The treatment choices for each person depend on the size and location of the tumor, the results of lab tests, and the stage or extent of the disease. A doctor also considers the person's age and general health when deciding on a treatment plan. Preservation of sight is an important consideration when thinking about different treatment options.
Many patients want to learn all they can about their disease and their treatment choices so that they can take an active part in decisions about their medical care. They are likely to have many questions and concerns about their treatment options.
The doctor is the best person to answer questions about treatment, such as what the treatment choices are, how successful it is expected to be, and what the side effects may be. Most patients also want to know whether they will have to change their normal activities.
Treatment for eye cancer usually involves local or systemic methods. Local treatments are used to destroy cancer cells in a particular area. Surgery and radiation therapy are forms of local treatment. Depending on location, limited surgical methods may be available. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy and biologic therapy are systemic treatments. A patient may have just one treatment or a combination of treatments.
Primary treatment for these tumors consists of surgery. It is important for the doctor to keep checking for cancer cells left behind. The surgery ends when all cancer cells have been removed. In some cases, Mohs surgery can be performed. This involves removing very small, thin pieces of tissue and immediately examining them under a microscope. If cancer cells are seen, more tissue is removed and examined. Once the tissue samples are clear of cancer cells, the procedure is completed.
If the tumor is large, cryotherapy (freezing of the tumor) may be needed. Researchers are also studying the use of chemotherapy eye drops for people who have conjunctival melanoma (and have tumors in several places on the eye). Conjunctival lymphomas may be treated with radiation alone, as long as there is no lymphoma elsewhere. Lymphomas that occur inside the eye, also called intraocular lymphoma, need to be treated with chemotherapy. Surgery usually is not used to treat lymphoma of the eye.
These are rare tumors. They can be either primary tumors of the iris (for example, malignant melanoma) or tumors that have spread from another tumor (such as, breast or lung). Treatment of these tumors depends on whether the tumor is growing and also whether there is any complication from the tumor (for example, uncontrolled glaucoma). In the case of glaucoma that does not get better with medication, or if the tumor is growing quickly, it may be necessary to remove the entire eye (enucleation). If the tumor is not growing and the glaucoma can be controlled with medication, the treatment can be less aggressive.
Melanomas. The treatment for choroidal melanomas can include thermal destruction (cryotherapy or photocoagulation), radiation, local resection or complete removal of the eye, or no treatment at all (observation alone). The choice depends on the size of the tumor, on whether or not it is growing, and whether or not the person is having symptoms. All these options should be discussed in depth with the doctor, weighing all the risks and benefits of each choice. In some cases, chemotherapy will be recommended.
Nevus. Nevi in the eye can be compared to raised freckles on the skin. They are very rare and almost never require treatment. But, nevi can turn into malignant melanoma. If they do, they are treated as malignant melanoma.
Doctors are always finding new ways to treat eye cancer. These new methods are tested in clinical trials. Before beginning treatment, a person should ask his or her doctor if there are any clinical trials he or she should consider.
Cancer of the eyelid is actually a type of skin cancer, not an eye cancer. The treatment most commonly used for cancer of the eyelid is surgery. The goal of surgery is to remove all of the cancer. The type of surgery used depends on the size of the tumor. If the tumor requires removal of most of the eyelid, the eyelid will be remade (reconstructed) using plastic surgery. In some cases, radiation may be needed after surgery to kill any cancer cells that may have been left behind. Radiation will usually affect eyesight.