Description

Retinoblastoma is a type of eye cancer that begins as a growth of the cells in the retina. The retina is the light-sensitive lining at the interior of the eye.

The retina is composed of nerve tissue that senses light as it comes through the front part of the eye. The light causes the retina to send signals to the brain. The brain interprets the signals as images.

Retinoblastoma occurs more frequently in young children. It is usually diagnosed before 2 years of age. It most often affects one of the eyes. Sometimes it happens in both eyes.

There are several treatments for retinoblastoma. For most children, the treatment does not require to remove the eye to get rid of the cancer. The prognosis for children with a diagnosis of retinoblastoma is quite good.

Symptoms

The Retinoblastoma signs and symptoms include:

  • A white color in the center of the circle of the eye when the light shone in the eyes. It may appear in photos with flash.
  • Redness of the eyes.
  • The swelling of the eyes.
  • Eyes that seem to be looking in different directions.
  • The loss of vision.

When to see a doctor

Make an appointment with a doctor or other health care professional if you notice any changes in your child's eyes that are of interest to you.

Causes

Retinoblastoma is caused by the changes within the cells in the eye. It's not always clear what causes changes that lead to this cancer in the eye.

Retinoblastoma is initiated only when the cells in the eye, to achieve changes in their DNA. A cell's DNA contains the instructions that tell the cell what to do. In healthy cells, the DNA contains the instructions to grow and multiply at a set rate. The instructions also say that the cells die at a set time. In cancer cells, changes in DNA to give different instructions. The changes, to tell the cancer cells to make many more cells quickly. Cancer cells can continue living when healthy cells would die. This makes too many cells.

In retinoblastoma, this growth of cells that occurs in the retina. The retina is the light-sensitive lining at the interior of the eye. The retina is composed of nerve tissue that senses light as it comes through the front part of the eye. The light causes the retina to send signals to the brain. The brain interprets the signals as images.

As the cancer cells accumulate in the retina, they can form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. At the time, cancer cells can break off and spread to other parts of the body. When cancer spreads, it is called metastatic cancer. The Retinoblastoma rarely spreads, especially if detected in time.

For the majority of cases of retinoblastoma, it is not clear what causes the changes in the DNA that lead to cancer. However, it is possible that children inherit the changes in the DNA of their parents. These changes may increase the risk of retinoblastoma.

Risk factors

Risk factors for retinoblastoma include:

  • The young age. Retinoblastoma is most common in very young children. Usually diagnosed by 2 years of age. The Retinoblastoma that happens later in life is very rare.
  • The changes in the DNA that are run in families. The DNA variations that increase the risk of retinoblastoma can be transmitted from parents to children. Children with these inherited DNA changes are likely to obtain retinoblastoma at a younger age. They also tend to have retinoblastoma in both eyes.

Complications

Children with retinoblastoma can develop complications.

Cancer that comes back around

After treatment, there is a risk that the cancer may come back in the eye, or close to it. For this reason, your healthcare team will create a plan for follow-up visits. Your child's follow-up plan will depend on the treatment your child received. A typical plan may include eye exams every few months during the first year after treatment.

The increased risk of other cancers

Children with the form of retinoblastoma that can run in families may have a higher risk of getting other types of cancer.

The risk of these types of cancer is higher:

  • The bone cancer.
  • Bladder cancer.
  • Breast cancer.
  • Hodgkin's lymphoma.
  • The lung cancer.
  • The Melanoma.
  • Pineoblastoma.
  • Soft-tissue Sarcoma.

Your child's health care team may recommend tests to detect these other types of cancers.

Prevention

There is no way to prevent retinoblastoma.

Some of the retinoblastomas are caused by changes in the DNA that are run in families. If the retinoblastoma runs in your family, tell your health care professional. Together, you might consider the possibility of genetic testing to find variations in the DNA that increase the risk of retinoblastoma. Your health care professional may refer you to a genetic counselor or other health care professional trained in genetics. This person can help you decide whether to have genetic testing.

If your children have an increased risk of retinoblastoma, the attention can be planned to manage the risk. For example, eye exams may start shortly after birth. That way, the retinoblastoma can be diagnosed very early. These screening tests could detect the cancer when it is small and has a greater chance of being cured.

If you have not had children, but are planning to, talk with your health care team about your family history of retinoblastoma. Genetic testing can help you and your partner to understand whether there is a risk of transmitting the DNA of the variations of your future children. Your health care team may have options to help you manage this risk.

Diagnosis

The Retinoblastoma diagnosis often begins with an examination of the eyes. Imaging tests can help show the size of the cancer.

