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Eye Cancer

About the Department

The good cells in the eye may transform or transmute and can quickly begin to expand in an abnormal and uncontrollable manner. This may lead to the formation of a mass of tissue referred to as a tumour. If the cancerous cells start from the eye, specifically the eyeball, it is known as intraocular cancer. The orbit of the eyeball is surrounded by tissues and muscles. If the malignant cells form here, it is called orbital cancer. Lastly, the eyelids and tear glands constitute the adnexal structures. When the cancer cells begin in the adnexal tissues, it is referred to as adnexal cancer. There are chances of secondary cancers affecting the eye, that may again result in eye cancers too.

Eye cancers are rare and may also be referred to as ocular cancers. It can affect people of any age; however, the risks are far higher as one gets older. The most common form of eye cancers is secondary in comparison to primary eye cancers. 

Melanomas affecting the eye and the orbit are the most common forms of cancers in adults. Over the past few decades, the rate of eye melanomas has been more or less stable. Lymphomas are next in line, that affect adults. In 9 out of 10 instances, melanomas start in the skin whereas it is the lymph nodes where the lymphomas start from. 

If you have been diagnosed with eye cancer, you require specialist knowledge, expert skill and experience of a team who can deal with eye cancer and do all that is necessary to preserve your vision. The Department of Head and Neck Cancer at Fortis Hospitals, Bannerghatta Road are adept at treating all types of eye cancer cases such as melanoma of the eye, lymphoma of the eye, retinoblastoma (in children), and tumours that spread to the eye from other organs. Not all eye tumours are cancerous in nature. The benign eye tumours may start developing on the eyelids or from within the wall of the eye due to unusual over-development of blood vessels encircling or within the eye. Regardless of the type of tumour – benign or malignant, the refined skilfulness offered by the eye cancer care team at Fortis is unparallel. 

Fortis Hospitals believes in providing you with a level of cancer treatment that can only be accessible at the top cancer centres in the country. Our eye cancer specialist team includes skilled experts in retinal surgery, corneal surgery, oculoplastics-reconstructive surgery, medical, surgical and radiation oncology. Using some of the most modern and advanced imaging and diagnostic screening technologies, Fortis experts aim to arrive at a diagnosis and carefully chalk out the treatment plan that is best suited to your present health condition. Our objective to catch the disease at its early stages, work towards preserving your sight, sustain your eye’s functionalities and enhance the overall quality of your life.

Areas of Care

The ophthalmologists at the department of head and neck cancer at Fortis Hospitals are highly experienced in treating all types of eye cancer patients. Eye cancer, depending on the location where it originates, may be divided in to three forms:

- Primary Cancers that start in a particular region on the eye or any of its connected structures
- Secondary Cancers occur from the sinuses and central nervous system that penetrates the eye and its associated structures
- Metastatic Cancers are cases when the cancerous cells have infiltrated the eye from other body parts

Types of eye cancers are as given below:

- Cancers of the Eyeball:

  • Uveal melanoma
  • Retinoblastoma

- Cancers of the Eyelid:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma
  • Sebaceous carcinoma (meibomian gland carcinoma)
  • Merkel cell carcinoma

- Cancers of the Conjunctiva

  • Squamous cell carcinoma
  • Melanoma
  • Mucosa-associated lymphoid tissue lymphoma (MALT)

- Cancers of the Orbit

  • Orbital lymphoma
  • Orbital sarcoma
  • Orbital and optic nerve meningiomas
  • Metastatic orbital tumours

- Lacrimal Gland Tumours

  • Lymphoma
  • Adenoid cystic carcinoma
  • Pleomorphic adenoma
  • Other lacrimal gland carcinomas

- Lacrimal Sac and Nasolacrimal Duct Cancers

  • Squamous cell carcinoma
  • Transitional cell carcinoma
  • Lacrimal sac lymphoma

Specialists at Fortis only uses cutting-edge medical and surgical therapies that helps them to detect the presence of cancer as accurately as possible. Working in collaboration with experts from allied medical fields, the cancer care team prepares the patient’s treatment plan meeting their individual requirements thereby improving their health, restoring their appearance and minimise the possibility of vision loss.

