what is the course of treatment for metastatic ocular cancer

Although surgery and radiation therapy have a role in the treatment of metastatic disease, systemic therapy is the mainstay of treatment for most patients. Single-agent chemotherapy is well tolerated but is associated with response rates of only 5% to 20%.

Full Answer

How are ocular metastases treated?

Treatment for ocular metastases requires a tight alliance between ocular and general oncologists. If a metastasis is the first indication of a systemic cancer—as it often is with lung cancer—the ocular oncologist may refer the patient to a general oncologist and advise the clinician about the type of tumor to look for.

What are the treatment options for metastatic lung cancer into the eye?

All three options of therapy promise. For lung cancer patients with metastatic carcinoma into the eye, there is no a danger to the survival, because the eye is not a vital structure. The prognosis for a patient depends on the response of the lung carcinoma to radiotherapy and/or to the chemotherapy.

What are the treatment options for ocular melanoma?

For a large tumor, enucleation is the usual treatment. Results of the Collaborative Ocular Melanoma Study (COMS) revealed that patients had similar survival rates whether they received radiation therapy before enucleation or had their eye removed with no prior radiation treatment.

What is the prognosis of ocular metastasis?

In general, prognosis is poor after an ocular tumor has metastasized. Without treatment, the median survival time is 2 to 8 months. We encourage you, though, to think of this as one data point, however. Many OM patients, even those with metastatic disease, have gone to live long, active lives.

What is the life expectancy of someone with metastatic ocular melanoma?

The 5-year survival rate for eye melanoma is 82%. When melanoma does not spread outside the eye, the 5-year relative survival rate is about 85%. The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 71%.

What is the most common type of cancer to metastasize to the eye?

The most common sources of ocular metastasis are breast cancer (primarily in women) followed by lung cancer (more commonly in men). However, other less common sources include gastrointestinal, prostate, lymphoid, leukemia, thyroid, kidney and skin (primarily melanoma).

What is the survival rate for metastatic melanoma?

The prognosis of patients with metastatic MM is grim, with a 5-years survival rate between 5-19%, and is dictated by the location and the number of metastases.

What happens when ocular melanoma spreads to the liver?

Uveal melanoma, the most common primary intraocular tumor,1–4 has an associated approximate 40% risk of metastasizing to the liver within 10 years of diagnosis of the primary tumor. Hepatic metastases, which occur in 95% of patients with metastatic uveal melanoma,5 result in death in almost all cases.

Can eye cancer spread to the brain?

In addition to damaging vision, eye tumors can spread to the optic nerve, the brain and the rest of the body. Therefore, early diagnosis and treatment are extremely important.

What is Orbital metastasis?

Several types of cancer can spread (metastasize) to reach the tissues around the eye (orbit). The most common orbital metastases are cancers of the breast, lung, kidney or prostate gland. About 20% of patients who present with an orbital metastasis do not have a known primary cancer elsewhere.

What are the treatments usually provided to a patient with metastatic melanoma?

Depending upon where and how big the metastases are, treatment may involve drug treatments, surgery, and/or radiation therapy. Advances in the use of immunotherapy and targeted therapy have improved survival for most patients, and they now are the preferred approaches for people with metastatic melanoma.

Does anyone survive metastatic melanoma?

Learn more about clinical trials here. Prognosis: Stage IV melanoma is very difficult to cure as it has already spread to other parts of the body. However, a small number of people respond well to treatment, achieve No Evidence of Disease (NED), and survive for many years following diagnosis.

Can metastatic melanoma be cured?

Although in many cases metastatic melanoma can't be cured, treatments and support can help you live longer and better. Doctors have therapies that have greatly increased survival rates. And researchers are working to find new medications that can do even more.

What is Stage 4 ocular melanoma?

Stage 4. The cancer has spread to nearby lymph nodes or to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. Cancer that has spread to a distant part of the body is also called metastatic eye cancer.

Can eye melanoma spread to the brain?

Metastasis of the ocular malignant melanoma to the brain is extremely rare and most often occurs simultaneously with liver metastases. Lorigan et al., in clinical and radiological studies, found a total of five cases of brain metastases in 110 cases of metastatic choroidal melanoma [3].

Can ocular melanoma spread to kidney?

Metastatic tumors are the most common malignancies of the kidney. We report a rare case of isolated metastatic ocular melanoma to the kidney occurring 20 years after diagnosis.

Which cancers can be metastasized to the eye?

Breast cancer is the most common tumor to metastasize to the eye, followed by lung cancer. Gastrointestinal, renal, prostate and skin cancers occasionally metastasize to the eye but account for a much smaller percentage of cases.

Where do tumors usually metastasize?

Cancers typically metastasize to the choroid, most often to the macular or perimacular region. Only rarely do they affect the iris, retina or optic disc.

How thick is a breast metastasis?

According to Dr. Shields, breast cancer metastases tend not to be very thick, measuring about 2 to 3 millimeters, vs. an average thickness of 5.5 mm for melanoma. Metastases also tend to be yellow and very homogeneous in appearance, and the overlying retinal pigment epithelium is not as disturbed as it often is with a melanoma.

