy drugs and targeted therapy drugs can be treatment options, especially if chemotherapy drugs are not effective for the type of eye cancer being treated. Immunotherapy drugs, namely pembrolizumab and ipilimumab, have been shown to treat melanoma.
6. Cryotherapy
Cryotherapy is a cancer treatment method by freezing cancer tissue. Cryotherapy can be given to patients with retinoblastoma who are still small.
Eye Cancer Complications
Complications that can occur from eye cancer include:
- Loss of sight or blindness
- Glaucoma
- Spread of cancer cells to other parts of the body (metastasis)
Eye Cancer Prevention
Because not all types of eye cancer know the exact cause, it is quite difficult to prevent eye cancer. The best thing that can be done is to avoid factors that can increase the risk of developing this condition. Some things that can be done are:
- Avoid exposure to sunlight or ultraviolet rays by wearing glasses UV-protected when the sun is hot
- Preventing HIV infection, which is one of the factors that can increase the risk of intraocular lymphoma
- Conduct early examinations on children if there is a family member who has a history of retinoblastoma