Eye tumors are a heterogeneous group of diseases, among which there are both benign and malignant lesions. Eye neoplasms of can also be divided into intraocular (growing directly from eyeball structures) and orbital (growing from anatomical structures of eye socket or eye auxiliary apparatus of – eyelids, lacrimal glands, etc.). Most intraocular lesions are malignant in nature. Eye tumors can also be primary, that is, the growth begins directly in organ of vision structures, and secondary, or metastatic (when a tumor in the eye is a metastasis of another location cancer).
Malignant lesions of organ of vision are quite rare tumors among adult population and account for no more than 5% of all malignant neoplasms. At the same time, all anatomical organ of vision structures can be affected – eyelids, conjunctiva, iris, retina, optic nerve, tissues of orbit.
Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, so our patients have the opportunity to receive assistance that will cover all or a certain part of necessary treatment. This is a very important step, because many people who need highly specialized treatment cannot receive it due to the lack of financial ability to pay for medical services.
Eye tumors are dangerous diseases not only in terms of affected eye function los, but also in terms of life, as some of them are malignant in nature, can grow and destroy nearby anatomical structures, and give distant metastases. Therefore, if this disease is suspected, it is necessary to consult an ophthalmologist as soon as possible. In course of additional examination, in case if neoplasm malignant nature suspected, doctor will refer the patient to a qualified oncologist.
Such specialists work in Oncology Department of Maimonides Multidisciplinary Medical Center. Our clinic operates in close and fruitful cooperation with the best Israeli oncology centers. We chose Israeli medicine as an example of providing medical services, because it is one of the best and most effective in the world. Each individual clinical case of eye tumors is managed jointly by attending oncologist, the head of the department – Dr. Iryna Stefanska and responsible oncologist directly from Israel. Thanks to such coordinated work of a professional team, we manage to achieve success even in the most difficult cases and preserve not only the patient's health and life, but also his vision.
Making up an examination plan and treatment scheme, our specialists use modern global treatment protocols and clinical recommendations, so the quality of providing medical services cannot be doubted. At the same time, a great treatment advantage at Maimonides Medical Center is an individual approach to each patient, because there are no two identical people and no two identical tumors. Therefore, making up a treatment plan, doctor takes into account age, patient’s gender, his main diagnosis, all tumor characteristics, the stage of disease, concomitant severe pathologies presence and patient’s wishes regarding diagnostic process and treatment. This approach contributes to remarkably better results of complex treatment and significantly improves prognosis.
In Oncology Department of Maimonides Clinic, patient is assisted not only by oncologists, but by a whole multidisciplinary team: oncologists, surgeons, ophthalmologists, radiation therapists, chemotherapists, rehabilitation specialists, plastic surgeons, psychologists and other specialists if necessary. All our specialists are highly qualified and have extensive working experience in Oncology Department. Most of them have repeatedly completed internships at the best oncology centers in the world. Our medical center uses only modern and safe medical and diagnostic equipment of expert class. If a certain narrow specialist or rare medical and diagnostic equipment is not available, patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services.
Types of eye tumors in adults
There are many types of eye tumors, including benign and malignant, primary and metastatic, intraocular and orbital, but the following types of eye neoplasms are most common:
- eye melanoma,
- metastatic lesions of eye,
- retinal glioma,
- tumors of eye mucous membranes (conjunctival tumors),
- orbital osteomas,
- orbital neurofibroma,
- eye lymphoma,
- orbital dermoid cyst,
- optic nerve glioma,
- intraocular vascular tumors,
- sarcoma of orbit and eye,
- mucous cyst of additional sinuses.
One of the most common eye tumors in adults is melanoma, which most often affects eye choroid. Choroidal melanoma arises from choroidal melanocytes ( choroid pigment cells). Most often, melanoma occurs between the ages of 55 and 60. It can have both a local character and multiple metastases that can lead to death. Symptoms appear late and include vision loss and signs of retinal detachment. Diagnosis is established with help of ophthalmoscopy , which, if necessary, is supplemented with an ultrasound eye scan, computer tomography, fluorescence tomography and consecutive photographs using a special camera. Small tumors are treated with laser therapy, radiation, or radioactive implants, which can preserve vision and save affected eye. In isolated cases, local resection is used. For large tumors, enucleation of eye is performed.
In second place among malignant eye lesions in adults are metastatic lesions of eye choroid. Choroidal metastases are quite common, because vascular membrane of eye is abundantly supplied with blood. Most often, these are breast cancer metastases in women or lung and prostate cancer in men. Clinical manifestations develop late and include visual impairment and retinal detachment. This disease is often detected as an incidental finding during routine ophthalmoscopy. Then, usually, an eye ultrasound examination follows and diagnosis is confirmed by a fine-needle biopsy. Treatment depends on primary cancer characteristics and usually includes systemic chemotherapy, radiation therapy, or a combination of these methods.
Symptoms of eye tumors
For a long time, eye tumors do not have any symptoms, but are discovered accidentally during a preventive examination or examination for another reason. In the later stages, patient has the following symptoms:
- visual acuity decreases;
- eye iris may change color, visible spots, inclusions may appear on it;
- patient may complain on flashes in eye, blurring of image, spots appearence, loss of visual fields;
- eyeball shifts, for example, deviates to front or back, shifts forward;
- strabismus (cross-eye) appearance;
- eye pain;
- changes in eyelids skin and eyelids shape;
- presence of visible neoplasms on eye mucous membrane, on the eyelids;
- pain during tears release, profuse tearing or, conversely, tears absence;
- photophobia.
he earlier problem is detected, the greater chances not only for a full recovery, but also for affected eye and vision preservation. Therefore, do not neglect preventive examinations at ophthalmologist, because one of these visits can save your life by early detection of eye malignant tumor.
Diagnostic methods of eye tumors
The basic rule of diagnosis in oncology: the earlier diagnosis of a malignant tumor is established, the better prognosis and treatment result. Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern equipment of an expert class, all our doctors perfectly master all methods of examining patients with eye malignant neoplasms suspected, are able to interpret obtained data correctly, which helps them create a modern, individual and effective treatment plan.
If you suspect a certain eye disease, including malignant neoplasms, you should contact an ophthalmologist as soon as possible. Already after a standard full ophthalmological examination, a specialist can make a preliminary diagnosis. An ophthalmologist examines eye in detail with a dilated pupil using special equipment – an ophthalmoscope, a slit lamp (this is equipment that allows us to examine all eye and fundus optical structures in detail under magnification). Also, with the help of a special RetCam camera , photofixation of changes in fundus is performed. Based on examination, doctor makes drawings of fundus, where he schematically depicts detected tumor. These pictures, together with RetCam photo, are a reference point and are subsequently used to control treatment.
In a comprehensive examination of a patient with ophthalmological pathology, our specialists always use eyeball ultrasound. Ultrasound allows us to assess blood flow, see the tumor on device monitor, determine its thickness and size. We also conduct our patients:
- measurement of intraocular pressure, which increases with intraocular tumors,
- electroretinography (measurement of retina electrical activity).
Neoplasm biopsy is not performed when intraocular malignant tumors are suspected,as this procedure can promote the spread of malignant cells and metastases development, which worsens the prognosis.
In case of epibulbar tumors (on the surface of eye, on eyelids), a biopsy is allowed and provides an accurate diagnosis All biopsy specimens are sent for revision to the best pathogistological laboratories in Germany, Israel, and USA.Thanks to such "molecular checks", we are absolutely sure of the diagnosis correctness and further treatment tactics.
Innovative molecular genetic tests are also available to our patients after biopsy. This is a mandatory part of modern diagnosis of oncological diseases. Thanks to molecular genetic diagnostics, we can choose the most effective treatment regimens, because the response to certain drugs action depends on type of malignant changes. An example of such modern diagnostics are test systems for molecular genetic testing. Such as the Foundation One and Caris Molecular Testing.
Eye malignant tumors examination complex necessarily includes CT and MRI of eye, head, thoracic organs, abdominal cavity, and pelvis. These methods of medical imaging allow us to confirm the diagnosis, determine tumor size, extent of its spread and the stage of disease, as well as detect all distant metastases. In particularly difficult cases, our specialists perform whole-body scanning using bone scintigraphy, PET-CT, PET-MRI.
