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Retinoblastoma

Tumor - retina; Cancer - retina; Eye cancer - retinoblastoma

 

Retinoblastoma is a rare, cancerous tumor of a part of the eye called the retina.

Causes

 

Retinoblastoma is caused by a mutation in a gene that controls how cells divide. As a result, cells grow out of control and become cancerous.

In about half the cases, this mutation develops in a child whose family has never had eye cancer. In other cases, the mutation occurs in several family members. If the mutation runs in the family, there is a 50% chance that an affected person's children will also have the mutation. These children will therefore have a high risk of developing retinoblastoma themselves.

The cancer most often affects children younger than 6 years old. It is most commonly diagnosed in children 1 to 2 years old.

 

Symptoms

 

One or both eyes may be affected.

The pupil of the eye may appear white or have white spots. A white glow in the eye is often seen in photographs taken with a flash. Instead of the typical "red eye" from the flash, the pupil may appear white or distorted.

Other symptoms can include:

  • Crossed eyes
  • Double vision
  • Eyes that do not align
  • Eye pain and redness
  • Poor vision
  • Differing iris colors in each eye

If the cancer has spread, bone pain and other symptoms may occur.

 

Exams and Tests

 

The health care provider will perform a complete physical exam, including an eye exam. The following tests may be done:

  • CT scan or MRI of the head
  • Eye exam with dilation of the pupil
  • Ultrasound of the eye ( head and eye echoencephalogram )

 

Treatment

 

Treatment options depend on the size and location of the tumor:

  • Small tumors may be treated by laser surgery or cryotherapy (freezing).
  • Radiation is used for both a tumor that is within the eye and for larger tumors.
  • Chemotherapy may be needed if the tumor has spread beyond the eye.
  • The eye may need to be removed (a procedure called enucleation) if the tumor does not respond to other treatments. In some cases, it may be the first treatment.

 

Outlook (Prognosis)

 

If the cancer has not spread beyond the eye, almost all people can be cured. A cure, however, may require aggressive treatment and even removal of the eye in order to be successful.

If the cancer has spread beyond the eye, the likelihood of a cure is lower and depends on how the tumor has spread.

 

Possible Complications

 

Blindness can occur in the affected eye. The tumor can spread to the eye socket through the optic nerve. It may also spread to the brain, lungs, and bones.

 

When to Contact a Medical Professional

 

Call your provider if signs or symptoms of retinoblastoma are present, especially if your child's eyes look abnormal or appear abnormal in photographs.

 

Prevention

 

Genetic counseling can help families understand the risk for retinoblastoma. It is especially important when more than 1 family member has had the disease, or if retinoblastoma occurs in both eyes.

 

 

Open References

References

Augsburger JJ, Bornfeld N, Correa ZM. Retinoblastoma. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 8.1.

Karcioglu ZA, Haik BG. Eye, orbit, and adnexal structures. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 67.

National Cancer Institute: PDQ childhood astrocytomas treatment. Bethesda, MD: National Cancer Institute. Date last modified August 14, 2015. www.cancer.gov/types/brain/hp/child-astrocytoma-treament-pdq . Accessed: January 19, 2016.

 
  • Eye

    Eye - illustration

    The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

    Eye

    illustration

    • Eye

      Eye - illustration

      The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

      Eye

      illustration

    Tests for Retinoblastoma

     
       

      Review Date: 12/23/2015

      Reviewed By: Adam S. Levy, MD, Division of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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