How many cases of eye cancer are there per year?

These are the most common ocular malignancies, with an estimated incidence of 30,000 cases per year (vs. about 2,500 cases of primary eye cancers). But many eye metastases go unrecognized.

Does radiation help with vision?

This is especially important for patients who may have only a few months to live. Most patients treated with radiation maintain good vision. Among patients with breast cancer metastases, Dr. Shields also is seeing good responses to hormonal therapy with the new aromatase inhibitors.

Can asymptomatic patients be treated?

Asymptomatic patients may simply be watched. If their systemic disease is out of control, these patients will be treated by their general oncologist. “But if the tumor is threatening vision, we’ll institute radiation therapy,” said Dr. Murray.

Do metastatic tumors affect the optic disc?

Only rarely do they affect the iris, retina or optic disc. “If you look in the eye and see a creamy yellow, elevated mass deep to the retina in the choroid,” Dr. Shields said, “that should be very suspicious for a metastatic tumor.”.

What is the best treatment for radiation blepharitis?

Radiation blepharitis (eyelid inflammation) can be treated with silvadine ointment, black tea soaks, or A&D ointment. If not already working with one, patients are strongly encouraged to consult with an oncologist to construct a proper surveillance schedule for ongoing observation and care.

What is the term for the removal of the eye?

Transretinal endoresection. Enucleation . Enucleation refers to full removal of the affected eye. After enucleation surgery, the patient is admitted to the hospital and the eye is removed under either local or general anesthesia. The enucleated eye cannot be treated or repaired and replaced in the eye socket.

How long after cataract surgery can you go home?

The patient usually leaves the hospital one or two days after surgery. In some cases, patients are permitted to go home the same day. Three to six weeks later, a specialist who makes artificial eyes (called an ocularist) fits the patient with a prosthesis.

What is a partial choroidectomy?

Transscleral partial choroidectomy (cyclochoroidectomy) – A viable therapeutic option for the subset of patients with choroidal or ciliochoroidal tumors who are poor candidates for radiotherapy but are highly motivated to avoid enucleation ( http://archopht.ama-assn.org/cgi/content/full/120/12/1659)

What is the most common form of radiation treatment?

Brachytherapy ("Plaque Therapy") Also known as sealed source radiotherapy or endocurietherapy, brachytherapy is the most common form of radiation treatment. With plaque therapy, a small disc-shaped shield known as a plaque encasing radioactive seeds (most often Iodine-125, though Ruthenium-106 and Palladium-103 can also be used) ...

Can an enucleated eye be repaired?

The enucleated eye cannot be treated or repaired and replaced in the eye socket. Instead, it is replaced with a ball implant that may be made of plastic, a porous material called hydroxylapatite, or other materials. The implant is sewn into position and the eye is allowed to heal.

Treatment Options

The liver is (initially) the exclusive site of choroidal melanoma metastasis in about 40% of patients. Of those patients, most have diffuse or multi-focal tumors which cannot be removed. Treatment options depend on the size, location and rate of tumor growth.

Observation

It is a patient’s right to choose or refuse treatment. Since many of the previously mentioned treatments can decrease a patient’s quality of life, each decision to treat must be weighed against potential side effects.

How to treat melanoma in the eye?

Treatment for ocular melanoma may include one or more of the following: Surgery. Iridectomy: Removal of part of the iris. Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. Iridocyclectomy: Removal of a portion of the iris and the ciliary body.

What type of radiation is used to treat melanoma?

Proton beam radiation therapy. Stereotactic radiosurgery. Laser therapy. Transpupillary thermotherapy (TTT) is the most common type of laser treatment for eye melanoma that uses infrared light to heat and kill the tumor.

What is the most common eye cancer?

Eye cancer occurs when cells in the eye grow out of control. The most common type of eye cancer is intraocular melanoma, though it’s still a fairly rare type of cancer . Ocular melanoma usually develops in the uvea (uveal melanomas) and rarely in the conjunctiva (conjunctival melanomas).

How long can you live with melanoma?

If your doctor catches and treats ocular melanoma (a kind of eye cancer) before it spreads to other organs, you have an 85% chance of being alive five years after diagnosis. If it’s metastasized to distant organs (as opposed to nearby lymph nodes, for example), the five-year survival rate drops to 13%. Eye cancer occurs when cells in the eye grow ...

What is the procedure for removing a melanoma?

Transscleral resection: Surgical removal of just a melanoma of the ciliary body or choroid. Enucleation: Removal of the entire eyeball. Orbital exenteration: Removal of the eyeball and some surrounding structures such as parts of the eyelid and muscles, nerves, and other tissues inside the eye socket.

What is a dark spot on the eye?

A growing dark spot on the colored part of the eye ( iris) Change in size or shape of the pupil. Change in position of the eyeball within the socket. Bulging eye. Change in the way the eye moves within the socket. Lump on the eye or in the eyelid that is growing.

How much cancer spreads outside the eye?