Eye exam

A health professional carefully examine your child's eyes during an eye exam. This could include the analysis of your child's vision and the use of a special light to examine the inside of the eye. Sometimes very young children find it difficult to hold still for a comprehensive eye exam. Your health care team may recommend a medication to put the child in a sleep-like state so that the examination can be completed. The results of the dele exam to your health care team clues about what is causing your child's symptoms.

Imaging tests

Imaging tests make pictures of the inside of the body. For retinoblastoma, imaging tests are used to examine the eye and the area around it. The images could show the size of the cancer and whether it has grown beyond the eye. Imaging tests may include ultrasound, and magnetic resonance imaging , among others.

Genetic testing

Genetic testing uses a sample of blood or saliva to find variations in the DNA. Genetic testing for retinoblastoma seeks to variations in a part of DNA called the RB1 gene.

All with retinoblastoma has variations in the RB1 gene in their cancer cells. But some children with retinoblastoma have the RB1 gene variations in all cells of their bodies. This can happen if the parents spend variations of DNA to his son. The variations can also happen if something changes in the RB1 gene as the child develops in the womb.

If genetic testing shows that your child has variations in the RB1 gene in all the cells in the body, this helps the health care team to your plan of treatment of the child. Variations in the RB1 gene in all the cells, also increases the risk of other types of cancer. Screening tests can help to see to the other types of cancer.

Treatment

Common retinoblastoma treatments include chemotherapy, therapy and cold laser therapy. Radiation therapy may be another option. The surgery to remove the eye, you can treat retinoblastoma, but is only used in certain situations.

Which is the best treatment for your child retinoblastoma depends on several factors. These factors include the size and location of the cancer, and whether the cancer has spread beyond the eye. Your health care team, it is also considered that their child's overall health and your own preferences.

Chemotherapy

Chemotherapy treats the cancer with strong medications. It is often the first treatment of retinoblastoma. Other treatments may be needed after the chemotherapy to kill any cancer cells that remain.

Types of chemotherapy for the treatment of retinoblastoma include:

  • The chemotherapy that travels through the entire body. Chemotherapy drugs can be administered through a vein or in the form of a pill. These drugs travel throughout the body to kill cancer cells. Giving the drugs in this way is called systemic chemotherapy. The treatment is usually given monthly for several months.
  • Chemotherapy in an artery near the cancer. Chemotherapy drugs can be put into an artery near the eyes. To obtain the medication at the right place, a thin tube that is inserted through the skin into an artery in the groin. The tube is advanced through the body until it reaches near the eyes. Then, the medicine is released through the catheter. Administer the medicine in this way is called intra-arterial chemotherapy. This allows the health care team to give the medication directly to the eye. The treatment is usually done on a monthly basis for a couple of months.
  • The chemotherapy is injected into the eye. Sometimes, chemotherapy drugs are injected into the eye with a needle. This form of giving the medicine is called by intravitreal injection of chemotherapy. Usually used after other types of chemotherapy. Can be used when the cancer is still, after other treatments or when the cancer comes back.

The cold therapy

Cold therapy, also called cryotherapy uses extreme cold to damage cancer cells. Usually used after chemotherapy to kill the cancer cells that are left. For very small retinoblastomas, cryotherapy may be the only treatment necessary.

During cryotherapy, a very cold instrument is placed in the eye. This causes the cells to near freezing. Once the cells are frozen, the instrument is withdrawn. This causes the cells to thaw. This process of freezing and thawing is repeated a couple of times in each session of cryotherapy.

Laser therapy

Laser therapy uses a laser light to heat up and damage the cancer cells. The medical term for this procedure is transpupillary thermotherapy. Usually used after chemotherapy to kill the cancer cells that are left. For very small retinoblastomas, laser therapy may be the only treatment needed. The treatments are usually repeated every couple of weeks until there are no signs of active cancer in the eye.

Radiation therapy

Radiation therapy treats cancer with a powerful energy. Types of radiation therapy used in the treatment of retinoblastoma include:

  • The placement of a radiation device on the eye.A device that emits radiation, it can be placed in the eye. This type of radiation is called plaque radiotherapy. It uses a small disk that contains radioactive material. The disk is then sutured in place in the eye and left for a couple of days, as it slowly emits radiation to the cancer. The placement of radiation close to the cancer reduces the possibility that the treatment is going to affect the healthy tissues outside of the eye. This type of radiation therapy is typically used for cancers that do not respond to chemotherapy.
  • The use of a machine to radiation in the eye.Radiation can be given for retinoblastoma using a machine that has the goal of energy rays at the cancer. The rays of energy can be X-rays, protons or other types of radiation. As your child lies on a table, the machine moves around your child, the delivery of radiation. This type of radiation is called external-beam radiation. The treatments usually occur daily for several weeks. External-beam radiation can cause side effects if the radiation beams to reach the delicate areas around the eyes, such as the brain. For this reason, the external radiation therapy is usually reserved for children with retinoblastoma that extends beyond the eye.

