Rare and almost always asymptomatic, tumors of the eye require the involvement of several specialists to be dealt with hope of success.
The most common of them is malignant melanoma, similar to a skin cancer. Generally affects the choroid or the ciliary body or the iris in one eye.
In half of the cases, this tumor is discovered during a routine eye exam.
Many other cancers invest the eye, in the form of metastases. p {margin-bottom: 0.21cm; It happens}, that is, that some cancer cells detach from the primary tumor, reaching the eye through the bloodstream or lymphatic system. Often these metastases of breast cancer or lung
If the tumor is setting behind the eyeball can cause the overhang.
The effect of the tumors on the view depends on their placement in the eye and of their speed of growth. In these cases, the therapeutic intervention of choice is radiotherapy. In severe cases, however, it may be necessary to remove the eye.
Retinoblastoma is certainly the most common tumor of childhood. Its incidence is estimated to be around one in every 30,000 births, and the average age at which it occurs is 2 years, although it may appear at birth and, moreover, have been reported with later onset. It can be either unilateral or bilateral; especially in the latter case was highlighted a familiarity with an autosomal dominant trait. Numerous investigations carried out into the causes of this cancer: currently, genetic factors are those most credited, since it seems that in many patients with retinoblastoma there is a deletion of the long arm of chromosome 13 With regard to the symptoms, the most common sign is the presence of so-called "white pupil" (leucocoria), accompanied by signs of convergent or divergent strabismus. Often the eye is reddened and sore, with the possibility of the presence of a secondary glaucoma; In addition, there is often decrease of visual acuity. Continues Dr. Carraro, who daily deals with problems and interventions related to the retina: "The tumor appears as a white mass of varied size, which causes exudative retinal detachments solids. In addition, it has the opportunity to grow not only inside the eye, but also outside it, invading the choroid, sclera and surrounding tissues. "
The diagnosis is usually clinical and based on the appearance of the tumor, and is thorough with ultrasound examinations and fluorangiografici (CT and MRI are most useful to check for metastasis).
Currently, the therapy uses radiation therapy, chemotherapy, laser therapy, cryotherapy and surgery. The latter, which consists nell'enucleazione, is reserved for the most invasive.
As for the prognosis, approximately 15-19% of cases, unfortunately, has a poor prognosis quoad vitam. The prognosis is changed radically in positive, however, for those tumors with a diameter less than 4 mm, and does not tend to invade the optic nerve. Turning to tumors of adulthood, malignant melanoma of the choroid is certainly the most common intraocular primary tumors. The average age of onset is around 50 years old, affects both sexes equally, and presents a major - albeit modest - incidence in patients with iris clear. It is usually a unilateral tumor.
Unfortunately, this cancer is often asymptomatic and has "discovered" to a normal routine check; only in relation to its location and, above all, to its size responsible for a retinal detachment, the patient begins to report decline in visual acuity and defects campimetrici.
The tumor shows a dark orange appearance and can be located both in the central part of the eye (localization sottomaculare), with marked reduction of visual acuity, and in the outlying districts, causing exudative retinal detachments-solid. The location very front, with involvement of the ciliary body, is defined as "malignant melanoma of the ciliary body."
The clinical diagnosis is made by observation of the fundus oculi and uses in-depth examinations such as ocular ultrasonography, angiography, magnetic resonance imaging. Moreover, it is of common use, even if not always infallible, the test with radioactive phosphorus that can provide indications on the type of cellularity of melanoma. The treatment makes use of the cyclotron proton beam, which in recent years has been shown to lead to significant regression of tumor masses. Instead, the surgery is reserved only for those cases in which the tumor, its location, has destroyed the central vision and when other treatments are not effective results. Prognosis: Patients with malignant melanoma of the choroid and ciliary body have a median survival of 50% at 5 years, 10 years at 65% (the presence of metastases, especially to the liver, bones and lungs, reduces dramatically the prognosis also 1 year). Another tumor of adulthood is the choroidal osteoma. Benign quoad vitam, this tumor appears to originate from the presence of ectopic cartilage in the choroid; often unilateral, affecting more frequently females, ranging in age between 20-30 years.
Coming to the symptoms, it is to be noted that such tumors can have various diameters extension (2-8 mm) and a thickness of 1-2 mm. Often located close to the optic disc, appear as a mass of creamy white color in well-defined borders, can cause defects campimetrici and decrease in visual acuity occurs if exudation in the macula. The diagnosis relies on the fundus oculi, the fluorescein angiography, ultrasonography and CT and MRI: "In fact, the differential diagnosis - always explains Dr. Fulvio Carraro - must be placed primarily with malignant melanoma of the choroid, because the prognosis of 'choroidal osteoma is much more benign is quoad vitam is quoad functionem compared to malignant melanoma. "
For the therapy is used to laser treatment only in cases where the macular exudation not resolve spontaneously. Finally, the definite prognosis is favorable.
The choroidal hemangioma, tumor of adulthood, one must define more properly "hamartoma". It extends entirely benign, and classically manifests into the fourth decade of life, affecting men and women equally.
The choroidal hemangioma is often asymptomatic, and often is discovered "by chance" in routine visits. It looks like a mass of orange-red with a diameter of between 2 and 6 mm, often located close to the optic nerve and temporally to the macula; when the tumor invades even the latter, the patient complains decrease of visual acuity and metamorphopsia.
The examination fluorangiografico retinal and ocular ultrasonography are very important for a good differential diagnosis with malignant melagnoma, with whom we often can be confusing, having both of the pathognomonic signs for choroidal hemangioma.
"In the presence of an" incidental finding "in which the macula is not involved and the retina for signs of initial detachment, says the specialist, you do not need any treatment, and it is sufficient periodic monitoring of the patient. In other cases, the treatment photocoagulation is the most indicated ".