Q: How does the eye work?
A: The eye is an organ that collects light and sends it to the brain. The brain turns this light from the eye into pictures that allow people to see. The eye is made up of different parts.
The eyelids keep the eyes moist and shield them from light. The conjunctiva is a very thin membrane that covers the eyeball and lines the eyelids. It lets the eyelid blink easily without irritating the eye. The cornea covers and protects the iris, which is the colored part of the eye. The ciliary body is muscle tissue that helps focus the eye. The retina lines the inside of the eye and acts almost like film in a camera, doing the work that helps people to see.
The retina has a layer of blood vessels under it called the choroid. The choroid feeds the retina. It also has cells in it called melanocytes. These cells can sometimes grow into a type of cancer called malignant melanoma.
Q: What is cancer of the eye?
A: Eye cancer is a very rare kind of cancer that starts in or on the eye (on the surface, on the iris, or within the eye beneath the retina) or in the skin around the eye (the eyelid). Because it is so rare, it is best for a person diagnosed with eye cancer to seek treatment from someone who specializes in this field. A person can ask their doctor to refer them to an eye cancer specialist.
Q: What are the different types of eye cancer?
A: There are different kinds of eye cancers. Below are some of the places near or on the eye where cancers can grow and the types of cancers that may be present on each one of these places:
Eyelid tumors--Basal cell carcinoma is the most common type of eyelid cancer. It can be removed with surgery. Other types of eyelid tumors include squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma.
Tumors that grow on the surface of the eye (conjunctival tumors)
Tumors that grow in the colored part of the eye (iris tumors)
Choroid tumors--These are tumors that grow in the layer of blood vessels that support the retina. They include melanoma of the choroids, choroidal nevus, and choroidal osteoma.
Tumors of the ciliary body
Retinoblastoma--This is a cancer of the eye that affects children. It is extremely rare in adults. It will not be discussed in this section.
Q: How is cancer of the eyelid treated?
A: The treatment most commonly used for cancer of the eyelid is surgery. The goal of surgery is to remove all of the cancer. The type of surgery used depends on the size of the tumor. If the tumor requires removal of most of the eyelid, the eyelid will be remade using plastic surgery. In some cases, radiation may be needed after surgery to kill any cancer cells that may have been left behind.
Q: How are conjunctival tumors treated?
A: The primary treatment for these tumors is surgery. It is important for the doctor to keep checking for cancer cells that may have been left behind. The surgery ends when all cancer cells have been removed. This is called perioperative microscopic examination of surgical margins.
If the tumor is large, cryotherapy (freezing of the tumor) may be needed. Researchers are also studying the use of chemotherapy eye drops for people who have conjunctival melanoma (and have tumors in several places on the eye). Conjunctival lymphomas may be treated with radiation alone, as long as there is no lymphoma elsewhere. Lymphomas that occur inside the eye, also called intraocular lymphoma, need to be treated with chemotherapy. Surgery usually is not used to treat lymphoma of the eye.
Q: How are tumors in the iris treated?
A: These are rare tumors. They can be either primary tumors of the iris (e.g. malignant melanoma) or spread from another tumor (e.g. breast or lung). Treatment of these tumors depends on whether the tumor is growing and also whether there is any complication from the tumor (e.g. uncontrolled glaucoma). In the case of glaucoma that does not get better with medication, or if the tumor is growing quickly, it may be necessary to remove the entire eye. If the tumor is not growing and the glaucoma can be controlled with medication, the treatment can be less aggressive, such as surgical removal of part of the iris (iridectomy) or radiation therapy.
Q: How are choroidal tumors and tumors of the ciliary body treated?
Melanomas. The treatment for choroidal melanomas can include thermal destruction (cryotherapy or photocoagulation), radiation, local resection or complete removal of the eye, or no treatment at all (observation alone). The choice depends on the size of the tumor, on whether or not it is growing, and whether or not the person is having symptoms. All these options should be discussed in depth with the doctor, weighing all the risks and benefits of each choice.
Nevus. Nevi in the eye can be compared to raised freckles on the skin. They are very rare and almost never require treatment. But nevi can turn into malignant melanoma. If they do, they are treated as malignant melanoma.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors conduct clinical trials to learn how well new treatments work and what their side effects are. If they look promising, they are then compared to the current treatment to see if they work better or have fewer side effects. People who participate in these studies may benefit from access to new treatments before the Food and Drug Administration approves them. Participants also help further our understanding of cancer and help future cancer patients.
Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including if the person is not comfortable with the treatment decision, if the type of cancer is rare, if there are different ways to treat the cancer, or if the person is not able to see a cancer expert.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
The person's primary doctor may be able to recommend a specialist such as a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.
The National Cancer Information Service (1-800-4-CANCER) informs callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
Patients can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.
Consult the Official ABMS Directory of Board Certified Medical Specialists. This reference book lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries. You can also view it online at www.abms.org.
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