Retinoblastoma is a rare cancer of the retina of the eye. The retina is in the back of the eye. It’s the part of the eye that receives light. Retinoblastoma is the most common tumor affecting the eye in children. It almost always occurs in children less than 5 years old.
The cancer is caused by a change in a gene. It may be a gene passed down from parents (inherited). Or it may be a gene change that happens by chance (sporadic).
In 1 out of 3 children with retinoblastoma, it’s present at birth (congenital). Of these children, 1 out of 4 has a form passed on from parents. It usually affects both eyes. It also increases the risk of other cancers such as sarcoma and melanoma.
In 2 out of 3 children with retinoblastoma, it occurs by chance. In these cases, it affects only one eye. There is not an increased risk of other cancers.
Symptoms may affect one or both eyes. Symptoms can occur a bit differently in each child. They can include:
- Leukocoria. This is an abnormal white reflection from the retina of the eye. The dark center part of the eye (pupil) actually looks white. This may only be seen in a dark room or in a photo.
- Strabismus (lazy eye). This is when the eyes are misaligned. The eyes don’t move together or look in the same direction.
Less common symptoms may include:
- Pain, redness, or swelling of one or both eyes
- Trouble seeing
Most of the time, retinoblastoma has not spread (metastasized) to other areas of the body when it’s diagnosed. If it has spread, other symptoms may include:
- Loss of appetite
- Weight loss
- Neurologic problems such as weakness, numbness, and trouble with movement
- Lump (mass)
The symptoms of retinoblastoma can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.
Your child's healthcare provider will ask about your child's health history and symptoms. He or she will examine your child and pay close attention to the eyes. The healthcare provider will likely advise that your child see an eye specialist (ophthalmologist).
The ophthalmologist will check your child's eyes with special tools. Your child may need a dilated indirect ophthalmoscopic exam. Your child may be given anesthesia medicine to sleep through the exam.
Your child may need other tests such as:
- Ocular ultrasound. This test uses sound waves to create images of the eyes.
- CT scan. A series of X-rays and a computer are used to make images.
- MRI. Large magnets, radio waves, and a computer are used to make detailed images.
- Blood tests. Your child’s blood may be tested for signs of disease, and for gene changes.
A child may be diagnosed with no symptoms. This may be the case if you have a family history of retinoblastoma. Your child may have eye exams often to check for signs of the cancer.
Part of diagnosing cancer is called staging. Staging is the process of seeing if the cancer has spread, and where it has spread. Staging also helps to decide the treatment. There are different ways of staging cancer. Retinoblastoma tumors are staged in 5 groups lettered A through E. The groups are based on how likely it is that the eye will be saved. Talk with your child's healthcare provider about the stage of your child's cancer and what it means.
Most children in the U.S. with retinoblastoma have very good prognoses. This means they have a good chance of recovery.
Your child will be treated by a team of different types of healthcare providers, such as:
- Children’s cancer specialist (pediatric oncologist)
- Retina specialist
- Specialist in using radiation to treat cancer (radiation oncologist)
- Others types of healthcare providers
Specific treatment for retinoblastoma will be determined by your child's healthcare providers based on:
- Your child's age, health, and health history
- Extent of the disease
- Your child's tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Many of the treatment methods require sleep medicine (anesthesia). Treatment may include the following:
- Surgery. In some cases, surgery may be done to remove the eye. This is called enucleation. This is not needed for all retinoblastomas. They eye socket and eye are replaced with an implant and artificial eye.
- Chemotherapy. Anti-cancer medicines may be given into a vein (IV) or by mouth (systemic). The medicines may reduce the size of the tumor so that other treatments can work better.
- Radiation therapy. Internal radiation (brachytherapy) may be done. External radiation is not often done. Radiation may be used when other treatment doesn’t work well. A small container (plaque) with radioactive material is placed near the tumor. The plaque is placed and removed during surgery. This may be used to treat some smaller tumors.
- Laser therapy or photocoagulation. A laser is used to destroy the blood supply to the tumor. This is used on some smaller tumors.
- Thermotherapy. Light is used to destroy cancer cells. This may be used for some small tumors. Or, it may be used with chemotherapy or radiation for larger tumors.
- Cryotherapy. A tool is used to freeze and kill the cancer cells.
- Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
- Clinical trials. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child.
With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:
- Getting medical treatment right away is important for the best prognosis. Cancer that has spread is harder to treat.
- Ongoing follow-up care during and after treatment is needed.
- New treatments are being tested to improve outcome and to lessen side effects.
A child may have complications from the cancer or from treatment, such as:
- Detached retina
- Spreading of the cancer (metastasis)
- Loss of eyesight
- Side effects of chemotherapy such as tiredness, bruising and bleeding, mouth sores, infections, vomiting, and diarrhea
- Bleeding or infection from surgery
- Growth of other cancers
- Heart or kidney problems
- Problems with growth and development
You can help your child manage his or her treatment in many ways. For example:
- Your child may have trouble eating. A dietitian may be able to help.
- Your child may be very tired. He or she will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
- If your child smokes, help him or her quit. If your child doesn’t smoke, make sure he or she knows the danger of smoking.
- Get emotional support for your child. Find a counselor or child support group can help.
- Make sure your child attends all follow-up appointments.
A child with retinoblastoma needs ongoing care. Your child will be cared for by a team of healthcare providers. They will treat any late effects of treatment and to watch for signs or symptoms of the tumor growing back. The healthcare providers will also check your child with imaging tests and other tests.
If your child has an implant and artificial eye, he or she should wear protective eyewear during activities that may harm the eye.
Family members may want to see a genetic counselor to learn more about the risk of retinoblastoma.
Call the healthcare provider if your child has:
- Symptoms that get worse
- New symptoms
- Side effects from treatment
- Retinoblastoma is a rare cancer of the retina of the eye. The retina is in the back of the eye. It’s the part of the eye that receives light.
- The cancer may be passed on from parents (inherited) or it may occur by chance (sporadic).
- The most common symptoms are an abnormal white reflection from the retina (leukocoria) and misaligned eyes (strabismus).
- It’s diagnosed by a dilated indirect ophthalmoscopic exam.
- In the U.S., the prognosis for most children with retinoblastoma is very good.
- There are many treatments for retinoblastoma including surgery, chemotherapy, radiation therapy, laser therapy, and cryotherapy.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
January 16, 2018
Holloway, Beth, RN, M.Ed. ,Welch, Annette, MNS, OCN