Histopathology Features Predicting Prognosis
The histopathologic features predicting poor prognosis of uveal melanoma include epithelioid cell type, high mitotic activity, large mean diameter of the 10 largest nucleoli, high microvascular density, presence of microvascular loops and networks, increased tumor-infiltrating lymphocytes and macrophages, and higher expression of insulin-like growth factor 1 receptor, and HLA class I and II antigens. Currently, most authorities rely on cytogenetic features rather than histopathologic features for prognostication.
Having An Eye Removed
Sometimes the only choice a doctor has in treating intraocular melanoma is to remove the eye. Because of this visual loss, a person with one eye may have trouble with depth perception. Most people adjust to these differences.
Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis . The prosthesis will look and behave almost the same as a natural eye. For example, the artificial eye will move along with the persons remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.
If enucleation is required, talk with your doctor about a prosthesis as soon as possible. It may take many weeks for you to receive one. Also, ask about support services that may be available to you to help adjust physically and emotionally to the loss of an eye. Learn more about rehabilitation.
Life After Cancer Treatment
After you finish treatment for cancer, give yourself time to adjust to the physical and emotional changes. We are still here to support you after your treatment finishes.
You will need regular check-ups with your treatment team. These may include some blood tests or physical examinations. Speak with your treatment team about the plan for you.
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Clinical Features Predicting Prognosis
Although the influence of age on the prognosis of uveal melanoma is uncertain, recent studies indicate that a poor prognosis is more likely associated with increasing age. Lower metastatic rates in younger patients could be related to smaller tumors, more robust immune response, or fewer genetic mutational events within the melanoma compared with older adults., At 10 years, metastasis in patients aged 1120 years is estimated at 10%, for 4150 years is 21%, and for 7180 years is 30%. The COMS study showed no difference in uveal melanoma-related metastasis and death based on gender. However, some reports suggest a better prognosis in females compared with males, with a twofold higher rate of mortality in males compared with females in the first 10 years of posterior uveal melanoma diagnosis. Hormonal factors, especially estrogen, may cause direct or indirect inhibition of development of metastasis in females.
AJCC classification is an important prognostic factor of posterior uveal melanoma. In a study of 7731 patients with posterior uveal melanoma based on T category of AJCC classification, the risk for metastasis and death increased twofold with each increasing tumor category, and the 10-year metastatic rate was 15% for T1, 25% for T2, 49% for T3, and 63% for T4 tumors.
Prognosis And Survival For Eye Cancer
If you have eye cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for eye cancer.
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What Causes Intraocular Melanoma
Genes, which are made of DNA, give instruction to cells about how to multiply. But if a gene mutates , it might allow cells to multiply out of control. That leads to cancer.
With intraocular melanoma, mutated DNA give the wrong instructions to melanocytes in the eye. The melanocytes grow and form tumors.
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
- 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.
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
- laser treatment
Ask your doctor as many questions as you need to. Together you can decide which treatment is best for you.
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.
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What Is Ocular Melanoma
There are many different types of cancer that can affect the eye, but ocular melanoma is the most common. Melanoma is a type of cancer that develops in the cells of the body that produce melanin the pigment that gives your skin its colour. Your eyes also have melanin-producing cells and can develop melanoma. Ocular melanoma is also known as uveal melanoma, intraocular melanoma or eye melanoma.
Ocular melanoma is rare with around 125-150 Australians diagnosed each year with this type of cancer. It is slightly more likely to be diagnosed in men, and can occur at any age but the risk increases as people get older.
Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- How the melanoma cells look under a microscope.
- The size and thickness of the tumor.
- The part of the eye the tumor is in .
- Whether the tumor has spread within the eye or to other places in the body.
- Whether there are certain changes in the genes linked to intraocular melanoma.
- The patient’s age and general health.
- Whether the tumor has recurred after treatment.
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Adjuvant Therapy And Surveillance
Given the high metastatic risk associated with Class 2 tumors and the poor long-term prognosis of metastatic disease, an improved understanding of the biological mechanisms underlying disease dissemination and the development of effective adjuvant therapies are critical. Thus far, no systemic adjuvant therapy has been shown to reduce the risk of metastasis or improve OS. Dacarbazine, an alkylating agent that prevailed as the standard of care for metastatic cutaneous melanoma prior to the development of immunotherapy, offered no survival advantage compared to observation in a randomized adjuvant trial. Although adjuvant interferon is approved by the FDA for use in resected cutaneous melanoma, two non-randomized studies failed to show any survival benefit with IFN therapy compared to matched historical controls following primary tumor treatment., A phase II study evaluating the combination of dacarbazine and IFN has completed accrual, with results anticipated in the near future.
Can Ocular Melanoma Be Treated
Most ocular melanomas develop in the uvea, a part of the eye that contains the iris, ciliary body and choroid. For this reason this form of cancer is called uveal melanoma. Although this is the most frequently diagnosed type of eye cancer, it is still very uncommon, with an annual incidence of 5.1 cases per million individuals.
Most uveal tumors arise from the pigment cells that reside within the uvea and give color to the eye. When an eye melanoma has spread to distant parts of the body, the five-year survival rate is about 15%.
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Getting Care For Symptoms And Side Effects
Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a persons symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.
Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.
People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment. Palliative care can also help if treatment involves changes to your face to help you find emotional support to cope with such changes to your appearance.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.