Symptoms & Diagnosis

Signs and Symptoms of Eye Cancer

The obvious symptoms of eye cancer are not always visible. In addition to that, the signs and symptoms vary from individual to individual. In the majority of cases, symptoms are detected during routine eye examinations.

The most familiar symptoms of eye cancer include:

- If you experience a loss of sight
- If you find your vision becoming blurry
- If you observe flashes and floaters such an object in your line or field of vision
- If you notice a dark or pigmented region on the conjunctiva
- If you observe a tiny yet firm and raised lump with a lesion in the middle of your eyelid
- If you see that there is an ulceration of your eyelid
- If you notice that your eyelashes are falling off
- If you observe a pigmented or brown coloured lesion on your eyelid
- If you see dark spots growing on your iris
- If you observe that the pupil is changing in shape or size
- If you notice a change in the position of your eyeball, particularly in the manner of its movements
- If you experience a bulge in your eye
- If you notice that you are having double vision
- If you experience ocular or orbital pain
- If you see that there is excessive tearing or tears stained with blood

Just experiencing these symptoms alone does not indicate the presence of eye cancer. It is best to make an appointment with your general physician and discuss what you are experiencing in detail as it may possibly be due to other health conditions as well. However, if you observe any sudden changes in your vision signal, seek medical assistance immediately. 

Our Diagnostic Services

Eye cancer is rare and there are no recommended diagnostics screenings available to detect this type of cancer in individuals who may be at an average risk. However, there are some tests available that will help in detection. In order to make an accurate diagnosis of your condition, your specialist at Fortis may recommend the following diagnostic tests:

- Physical Examination:
At your initial consultation, your doctor will conduct a thorough physical check-up, examining your body for the presence of any visible signs of abnormalities.

- Eye Examination:
In the majority of cases, eye cancer may be found during routine eye tests. The ophthalmologist will examine your eye with a lighted tool known as an ophthalmoscope and a slit lamp. This is actually a microscope with a light attachment. 

- Imaging tests:
A number of imaging tests may be prescribed during this initial detection phase including:

  • Ultrasound
  • Computed tomography (CT or CAT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET) scan

- Fluorescein Angiography:
During this diagnostic screening, it takes an image of the blood vessels in the ocular area. By injecting a fluorescent dye known as fluorescein in the patient’s arm, the dye travels through the body and reaches the blood vessels in the eye. By taking many pictures in quick succession of the eye area, the doctor is able to rule out any other eye related issues other than cancer. 

- Indocyanine green angiography:
This diagnostic test is similar to a fluorescein angiography. However, the test uses a different dye called indocyanine green.

- Fine needle biopsy:
This method helps to remove a portion of the suspected malignant cells from the eye with the help of a needle. The sample is later analysed under a microscope for the presence of cancerous cells. 

- Cytogenetics and gene expression profiling:
In order to gather further information on your prognosis, the specialist may recommend this diagnostic test that will help him to chart out your treatment plan. This screening is performed by using a sample of the patient’s tissue collected either during the biopsy or surgery. 

The Cytogenetics screening is an analysis of the DNA strands that includes checking the size, number, shape and chromosomal arrangements. Gene expression profiling is used to identify certain genes, proteins, and other features distinctive to the tumorous growth. 

If the eye cancer has spread to other body parts, your doctor may ask you to undergo the following test:

- Tests for metastases and risk of metastases:
By screening the levels of liver enzymes present in the liver, the doctor is able to check if the cancer from the eye has penetrated through the blood to the liver. Additional CT Scans and Ultrasound of the liver area may be done to confirm the spread of cancer to this part of the body. 

Once all the outcomes of the diagnostic tests are available, you will make an appointment with your consulting specialist at Fortis Hospitals and review them together. Your next course of action in terms of treatment options available to you should also be discussed during this consultation. Whilst confirming the diagnosis of eye cancer can be an overwhelming experience for you and your family, it is best to make your specialist aware of any concerns and preferences that you may have when you are discussing your therapy options with your cancer care team.