Based on received data, oncologist together with ophthalmologist makes an accurate diagnosis indicating the stage of malignant process and formulates a treatment scheme, according to patient’s individual characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in the clinic, without leaving Ukraine.
Eye tumors modern treatment
One of the most important advantages of eye tumor treatment at Maimonides Medical Center is a comprehensive approach application to each individual patient and his disease. In fight against tumor, doctor uses the entire available arsenal of methods. Therapy is always a combination of two, three, or even more methods. As a rule, treatment scheme includes tumor surgical removal in combination with chemotherapy and radiation therapy. In some cases, certain innovative treatment methods are added to the treatment program (targeted drugs, immunobiological drugs, etc.).
Chemotherapy occupies an important place in eye tumors treatment, as it makes it possible to destroy tumor and at the same time preserve patient's eye and vision. As is known, treatment method is based on special drugs applicationthat suppress growth and division of malignant cells, thus leading to a complete reduction of neoplasm. Unfortunately, chemotherapy drugs act not only on bad cells, but also on healthy cells of our body, which is why the main side effects of chemotherapy treatment are connected.
Chemotherapy can be systemic, when drugs are administered parenterally or orally, as well as contact or regional, when drug is delivered in a certain way directly to tumor (brachytherapy). The second method is more effective and has significantly fewer side effects, as there is no impact on healthy surrounding tissues.
Ophthalmic artery chemotherapy is a type of regional chemotherapy . It is a complex procedure that requires modern equipment and is performed by an interventional radiologist. Doctor inserts a catheter into vessel (usually femoral artery on leg), which is brought up to eye artery. Next, through this catheter, a certain dose of chemo medecine is injected directly into eye artery, which immediately reaches tumor and acts in desired area. Thus, there are no unwanted side effects, as from systemic chemotherapy.
Intravitreal chemotherapy is also a type of regional chemotherapy, drugs are injected directly into eye (into vitreous body). Procedure is performed on an outpatient basis and is almost painless.
Periocular chemotherapy is also a type of regional technique, when drugs is injected into eyeball surrounding tissues using a thin needle. This technique is used in combination with ophthalmic artery chemotherapy or intravitreal technique to achieve the best results and prevent disease recurrence in future.
Surgical methods of eye tumors treating include such modern procedures as focal (contact) neoplasms treatment methods. Our doctors perfectly master eye neoplasms laser destruction method. A focused beam of laser radiation is delivered through pupil to tumor bed, which leads to its destruction. This technique can be applied in outpatient settings, it is almost not accompanied by pain.
Another minimally invasive eye neoplasms treatment method is cryodestruction. At the same time, a special sensor is brought to tumor site, which generates ultra-low temperatures, and with the help of it tumor is destroyed.
Another modern and effective eye tumors treatment method is brachytherapy. This is a type of contact radiation therapy, when special radioactive plaques are placed on affected eye. These are special disks that are produced individually for each patient. This treatment takes place in Radiology Department hospital.Placement and removal of radioactive plaques is a minor surgical intervention. Discs are removed 1-4 days after installation (depending on required radiation dose).
In some cases, doctors are forced to use general remote stereotaxic radiation . Our clinic uses advanced accelerators equipped with breathing control systems and other devices to make treatment faster and safer.
Eyeball removal (enucleation) is performed only in extreme cases, when it is impossible to save diseased eye with any modern methods. Even if patient has been enucleated, the next stage of treatment is reconstructive plastic surgery and modern prosthesis installation, which in no way differs from real eye.
Immunobiological therapy and targeted drugs are actively used in eye malignant tumors treatment. The most modern drugs that belong treatment method are monoclonal antibodies. These are drugs created from human T-lymphocytes to stimulate immune system. Immune system is unable to manage with ever-increasing number of rapidly dividing atypical cells. It is helped by immune response cells grown in large quantities in laboratory. This cells are equipped with specific receptors that catch cells with a certain mutation (a particular type of malignant cells) and destroy them, while not harming the rest of healthy cells in body.
In each case, decision on certain treatment methods combination is made jointly by a team of specialists.Each patient and his disease is different, so our doctors, relying on their experience in eye malignant tumors treatment, often go beyond the standard protocols, changing treatment regimens and doses of necessary drugs, radiation technique in order to get the best possible results for their patients.