Eye Cancer: Treatment Choices
The treatment choices for eye cancer depend on the size and location of the tumor, the results of lab tests, and the stage or extent of the disease. Your healthcare provider also considers the your age and general health when deciding on a treatment plan. Your healthcare provider will likely try to save your sight when thinking about different treatment options.
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, what you'll look like, and if you’ll be able to see with the affected eye. Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, the goals of these treatments, how successful they’re expected to be, and what the risks and side effects are.
Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It’s important to take the time you need to make the best choice.
Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. Eye cancer is very rare, and you may want to find a specialist who has experience treating it. You may also want to involve your family and friends in the decision-making process.
Treatment of eye cancer
Depending on your situation, you may have several options for treating this cancer.
This is a common approach. Your healthcare provider may only need to remove the growth and a small area of tissue around it. But in some cases, he or she will need to remove your whole eye and maybe other surrounding tissues. These can include your eyelid and muscles around your eye.
Different types of radiation are sometimes used for treating this cancer. Your healthcare provider may use a machine to direct beams of radiation into your eye. Or he or she may attach a small radioactive disk to your eye next to the tumor. If you have this procedure, you'll have anesthesia to put you to sleep before it starts. The disk normally stays in place for about a week.
Your healthcare provider may use a special laser that destroys the tumor and blood vessels that feed the tumor. This is most often used for small tumors.
This is the use of heat to destroy cancer cells.
This is the use of cold to freeze and destroy cancer cells.
Active surveillance or watchful waiting
You may not start treatment right away, but your healthcare provider will closely watch the tumor. Some eye tumors grow very slowly, and most treatments affect vision. You can eventually start treatment if the cancer starts to grow or cause problems.
Researchers are always looking for new and better ways to treat eye cancer. These new methods are tested in clinical trials. Before starting treatment, ask your healthcare team if there are any clinical trials you should consider.
You may have just one type of treatment or a combination of treatments.
Treating specific types of eye cancer
Primary treatment for these tumors includes surgery. In some cases, your healthcare provider may do Mohs surgery. This involves removing very small, thin pieces of tissue and looking at them right away them under a microscope. If your healthcare provider sees cancer cells, he or she may remove more tissue. Once the tissue samples are clear of cancer cells, the procedure is done.
If the tumor is large, you may have cryotherapy. Researchers are also studying the use of chemotherapy (chemo) eye drops for people who have conjunctival squamous cell carcinoma (the drops are used after surgery) and for conjunctival melanoma. These may be options when there are tumors in several places on your eye.
Conjunctival lymphomas may be treated with radiation alone, as long as there is no lymphoma anywhere else. Lymphomas that occur inside the eye (intraocular lymphoma) need to be treated with chemo. Surgery is not normally used to treat lymphoma of the eye. But in some cases, your healthcare provider may do a biopsy to confirm intraocular lymphoma.
Tumors in the iris
These are rare tumors. Treatment of these tumors depends on whether the tumor is growing. It also depends on whether there is any complication from the tumor, such as uncontrolled glaucoma. If you have glaucoma that does not get better with medicine or if the tumor is growing quickly, your healthcare provider may remove your entire eye (enucleation). If the tumor is not growing and the glaucoma can be controlled with medicine, you may need surgery to remove only the tumor. In some cases, you may need radiation.
The treatment for choroidal melanomas can include thermal destruction (cryotherapy or photocoagulation), radiation, surgery to remove the tumor, or complete removal of your eye. Or you may not have any treatment at all. The choice depends on the size of the tumor, if it’s growing, and if you’re having symptoms. Talk about each option with your healthcare provider. Be sure to weigh all the risks and benefits of each choice. In some cases, you may need chemo.
Nevi in the eye is like freckles on your skin. They are very rare and almost never require treatment. But Nevi can turn into malignant melanoma. If they do, they are treated as malignant melanoma.
Cancers of the eyelid
Some types of cancer involve glands of the eyelid, such as the sebaceous gland. The treatment most commonly used for cancer of the eyelid is surgery. The goal of surgery is to remove all of the cancer. The type of surgery you have depends on the size of the tumor. If you need most of you eyelid removed, your healthcare provider will reconstruct it using plastic surgery. In some cases, you may need radiation. This can kill any cancer cells that may have been left behind.
Treatment side effects
Side effects of treatments for eye cancer depend on the type of treatment used, the type of cancer, and the part of the eye involved. Many types of cancer can affect the various structures of the eye.
Your healthcare provider will try to treat your cancer so that your vision, appearance, and quality of life is affected as little as possible. He or she will only remove your eye if it’s the only way to fully remove the cancer.
If you need to have an eye removed, your healthcare provider will discuss the surgery and side effects with you. This surgery can affect your appearance, but there are ways to reconstruct your eye. You may need to see a plastic surgeon. Your healthcare provider may also suggest a prosthetic (artificial) eye, so that your appearance will not change drastically.
Treatments or growth of the cancer may cause changes in or loss of vision. Your healthcare provider will discuss the side effects and possible risks of your treatment with you before your treatment starts.
March 21, 2017
Melanoma. The Merck Manual for Healthcare Professionals.
Griggs, Paul B., MD,Stump-Sutliff, Kim, RN, MSN, AOCNS