Treatment Options

When formulating your treatment plan, there should be a sense of the coordinated care and effective communication between the cancer care team and the patient. If the patient feels that there is a lack of effective communication about what the cancer care team hopes to achieve through the treatment plan, then the patient should discuss it immediately with his consultant specialist at Fortis. 

The route of treatment for eye cancer depends on multiple factors including the stage and type of ocular cancer, any possible side effects, the patient’s current medical condition and their preferences. Your treatment plan may include one of more of the following: 

- Active surveillance/observation may be recommended as a possible method of treatment by the specialist in case the intraocular melanoma is growing slowly or is small in size. It may also be used if the patient is not displaying any symptoms, especially in the case of older patients, those in critical condition or if the tumour is located in the patient’s useful eye. 

This process is more of a ‘wait and watch’ approach. With close monitoring continuously, if the tumour shows signs of becoming aggressive, that basically indicates the beginning of active treatment.

- Surgical therapy can be performed in multiple ways in case of eye cancer. It includes the following procedures:

- Eye-preserving surgery is possible in the case of eyelid cancers, conjunctival cancers and orbital cancers. Using the most modern techniques, surgeons remove the cancer whilst making all possible effort to preserve the patient’s aesthetic appearance of the eye, eyelid and facial area along with their respective functionalities.

- Iridectomy is performed where the iris or the coloured part of the eye is removed.

- Iridotrabeculectomy is a surgical procedure during which the iris and a tiny portion of the outer section of the eyeball are removed.
- Eye reconstructive surgery is executed by an ophthalmic plastic, or oculoplastic surgeon who work to repair the functioning of the eye, preserving the patient’s sight and enhance the cosmetic appearance, once the cancer of the eyelid, conjunctiva or orbit has been removed during a prior surgical operation. 

- Enucleation is an operative process where the patient’s entire eye is removed. It is performed only in the very critical of cases. 

- Orbital exenteration involves a surgery where the eye, eyelids, surrounding skin, orbital muscles, fat and nerves are removed.

- Radiation therapy helps in treating eye cancer in the following ways:

- Brachytherapy involves using tiny radiative seeds that have been inserted into the patient’s body, very close to the tumour. 

- 3D-conformal radiation therapy is performed by using multiple radiation beams that are targeted on the shape of the tumour. 

- Intensity-modulated radiotherapy (IMRT) attacks the particular shape of the tumour.

- Gamma Knife stereotactic radiation surgery uses high powered radiation beams targeted towards the cancerous cells from multiple angles. 

- Proton therapy is generally used in the case of cancers in the orbit, optic nerve and specific types of lacrimal sac/duct cancer.

- Laser treatment includes using intense, high energy beam of light that is focussed to kill the eye cancer tissue. 

- Cryotherapy form of eye cancer treatment uses extreme cold to kill the malignant cells. 

- Monoclonal Antibodies uses special antibodies to work with the patient’s immune system that will enable the patient to fight the cancer. 

- Chemotherapy or topical chemotherapy uses eye drops possibly in combination with surgical therapy for specific types of conjunctival carcinoma and conjunctival melanoma.

During your treatment, speak to your specialist at Fortis of the possible side effects that you may experience. Also discuss the goals of your treatment and what your cancer care team at Fortis aims to achieve at the end of each treatment phase. With such highly specialised technologies accessible at Fortis Hospitals, your care team personalises your cancer care with the most advanced cancer therapies that are available in India. 

Our Team That Cares

Working with a multi-disciplinary approach, your eye cancer specialist team at Fortis includes ocular pathologists, oculoplastic surgeons, and medical and radiation cancer specialists who are some of the leading experts in their respective fields of medicine. Conducting a thorough evaluation of your overall health condition, your care team will develop an individualised therapy plan that addresses your distinctive health needs. Focusing on 100% patient care, the team aims to provide you with the necessary knowledge and tools to optimise your visual functionalities, in turn improving the quality of your life.