Localized (no sign the cancer has spread outside the eye): 85% . Regional (cancer has spread outside the eye to nearby structures or lymph nodes ): 71%. Distant (cancer has spread to distant parts of the body such as the liver): 13%.

How many procedures are performed for metastatic melanoma?

We perform more than 350 procedures annually for patients with metastatic uveal (ocular) melanoma. The course of treatment for this disease is generally determined by progression of the disease in the liver. There are currently no effective systemic chemotherapy regimens for treatment of liver metastases from this tumor.

What is the treatment for liver tumors?

Chemoembolization is performed in patients with more extensive tumor involvement in the liver. BCNU (a chemotherapy drug) dissolved in an oily liquid (Ethiodol) is injected directly into the arteries supplying the liver, along with a temporary dissolvable agent (Gelfoam) to block off the blood supply to the tumors.

How long does it take to recover from a liver metastasis?

This procedure improves survival for those with liver metastases from, at best, five months under conventional treatment to an average of 14.5 months. There are just a few other centers in the country that treat uveal (ocular) melanoma, and none through immunoembolization.

Is melanoma a low incidence?

The incidence of ocular, or uveal, melanoma is very low – about six cases per one million Americans – but the chances are good that patients with advanced stages of the disease will seek treatment at Jefferson. Jefferson has become a national referral center for patients whose uveal cancer has metastasized.

What cancers can be metastasized to the eye?

Ocular or eye metastasis are usually from a breast cancer (in women) and lung cancer (in men). Other less common sites of origin include the prostate, the kidney, the thyroid, and gastrointestinal tract. Blood cell cancer (lymphoma and leukemia) can also metastasize into the eye and orbit. In 18% of patients, the primary source ...

What is the treatment for a tumor?

Treatment options often include chemotherapy, immunotherapy and radiation therapy. In general, chemotherapy and immunotherapy take a relatively long time to work, whereas radiation therapy is more rapid. The choice of chemotherapy, immunotherapy or radiation therapy typically depends on the type of tumor and the temporal “timing” risk for loss ...

What is choroidal metastasis?

Treatments. After irradiation, a regressed choroidal metastasis displays spicular hypertrophy of the retinal pigment epithelium. Most patients with ocular metastasis have either a known primary cancer and/or metastatic tumors in other parts of their body.

Can choroidal metastasis be seen in the eye?

As stated, most patients with choroidal metastasis have no symptoms. However, if the metastasis is on the eye or eyelids, it may be visible. If the metastasis is located behind the eye (in the orbit), the eyeball may be visibly displaced out or to the side. If the metastasis is within the eye (the most common), metastasis patients can can have symptoms of flashing lights, floating spots or distortion of their vision. In that waiting until patients are symptomatic may be too late to preserve vision, Dr. Finger suggests that all patients with a history of metastatic cancer should have periodic eye examinations.

Can ocular metastasis be bilateral?

History taking can also uncover the signs or symptoms of these other cancers. If an eye cancer specialist suspects ocular metastasis, both eyes and orbits should be examined because ocular metastases can be both bilateral and/or multifocal.

Can intraocular cancer go undetected?

Though they are the most common intraocular cancer in adults, they usually go undetected. This is because most ocular metastases go undetected unless they affect vision, are visible to the patient, or push the eye forward. Eye metastasis are most commonly found in the vascular choroid (choroidal metastasis) within the eye.

Can lymphoma be metastasized to the eye?

Blood cell cancer (lymphoma and leukemia) can also metastasize into the eye and orbit. In 18% of patients, the primary source of the metastasis may be undetectable. In these cases, Dr. Finger may have to biopsy the ocular tumor to obtain tissue for pathology (to determine the primary source).

What is the procedure to remove a tumor from the eye called?

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is also called surgical resection. Eye surgery is typically performed by an ophthalmologist. Surgery to the eye is quite common in the treatment of intraocular melanoma.

What is intraocular melanoma?

Many people with intraocular melanoma are treated by more than one specialist with more than one type of treatment. This is called a multidisciplinary team approach. For example, patients who receive radiation therapy to the eye may need to also talk with an ophthalmologist or plastic surgeon to make sure the eye can still function after treatment.

What is the most common type of radiation treatment?

The most common type of radiation treatment is called external-beam radiation therapy , which is radiation given from a machine outside the body. Traditional external-beam radiation therapy may be given after enucleation or as a palliative treatment (see below).

What is the procedure to remove choroidal tumors?

Sclerouvectomy/endoresection: Surgery to remove the choroidal tumor while keeping the eye. Enucleation: Removal of the eye. In some cases, surgery may also be used to place a radioactive disc for internal radiation therapy, also called brachytherapy. More information about radiation therapy is below.

How to save a small eye?

If the spread is small, some doctors will try to save the eye by removing the outer part of the tumor and treating the eye with radiation therapy. Talk with your doctor about possible treatment options, potential side effects, and clinical trials open to you before choosing a treatment plan.

What is radiation therapy?

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

What is a clinical trial?

A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies.