Treatment decisions for eye cancer
The main treatments for eye cancer are surgery, radiotherapy and chemotherapy. But you may have other treatments that your eye specialist will discuss with you. Your treatment will depend on:
- the type of eye cancer you have and where it is in the eye
- the size of your cancer and how far it has grown or spread (the stage)
- your general health and level of fitness
As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to treat and possibly cure it. When planning your treatment your doctors will try their hardest to save as much of your sight as they can.
There are different types of eye cancer, depending on the type of cell the cancer starts in. For example, melanoma of the eye and lymphoma of the eye.
Melanoma of the eyeball
Treatment for eye melanoma is usually surgery or radiotherapy, or both.
Whether you have surgery or radiotherapy depends on:
- where the cancer is
- the size of the cancer
- how much it is affecting your sight
If the cancer is large or already stopping you from seeing out of the eye, you will probably have surgery to remove the eye. This operation is called an enucleation. Otherwise your doctor might recommend that you have one of the following:
- radiotherapy
- an operation to just remove the cancer (but not the eye)
- laser treatment
Ask your doctor as many questions as you need to. Together you can decide which treatment is best for you.
It can come as quite a shock if you need to have surgery to remove your eye. You will need time to come to terms with this change. As long as you have sight in one eye, it may not make much difference to what you can and can’t do. You may still be able to drive, for instance.
It may help to know that many people who have had this surgery rate their quality of life as highly as people who have kept their eye.
This type of cancer can be so slow growing that you don’t always need treatment, especially if you don’t have symptoms. Your doctor will give you regular check ups to make sure the cancer is not getting bigger.
If the cancer grows, or if it is causing symptoms, you may have one of the following:
- removal of the melanoma
- removal of the whole eye (an enucleation)
- radiotherapy
If melanoma of the choroid or ciliary body is not getting bigger you may not need treatment straight away. You will have regular check ups to make sure the tumour has not started to grow. This is sometimes called periodic observation.
If you do need treatment you might have one of the following:
- radiotherapy
- photocoagulation
- transpupillary thermotherapy
- photodynamic therapy
- surgery to remove just the cancer
- surgery to remove the whole eye (enucleation)
Photocoagulation, transpupillary thermography and photodynamic therapy are all types of laser therapy. They use a source of heat or light to destroy the cancer cells.
Your eye specialist will discuss the treatment choices with you. This usually depends on the size of the cancer.
If the cancer has come back in your eyeball (intraocular) you will most likely have surgery to remove your eye (enucleation). You may also have radiotherapy after surgery to kill off any cancer cells left behind.
If your cancer has spread outside the eyeball, for example to the optic nerve or the eye socket, it is called an extraocular melanoma. Your doctor might also call this extraocular extension. Unfortunately, you will probably need surgery to remove your eye and some of the surrounding tissue. This makes sure all the cancer is gone. You might also have radiotherapy.
Sometimes eye melanoma can spread to, or come back, in another part of the body. For example, it can spread to the liver. This spread is called liver secondaries or metastases. You might be able to have an operation to remove the cancer in the liver if it is only affecting a small area. Some people may be offered treatment with immunotherapy.
You may have treatment as part of a trial if your cancer has come back or spread. Because eye melanoma is rare, there are fewer trials available for people to join. Trials are looking at chemotherapy, targeted drugs and immunotherapy.
It is sometimes possible to have treatment directly into the liver. It is important to remember that these treatments may only be suitable for a few people. Your specialist will explain if these treatments are right for you.
They include:
- radiofrequency ablation
- hepatic artery infusion
- transarterial chemoembolisation
- selective internal radiotherapy (SIRT)
Lymphoma of the eye
Treatment for lymphoma of the eye depends on the type of lymphoma and if it has spread. It is treated in a similar way to other types of non-Hodgkin lymphoma. You may have radiotherapy, chemotherapy or both. You would not usually have surgery to treat lymphoma that develops inside the eye (intraocular lymphoma).
Radiotherapy
Your doctor may suggest external radiotherapy to your eye and brain. This can get rid of the cancer in the eye and also help stop it coming back in the brain or spinal cord.
Chemotherapy and targeted drugs
Most people with lymphoma of the eye will have chemotherapy. You usually have this through a drip into your vein.
You may also have chemotherapy injected into the fluid around your spinal cord (intrathecal chemotherapy). You might have this with radiotherapy. Some people have chemotherapy put into their eye (intravitreal chemotherapy). This is more likely for lymphoma that has only come back in the eye.
For some types of non-Hodgkin lymphoma, you have targeted cancer drugs. You might these drugs through a drip into your vein or as tablets.
Squamous cell cancer of the conjunctiva
Squamous cells are flat and cover many surfaces in the body. Most squamous cell cancers are found on the skin. But they can develop in other parts of the body including the conjunctiva in the eye.
The conjunctiva is the clear, moist membrane that covers the front of the eye and lines the inside of the eyelid. Although rare, squamous cell cancer is the most common cancer of the conjunctiva. This cancer is generally slow growing (low grade), and very rarely spreads to other parts of the body.
Treatment includes:
- surgery to remove the cancer
- freezing therapy (cryotherapy)
- chemotherapy eye drops (topical chemotherapy)
Basal cell cancer and squamous cell skin cancer around the eye
Basal cell cancer and squamous cell cancer are types of skin cancer that can be found on the skin. They may be found on the eyelid. You may have one of the following treatments:
- surgery
- cryotherapy
- creams to put directly onto the skin
- radiotherapy
- photodynamic therapy (treatment using a light sensitising drug and a very bright light)
Retinoblastoma
Retinoblastoma most commonly affects children under the age of 5. Because it is so rare it is treated in specialist centres. This could be at a specialist eye hospital or a major children's cancer centre. Your eye specialist will explain the best treatment and what is involved.
Treatment options depends on stage and size and may include the following:
- cryotherapy (freezing therapy)
- laser therapy
- chemotherapy
- surgery
- radiotherapy
Your eye specialist will always explain why a specific treatment is best for your child. And you can always ask questions if treatment decisions are not clear.
