A hemangioma is a tumor comprised of blood vessels and can grow within the choroid, the blood vessel layer beneath the retina. Choroidal hemangiomas are not cancers and never metastasize. However, if the hemangioma is located in the area of central vision of the eye it can leak fluid that causes a retinal detachment and visual function may be affected.
Many choroidal hemangiomas can be safely monitored by your eye doctor without the need of further treatment. Photographs can be used to document evidence of growth or leakage and the need for treatment. Treatment options may include photodynamic therapy, laser photocoagulation to decrease the amount of fluid leakage, or low doses of external beam radiation therapy.
Choroidal melanoma is the most common primary intraocular (occurring inside the eye) tumor in adults. It arises from the pigmented cells of the choroid of the eye and is not a tumor that started somewhere else and spread to the eye.
A choroidal melanoma is malignant, meaning that the cancer may metastasize and eventually spread to other parts of the body. Because choroidal melanoma is intraocular and not usually visible, patients with this disease often do not recognize its presence until the tumor grows to a size that impairs vision by obstruction, retinal detachment, hemorrhage, or other complication. Pain is unusual, except with large tumors. Periodic retinal examination through a dilated pupil is the best means of early detection.
Cutting out the tumor and leaving the rest of the eye is not routinely advised for this type of cancer. Opening the eye during surgery would allow the tumor cells to float around into the spaces around the eye, which could spread cancer cells to other parts of the eye. In addition, some studies have shown that up to 50% of choroidal melanomas invade the sclera. Therefore if the tumor is removed from the eye there is a high possibility that cancer cells will remain within the sclera. Lastly, many eyes do not tolerate this procedure and severe complications may occur such as detachments of the retina, hemorrhages, and recurrence of the tumor which may result in having to remove the eye anyway.
Treatment recommendations for choroidal melanoma usually are based on the size of the tumor. Small suspicious melanomas usually are closely watched for evidence of growth before treatment is recommended. Medium-size tumors may be treated with either radioactive plaque therapy or enucleation (removal) of the eye. The Collaborative Ocular Melanoma Study (COMS), supported by the National Eye Institute of the National Institutes of Health, has documented equal success rates for plaque radiation therapy or enucleation for preventing the spread of cancer. Large-size tumors usually are best treated by enucleation. This is because the amount of radiation required to treat the tumor is too much for the eye to tolerate. The COMS study found no benefit to large-size tumor patients having radiation therapy prior to enucleation.
Malignant tumors from other parts of the body can spread in and around the eye. Metastatic cancers that appear in the eye usually come from a primary cancer of the breast in women and the lungs in men. Other, less common, sites of origin include the prostate, kidneys, thyroid, and the gastrointestinal tract. Blood cell tumors (lymphomas and leukemia) also can spread to the eye. The care of patients with metastasis to the eye should be coordinated between the eye cancer specialist, medical oncologist, and radiation oncologist. Treatment options may include chemotherapy, external beam radiation therapy, or, more rarely, enucleation.
Like a raised freckle on the skin, a nevus can occur inside the eye. And, like a skin nevus, a choroidal freckle can become malignant, so should be closely monitored. A choroidal nevus should be examined by an ophthalmologist every four to six months to check if the pigmentation or size of the nevus has changed. In most cases, the only treatment recommended is close observation and monitoring by an ocular oncologist.
Conjunctival tumors are malignant cancers that grow on the outer surface of the eye. The most common types of conjunctival tumors are squamous cell carcinoma, malignant melanoma, and lymphoma. Squamous cell carcinomas rarely metastasize, but can invade the area around the eye into the orbit and sinuses. Malignant melanomas can start as a nevus (freckle) or can arise as newly formed pigmentation. Lymphoma of the eye can be a sign of systemic lymphoma or be confined to the conjunctiva.
Both squamous cell carcinomas and malignant conjunctival melanomas should be removed. Most small conjunctival tumors can be photographed and followed for evidence of growth prior to treatment. Small tumors can be completely removed surgically. In other instances cryotherapy (freezing therapy) may be necessaryor chemotherapy eye drops may be used to treat the entire surface of the eye.
Tumors of the eyelid may be benign cysts, inflammation, or malignant skin cancers. The most common type of eyelid cancer is basal cell carcinoma. Most basal cell carcinomas can be removed with surgery. If left untreated, these tumors can grow around the eye and into the orbit, sinuses and brain. A simple biopsy can determine if an eyelid tumor is malignant. Malignant tumors are completely removed and the eyelid is repaired using plastic surgery techniques. Additional cryotherapy (freezing-therapy) and radiation therapy sometimes are required after surgery.
Tumors can grow within and behind the iris. Though many iris tumors are cysts or a nevus, malignant melanomas can occur in this area. Most pigmented iris tumors do not grow. They are photographed and monitored with a special slit lamp and high frequency ultrasound to establish a baseline for future comparisons. When an iris tumor is documented to grow, treatment is recommended. Most small iris melanomas can be surgically removed. Radiation plaque therapy or enucleation may be considered for larger iris tumors.
Lymphoma tumors can appear in the eyelid tissue, tear ducts and the eye itself. In most patients with large cell non-Hodgkin's lymphoma, the disease is confined to the eye and central nervous system. In these patients, symptoms appear in the eye an average of two years before they are seen elsewhere. The disease itself as well as treatment, which may include external beam radiation, chemotherapy, or both (chemoradiation) to the central nervous system, can affect visual functioning.
This extremely slow-growing tumor usually is found on the surface of the optic disc. Almost all cases of melanocytoma are benign and malignant transformation is rare. It is probably present at birth and typically, there are no symptoms. Under clinical examination and fluorescein angiographic studies, melanocytoma appears as a deeply pigmented area located over the optic disc. In the majority of cases, close observation is recommended and no treatment is required. If malignant transformation does occur, enucleation, may be considered.
Tumors and inflammations can occur behind the eye. These tumors often push the eye forward causing a bulging of the eye called proptosis. The most common causes of proptosis are thyroid eye disease and lymphoid tumors. Other tumors include hemangiomas (blood vessel tumors), lachrymal (tear) gland tumors, and growths that extend from the sinuses into the orbit. Though CT scans, MRI's and ultrasounds help in determining the probable diagnosis, most orbital tumors are diagnosed by a biopsy.
When possible, orbital tumors are totally removed. If they cannot be removed or if removal will cause too much damage to other important structures around the eye, a piece of tumor may be removed and sent for evaluation. If a tumor cannot be removed during surgery, most orbital tumors can be treated with external beam radiation therapy. Certain rare orbital tumors may require removal of the eye and orbital contents. In certain cases, orbital radiotherapy may be used to treat any residual tumor.
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