Retinal cancer is a life-threatening disease, but if treated properly and promptly, the disease is rarely fatal.
What is retinoblastoma?
Retinoblastoma also known as retinal cancer is a malignant eye disease seen in young children. This is a serious disease that can not only damage the eye’s function but also be life threatening. The tumor may grow in one or both eyes. The disease may be inherited or sporadic. Genetic retinoblastoma can also cause other types of cancer in children.
Most patients are diagnosed before 2 years of age but can be detected at birth and in adults over 52 years of age.
If detected and treated early, it can be cured with a 5-year survival rate of up to 90-95% and retain high eyeballs.
Retinal cancer is a malignant eye disease seen in young children.
The cause of retinoblastoma is due to a genetic abnormality related to or inherited.
Retinoblastoma is related to family factors: accounting for 6%. The disease usually manifests as early as a few months old, often with both eyes. Your child may have another type of cancer.
Retinoblastoma unrelated to family factors: 94%. The reason is a genetic mutation in which 80% are not inherited and 20% may be inherited.
Symptoms of retinoblastoma
Symptoms of retinoblastoma depend on the size of the tumor, the stage of the disease, and complications of the tumor in the eye. A number of cases have been found to be opportunistic due to eye exams for premature infants or school children.
White pupils: More than 50% of the disease is detected from white pupils. Signs can be described by many different words such as “cat eye”, “animal eye” … When looking into the eyes of the child will see light, can see 1 or 2 white or yellow pupils when taking photos I use flash. This is particularly noticeable at night or in a dark room as the pupils will dilate.
Strabismus: More than 30% of children with retinoblastoma are detected from this sign.
Vision loss: 8% of cases detected by this sign.
Other signs: redness and eye pain due to glaucoma, uveitis, orbital cellulitis, vestibular hemorrhage …
In the late stages, the tumor may progress behind the eyeball as it invades the optic nerve, spreads into the eye sockets and spreads far. The tumor invades through the optic nerve or subarachnoid space into the intracranial. The tumor can spread into the skull, spinal cord and lymph nodes. From there the tumor along the bloodstream, lymphatic vessels metastasize far to the organs in the body.
Clinical forms of childhood retinoblastoma include:
One eye retinoblastoma: 75% of cases, children 2-4 years old.
Bilateral retinoblastoma: seen in 25% in children younger than 14-16 months of age, with genetics in 40%.
Trilateral retinoblastoma: is a retinoblastoma and additional pineal cell tumors, accounting for 3-9%. The disease has a very poor prognosis. Most children die within 35 months.
Stages of retinoblastoma:
Retinoblastoma is staged according to S. Jude Children’s Research into 4 stages:
Stage 1: U (one or more foci) is localized in the retina.
Stage 2: U (one or more foci) spreads outside the retina but is limited to the eyeball.
Stage 3: Tumor invasive outside the eyeball, metastatic intracranial.
Stage 4: There is a metastatic distance along the bloodstream (internal organs, bones, bone marrow …).
Risk subjects for retinoblastoma:
Children, especially under 2 years old
Children have abnormal eye symptoms such as squint, red eyes, hemorrhage, cat eye images, etc.
Children with sick family members
Prevention of retinoblastoma:
There is no specific preventive measure
The best way is to examine your baby’s eyes when there are any suspicious signs
Screening and screening for children with family factors
Tests in the diagnosis of retinoblastoma include:
Brain X-ray: 75% of cases have intraocular calcification and the tumor invasion can be identified.
Ultrasound: especially useful in cases of cloudy cataracts
Computerized tomography: advanced technology to help determine the calcification and pre-assess the treatment of disease activity in the optic nerve, in the eye socket and in the brain
Determination of LDH in vitreous fluid: Increased LDH is seen in more than 90% of retinal cancer patients
CEA and AFP levels rise in the blood and then gradually decrease to normal levels after removal of the eyeball.
Cerebrospinal fluid test assesses the invasion of the tumor into the CNS
Pathology: is not a mandatory test when diagnosing retinoblastoma because the diagnosis is mainly by non-invasive methods of eyeball. The postoperative valuable surgical procedure helps to assess the extent of tumor invasion.
Measures to treat retinoblastoma
Surgical, chemical and radiation treatments achieved satisfactory results with an overall survival rate after 5 years with 90% of intraocular tumors, and 10% of external invasive tumors. . The current treatment trend is towards living with preserving vision of patients.
Surgical removal of the eyeball
Large tumors (> 60% volume of eyeball)
The patient has no vision
The tumor invaded the optic nerve, invaded the anterior chamber
Failure of previous conservation treatments
After surgery, there may be auxiliary chemicals or radiotherapy in cases of invasive iris, creases, choroid …
After surgery, the eyeball can be fitted to a child.
Surgical complications: spreading cancer cells into the eye socket.
Rays of radiation
Indicated in the case of large tumors on both sides, having germinated into the lens, tumors near the optic nerve
Complications of radiation: damage to the retina, optic nerve, lacrimal gland and lens
The second cancer that comes after radiation is also a complication to note, especially in patients with hereditary retinoblastoma.
Optical laser east
Applicable for tumors of small size, width <4.5mm and thickness <2.5mm
Direct treatment within the tumor, clotting the blood vessels to supply the tumor
Chemicals are used in cases such as:
Multiple invasive polyps> 25% of retinal areas without radiation therapy
All large tumors are not removed
The tumor invades the cornea
The damage spreads outside the eyeball.
Bad prognosis factors include:
Delayed diagnosis of disease greater than 6 months.
History of intraocular surgery that has the ability to germinate into glass or spread malignant cells out of the eye.
Patients with cataracts.
Radiotherapy using external radiation can lead to secondary cancers, especially in patients with inherited retinoblastoma.
Tumors that invade the choroid, optic nerve or eye socket increase the risk of metastases.
Risk of spillover into the optic nerve: extracellular growth pattern (for example, from the outer layers of the retina towards the choroid), increased intraocular pressure and the thickness of the mass ≥ 15 mm.
Risk of spreading into the choroid: increased intraocular pressure; new blood vessel iris.
The prognosis also depends on the state, location and extent of the tumor recurrence.