Learn more about palliative care.
What Should I Ask My Healthcare Provider
If you have intraocular melanoma, you may want to ask your provider:
- What is the size of the tumor?
- What treatments are right for me?
- Will treatment affect my vision?
- Are there clinical trials I can take part in?
- Can the cancer come back after treatment?
A note from Cleveland Clinic
Intraocular melanoma is cancer inside the eye. It affects cells in the uvea, or the middle part of the eye. Symptoms can include vision loss or changes to the shape and appearance of the eye. Intraocular melanoma can spread to other parts of the body such as the liver. The most common treatments are radiation therapy and surgery.
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Advanced And Recurrent Melanomas
Most uveal melanomas are still only within the eye when they are first diagnosed. It is rare for the cancer to have already spread outside of the eye. But unfortunately, in about half of all patients the melanoma will come back at some point after treatment.
Cancer that comes back after treatment is called recurrent. Recurrence can be local or distant .Treating melanomas that come back depends on many factors, including where the cancer recurs and what type of treatment was used initially.
Cancers that recur within the eye are usually treated by removing the eye .
When melanoma recurs outside the eye , it most often comes back in the liver. It might also come back in other areas, like the lungs or bones. These cancers are often hard to treat.
If the cancer is only in the liver, different types of treatments might help keep the cancer under control or help relieve symptoms. These include surgery , radiation therapy, destroying tumors by heating or freezing them, or injecting drugs or other substances into the liver to try to kill the tumors or cut off their blood supply. Tumor ablation and radiation might also be used for tumors that have spread to other parts of the body, such as the lungs.
Small Choroidal And Ciliary Body Tumor
The following are some treatment options for a small choroidal or ciliary body tumor:
-
Active surveillance/observation
-
Radiation therapy
-
Laser therapy
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Surgical resection and/or enucleation
Careful observation is a common treatment plan, although patients and their doctors may choose another option depending upon the location of the tumor or whether the tumor begins to grow.
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Treatment For Eye Cancer
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team .
Your doctor or cancer specialist will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
Treatment for eye melanoma may include:
See also
Treating Eye Melanoma By Location And Size
The main factors in deciding on treatment for eye melanoma include the location and size of the cancer, as well as the likelihood of saving vision in the eye. There is not much advantage in saving an eye if a small melanoma in a crucial place has already destroyed vision in the eye. On the other hand, doctors will not necessarily want to remove an eye that functions normally even if the tumor is large. Because of this, your treatment plan will depend on your situation, and could be different than what’s described here.
Its important to keep in mind that outcomes and quality of life both tend to be similar over time for people who have had an eye removed and those who have had radiation therapy. Radiation therapy is more likely to preserve some vision in the eye, especially during the first few years after treatment, but studies have found that people who have had radiation therapy are also more likely to be more anxious about the chance of the cancer coming back. Be sure to talk with your doctor before treatment about what is most important to you.
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After Eye Cancer Treatment
After treatment for eye melanoma you will see your ophthalmologist and specialist nurse again for a follow-up appointment. You will probably have regular checks for a few years. Your doctor or specialist nurse will explain how often you will see them.
Your doctor or specialist nurse will check your eye and the surrounding area. You may have scans or x-rays to check both the eye and other parts of the body. If you have any problems or notice any new symptoms between these appointments, tell your doctor. You do not need to wait until your next appointment.
Eye melanoma can sometimes spread to other parts of the body. The most common place is the liver, but it can also spread to the lungs and bones. It is important to tell your specialist if you notice any new symptoms, wherever they are in the body, in case further treatment is needed.
Management Of Primary Uveal Melanoma
Local treatment for uveal melanoma consists of either globe-preserving therapies or enucleation. Based on a 2006 Collaborative Ocular Melanoma Study Group study that demonstrated equivalent survival outcomes for patients with medium-sized choroidal melanomas randomized to iodine-125 brachytherapy versus enucleation, the majority of primary uveal melanomas in the United States are treated with first-line plaque brachytherapy.
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Ciliary Body Melanoma And Choroidal Melanoma
The symptoms of ciliary body and choroidal melanoma include blurred vision , photopsia , floaters , visual field loss , visible tumor , pain , metamorphopsia , and 30% of patients are asymptomatic. Ciliary body melanoma is often diagnosed late as the lesion remains hidden behind the iris, and the patient seldom has any clinical symptoms until the lesion is large. Consequently, when the tumors are eventually diagnosed, they present as fairly large with a mean basal diameter of 11.7mm and tumor thickness of 6.6mm. Ring melanoma of the ciliary body is a rare distinct entity in which the tumor extends circumferentially involving the entire ciliary body, often without any nodular component.
Choroidal melanoma presents as a dome-shaped mass or has a mushroom configuration because of rupture of Bruchs membrane , and rarely presents as a diffuse variant . The lesion can be pigmented , nonpigmented , or has a mixed color , associated with retinal detachment , intraocular hemorrhage , or extraocular extension . In a review of 7256 cases of choroidal melanoma, the mean basal diameter was 11.3mm and mean tumor thickness was 5.5mm.
Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
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Help Getting Through Cancer Treatment
People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life.
Different types of programs and support services may be helpful, and can be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help.
The American Cancer Society also has programs and services including rides to treatment, lodging, and more to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.