Retinoblastoma (patient information)

Retinoblastoma
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Retinoblastoma?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
Retinoblastoma On the Web
Ongoing Trials at Clinical Trials.gov
Images of Retinoblastoma
Videos on Retinoblastoma
FDA on Retinoblastoma
CDC on Retinoblastoma
Retinoblastoma in the news
Blogs on Retinoblastoma
Directions to Hospitals Treating Retinoblastoma
Risk calculators and risk factors for Retinoblastoma

For the WikiDoc page for this topic, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D,Jyostna Chouturi, M.B.B.S [2], Sahar Memar Montazerin, M.D.[3]

Overview

Retinoblastoma is eye cancer. It originates from the inner layer of the eye, retina and usually occurs in children under 3 years.

What are the symptoms of Retinoblastoma?

Retinoblastomas are usually found in infants or children.

• The center circle of the eye (pupil) often appears white or pink when you shine a light in a child's eye.
• Lazy eye (strabismus): Both eyes do not appear to look in the same direction.
• Vision problems
• Eye pain
• Redness of the white part of the eye
• A pupil that does not get smaller when exposed to bright light
• Eye swelling

Other health problems may also cause these symptoms. Only a pediatrician can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Retinoblastoma?

• Retinoblastoma is caused by a mutation in a gene controlling cell division of retinal cells, causing these cells to grow out of control and become a pile of cells (tumor).
• It is not clear what causes the mutation, but in some cases, children can inherit the mutation from their parents (Familial form).
• In a little over half of the cases, this mutation develops in a child whose family has never had eye cancer.
• After the development of the tumor within the eye globe, it also may invade the nearby structures or even spread to further sites of the body.

Who is at highest risk?

• Those who have a mutation in the RB1 gene are at risk of tumor development.
• A person with a family history of members of retinoblastoma in a parent, sibling, or first/second-degree relative is also at risk.

Diagnosis

The following methods are used to diagnose the tumor:

• Eye exam: The doctor will do an eye exam to determine what's causing your child's signs and symptoms. The doctor may also recommend using anesthetics to keep the child still.
• Imaging studies: These methods help the physician to assess the tumor growth and invasion to the nearby structures. Imaging studies are such as:
  • Ultrasound: a painless test which uses sound waves to create a picture of the eyeballs and locate the approve the tumor presence.
  • Computed tomography (CT) scan: It can confirm the location of cancer and show the tissues near the tumor.
  • Magnetic resonance imaging (MRI): An MRI produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
  • Whole Bone Scan: The goal of a whole body bone scan is to show if cancer has spread and involve the bones.

When to seek urgent medical care?

• Call your health care provider if you notice any change in your child'eye that concerns you.
• If you have a family history of retinoblastoma ask your primary care provider when to start eye exam in your child.

Treatment options

Treatment differs depending on the following factors:

• Size of the tumor
• Location of the tumor
• Spread of the tumor to the structures other than the eye
• Overall health status of the affected child
• The parents' preferences

Available treatment options are:
Chemotherapy which kills the cancerous cells using chemical drugs.

• It can be prescribed in pill form or through the blood vessels.
• This method causes the tumor to shrink, so other treatment forms treat the remaining tumor (if any).
• This treatment can decrease the need for the eye surgery.
• It may also be used in case of spread of tumor outside the eye globe and other sites of the body.
• intra-arterial chemotherapy, a new type of chemotherapy, transfer the chemical drug directly to the tumor via a tiny tube (catheter) in the eye artery.
• Intravitreal chemotherapy is also used for retinoblastoma that has spread within the eye via direct injection of the chemical drug into the eye.
  • This method is usually used when the tumor is resistant to other types of treatment.

Radiation therapy which kills cancerous cells using high energy beams such as X-ray and protons.
Radiotherapy categorized into two categories:

• Internal radiation (brachytherapy) which the device is within or in the close distance of the tumor temporarily.
  • This method uses a small disk which is stitched in place and left for a few days while it radiates the beam to the retinoblastoma tumor.
  • This method reduces the risk that treatment will affect healthy eye tissue due to the placement of the device near the affected eye.
• External beam radiation which uses high-powered beams to radiate the tumor from a large machine outside of the body.
  • This method can cause side effects due to simultaneous radiation of other parts of the body such as the brain so, external beam radiation is typically reserved for children with advanced retinoblastoma and those for whom were resistant to other forms of treatment.
    

Laser therapy (laser photocoagulation) which uses a laser to destroy blood vessels supplying the tumor with oxygen and nutrients.

Cold treatments (cryotherapy) which uses extreme cold to kill cancerous cells.

Surgery removes the tumor which is too large to be treated by other methods.

• It decreases the risk of spread of the tumor to the nearby structures.
• Surgical methods for retinoblastoma include:
  • Surgery to remove the affected eye (enucleation) as well as a portion of the optic nerve, which extends from the back of the eye into the brain
  • Surgery to place an eye implant which replaces the empty space of the eyeball by a special ball — made of plastic or other materials — in the eye socket and connects the muscles that control eye movement to the implant.
  • Fitting an artificial eye which involves the placement of a custom-made artificial eye that can be made to match your child's healthy eye.
• Surgery may be complicated by side effects such as infection and bleeding.

Where to find medical care for Retinoblastoma?

Directions to Hospitals Treating retinoblastoma

Prevention of Retinoblastoma

• Because retinoblastoma is caused by a genetic mutation, it remains unpreventable. But it is very important to detect cancer early and get the most effective treatment.
• In the inheritable form of the disease, however, other children of the family should be screened using genetic analysis for the presence of the mutation, so eye exam can start at an early age and diagnose the tumor when it is surgically removable.

What to expect (Outlook/Prognosis)?

The prognosis of retinoblastoma depends on the following:

• Whether or not the tumor can be removed by surgery.
• The stage of cancer: the size of the tumor, whether cancer has spread
• The child’s general health

Possible complications

• Invasion of the tumor to the nearby structure
• Development of other tumors in inheritable form of the tumor
• Return of the tumor in the treated eye
• Side effects of radiotherapy