Cancers in eye are not uncommon

Many people are not aware that cancers or tumors can appear in eye as well, and believe that  if it does, it must be quite rare. However in one year i saw around 200 newly diagnosed patients with eye cancers at Tilganga itself. This data excludes the benign tumors of eye and orbit. I am sure many similar patients are being seen in other eye hospitals and some go undiagnosed as well. So isnt eye cancers significantly common? In this article i shall be briefing about the types of common eye cancers we come across daily.

The impact of eye cancer in a patient is three fold- one is the chance of having to live blind for ever and another is fear of distant metastasis and loosing life to cancer.The third one is that one childhood cancer called Retinoblastoma occurs in babies from birth to five years of age which is quite shocking and hearbreaking news  to the new parents.Last year we saw 40 new cases of retinoblastoma presenting to us from east like Bhojpur district to far west like Kalilali. Many were from Terai belt of Nepal and from neighbouring states of India as well. The smallest one i saw was of 28 day old baby and oldest one was 4 and half year old.The younger the age of presentation, the more likely that the baby had genetic mutation in prenatal life;ie the patient has chance of getting tumor in both the eyes and his younge siblings are also at risk, which is a devastating news to the parents. The earliest sign of retinoblasotoma is white pupillary reflex (instead of black in normal light and red in photos taken with flash) as shown in Figure 1. Some parents notice this early and visit hospital out of curosity when there is a chance of getting diagnosed early. While some old people of house assure them that it is a good luck sign and wait until it grows out of eye thus making the vision and life threatening decision. Other signs of retinoblastoma are squinting, abnormal persistant red eye without infection or one eye appearing larger than other eye.If the patients are not treated on time, the tumor grows outside the eye on the face as shown in Fig 2. The treatment options are surgery, chemotherapy,laser therapy, radiation and cryotherapy depending on the tumor type and mode of presentation. Retinoblastoma is caused by genetic mutaion before birth;it is not attributed to the food habits or any other medical condition of mother during pregnancy.The other malignant tumors of eye in children are rhabdomyosarcoma, medulloepithelioma, leukemia, metastatis etc which i am not discussing in this paper.

In adults, eye cancer can apper from eyelid, surface of eye, inside the eyeball or in back of eye causing eye to bulge forward from its socket. The eyelid cancers are common in sun exposed individual and they are basal cell carcinoma, sebaceous cell carcinoma and squamous cell carcinoma. Here too if they present early like in Figure 3,the tumor can be excised completely and the patient can be free of disease easily. However late presentation means that tumor has grown big thus requiring larger resection or the tumor has spread in the eyeball or behind it in the orbit where simple surgery like excision biopsy is not enough , so we may need to remove eyeball or whole of the orbital content called exenteration and give radiation as well. Therefore any growth of mass or appearance of painless ulcers  in the eyelids or sudden enlargement of nevus is suspecious of eyelid carcinoma. Unlike the other cancers of body, eyelid tumors should present early beacuse any growth is easily visible.

Ocular surface squamous neoplasia (OSSN) is a tumor of outer part of eyeball that is conjunctiva(the white part of eye) and cornea(the black part of eye).  The pre cancerous lesion called CIN and its cancerous part called invasive squamous cell carcinoma are difficult to differentiate in early stages. However it is advisiable to seek advise whenever there is  some growth of mass, persistant painless red eye or white lesions on cornea.Smoking, sun exposure and immunocompromised stage are the risk factors. The early and late stages appearances are shown in Figure 4 and Figure 5. The treatment of choice is complete excison biopsy with base and margin cyrotherapy whenever possible in small lesions. Topical chemotherapy and immunotherapy drugs are also available for use in selected cases. However again, if the patients present late, then destructive surgeries are again required as for eyelid tumors.

Apart from retinoblastoma, there are other intraocular cancers which are seen in adults. The common ones are melanoma, adenocarcinomaetc. We frequently encounter metastasis from breast, lung and bones as well.These cancers causes decrease in vision and floaters and sometimes goes unnoticed by patients when the vision in other eye is good. Treatment options are plaque brachytherpy in early stage and enucleation( eye removal surgery) in late stages. Therefore metastatis to eye should be suspected in patients with breast and lung cancers when they complain of decraese in vision.

Cancer can arise from any  part of the eye and orbit. Tumors from orbital contents(the structues around eyeball like lacrimal gland, muscles, nerves and bones) generally produces proptosis ie outward bulging of eyeball as shown in Figure 6. Though proptosis is commonly caused by thyroid related disease or by inflammation, we send for CT scan or MRI scan in these cases to rule out tumors of orbit.Common cancers of orbit are lacrimal gland adenocarcinoma, lymphoma, multiple myeloma, local invasion from paranasal sinus cancers, rhabdomyosarcoma  and neuroblastoma in children and metastasis form breast, lung,prostrate,kidney cancers to name the few.

Apart from the above malignant lesions of eye, there are a lot more of benign tumors which is beyond the scope of this article. Hence i wound like to conclude that though eye appears to be a small organ, the cancers of eye can be of varid types which are sight thereatening to life threatening. As for any other cancers of the body, early diagnosis and treatment is always recommened to save vision and life.