The Victoria Cohen Eye Cancer Charitable Trust is the chosen charity at this year’s COVER Excellence Awards. In this article Professor Mandeep Sagoo provides an introduction to eye tumours.
Eye tumours, also known as ocular tumours, encompass a broad spectrum of abnormal growths within the eye or its surrounding structures.
These tumours can be benign (non-cancerous) or malignant (cancerous), and they may arise in various parts of the eye, including the eyelids, conjunctiva, cornea, iris, ciliary body, retina, and optic nerve. Understanding eye tumours involves recognizing their types, causes, symptoms, diagnosis, and treatment options.
Types of Eye Tumours:
Eyelid Tumours: Tumours can form on the eyelids, typically as basal cell carcinoma or squamous cell carcinoma, which are often related to prolonged sun exposure. They can manifest as painless nodules or ulcers on the eyelids.
Ocular Surface Tumours:
The conjunctiva is a transparent membrane covering the whites of the eyes and the inner surface of the eyelids and the cornea is the clear part of the front of the eye. Tumours in this region can be benign, such as pinguecula or pterygium, or malignant, such as conjunctival melanoma.
Intraocular tumours:
These are tumours located inside the eye in structures such as the iris, ciliary body, retina, choroid (deep vascular layer of the eye) or optic nerve. Retinoblastoma is a notable malignant tumour that affects the retina, primarily in children. It can lead to vision loss or even life-threatening complications if left untreated.
Optic nerve glioma can impair the transmission of visual signals from the eye to the brain. Melanomas can rarely affect the choroid, in approximately 600 adults every year in the UK, and often present with vision symptoms such as flashes of light or blurred vision.
Causes and Risk Factors:
The causes of eye tumours vary depending on the specific type. While some are related to genetic factors, others may be associated with environmental factors like UV radiation or certain viruses. Individuals with a family history of eye tumours may be at higher risk, and in some cases, genetic mutations can predispose individuals to ocular cancers.
Symptoms:
The symptoms of eye tumours can include blurred vision, changes in the appearance of the eye, pain, redness, increased tearing, a visible lump or nodule, and in some cases, vision loss. Some tumours cause no symptoms - a quarter of intraocular melanomas, causing no symptoms, are detected routinely by an optometrist. Early detection is crucial for prompt treatment and better outcomes.
Diagnosis:
Diagnosing eye tumours involves a thorough eye examination, including visual acuity tests, slit-lamp examination, and dilated eye exams. Imaging tests like ultrasound, MRI, or CT scans may be used to visualise the tumour's size and location. Many types of eye tumour can be diagnosed on examination and imaging, but in some cases a biopsy is needed.
Treatment Options:
The treatment of eye tumours depends on the type, size, and stage of the tumour. Treatment options include surgery, radiation, chemotherapy, laser or freezing (cryotherapy) and targeted therapy.
Surgical removal of the tumour is often necessary for both benign and malignant tumours. For smaller tumours, this may involve excision or biopsy. In cases of larger or malignant tumours, more extensive surgeries may be required, such as removal of the eye.
Radiation therapy, including external beam radiation or brachytherapy (localised radiotherapy), used to target and destroy cancerous cells. Systemic or local chemotherapy may be used in conjunction with other treatments, especially in children with retinoblastoma. Laser or cryotherapy are used to destroy tumour tissue by heat or cold. Targeted therapies can be sued in some cases, targeted to focus on specific molecular markers within the tumour.
Prognosis:
The prognosis for eye tumours varies widely depending on the type, stage at diagnosis, and response to treatment. Early detection and treatment generally lead to better outcomes. Malignant tumours have a risk of spread and may require more aggressive treatments.
In summary, eye tumours encompass a diverse range of growths within or around the eye. Early detection, accurate diagnosis, and appropriate treatment are crucial for preserving life, the eye and vision in that order. Regular eye exams and prompt medical attention for any eye-related symptoms are essential in the management of eye tumours.
Whilst common tumours may be managed by local health professionals, rare cancers of the eye are best managed in specialist ocular oncology clinics that have access to dedicated diagnostic and treatment modalities.
Consultants that practice ocular oncology are fully trained eye surgeons that have gone on to train further for 1-2 years of specialised study and experience in eye tumour management. Some countries have better provision than others for the number of ocular oncologists - the UK has less than a dozen specialists.
The Victoria Cohen Eye Cancer Charitable Trust was set up in memory of the late Victoria Cohen, Director of Ocular Oncology at Moorfields Eye Hospital and President of the International Society of Ocular Oncologists.
The charity's mission is to promote the training of ocular oncologists, particularly in countries where there is little provision and outcomes are poor. Applications from eye surgeons who wish to specialise in ocular oncology are taken from across the globe and considered by an international panel of Victoria's colleagues. An award is made to the recipient who most closely embodies the values of Victoria's own career in developing ocular oncologists.
The first two awards have been won by eye surgeons from India and Nigeria and these recipients will train in the US and Israel respectively, after which they will return home to lead services in their own centres, improving the care in this rare disease speciality, raising outcomes for survival, retaining the eye and vision.
For more information, please visit www.vcecct.org
- Mandeep S. Sagoo
Professor of Ophthalmology and Ocular Oncology, UCL Institute of Ophthalmology;
Consultant Ophthalmic Surgeon, Moorfields Eye Hospital & Barts Health NHS Trust,
London, UK