The placement of a radiation device on the eye. A device that emits radiation, it can be placed in the eye. This type of radiation is called plaque radiotherapy. It uses a small disk that contains radioactive material. The disk is then sutured in place in the eye and left for a couple of days, as it slowly emits radiation to the cancer.

The placement of radiation close to the cancer reduces the possibility that the treatment is going to affect the healthy tissues outside of the eye. This type of radiation therapy is typically used for cancers that do not respond to chemotherapy.

The use of a machine to radiation in the eye. Radiation can be given for retinoblastoma using a machine that has the goal of energy rays at the cancer. The rays of energy can be X-rays, protons or other types of radiation. As your child lies on a table, the machine moves around your child, the delivery of radiation. This type of radiation is called external-beam radiation. The treatments usually occur daily for several weeks.

External-beam radiation can cause side effects if the radiation beams to reach the delicate areas around the eyes, such as the brain. For this reason, the external radiation therapy is usually reserved for children with retinoblastoma that extends beyond the eye.

Eye removal surgery

When other treatments have not worked or when retinoblastoma is too large to be treated by other methods, the surgery to remove the eye, can be used. In these situations, removal of eyes can help prevent the spread of the cancer to other parts of the body. Eye removal surgery for retinoblastoma includes:

  • The surgery to remove the affected eye. The surgery to remove the eye is called enucleation. Surgeons disconnect the muscles and tissue around the eyes and remove the eyeball. A portion of the optic nerve, which extends from the back of the eye to the brain, it is also deleted.
  • The surgery to place an implant-eye.Immediately after the eyeball is removed, the surgeon places a special ball in the basin of the eye. The ball is called an implant. The muscles that control eye movement are sometimes attached to the implant. After his son is healed, the muscles of the eye is adapted to the implant. You can move only as the natural eye did. However, the implant can't see.
  • Fitting of an artificial eye.Several weeks after the surgery, a custom-made artificial eye can be placed on the eye of the implant. The artificial eye can be made to match the look of your child's healthy eye. The artificial eye is located behind the eyelids. As your child's eye muscles that move the eye of the implant, you will see that your child is moving the artificial eye.

The surgery to place an implant-eye. Immediately after the eyeball is removed, the surgeon places a special ball in the basin of the eye. The ball is called an implant. The muscles that control eye movement are sometimes attached to the implant.

After his son is healed, the muscles of the eye is adapted to the implant. You can move only as the natural eye did. However, the implant can't see.

Fitting of an artificial eye. Several weeks after the surgery, a custom-made artificial eye can be placed on the eye of the implant. The artificial eye can be made to match the look of your child's healthy eye.

The artificial eye is located behind the eyelids. As your child's eye muscles that move the eye of the implant, you will see that your child is moving the artificial eye.

Risks of surgery include infection and hemorrhage. Extraction of an eye it will affect your child's vision. The majority of children to adapt to the changes in vision over time. Your child will have to take special precautions to protect the healthy eye. For example, after the surgery, the children must wear protective goggles or sports glasses, while the game of sports.

Clinical trials

Clinical trials are studies to test new treatments and new ways of using existing treatments. While the clinical trials give your child the opportunity to try out the latest in the retinoblastoma treatments, we can not guarantee a cure.

Ask your child's doctor if your child is eligible to participate in clinical trials. Your child's doctor can discuss the benefits and risks of participating in a clinical trial.

Coping and support

When your child is diagnosed with cancer, it is common to feel a range of emotions. Parents sometimes say that they feel a state of shock, disbelief, guilt and anger after their child's diagnosis. Each one finds their own way of dealing with stressful situations. Until you find what works for you, you can try:

Gather all the information you need

To find out enough about retinoblastoma feel comfortable making decisions about the care of your child. Talk with your child's healthcare team. Keep a list of questions to ask at the next appointment.

Ask your health care team where you can learn more about retinoblastoma. Good places to start include the web sites of the National Cancer Institute and the American Cancer Society.

Organize a network of support

Find friends and family that can help support you as a caregiver. Loved ones may accompany their child to appointments or sit to the side of the bed in the hospital when you can't be there.

When you are with your child, their friends and family can help out by spending time with their other children or help around your home.

Take advantage of resources for children with cancer

Find special resources for families of children with cancer. Ask your clinic's social worker about what is available.

Support groups for parents and siblings to put you in touch with people who can understand what they are feeling. Your family may be eligible for summer camps, temporary housing and other forms of support.

Keep your routine as much as possible

Young children may not understand what is happening to them as they undergo treatment for cancer. To help your child deal with the situation, try to maintain a normal routine as much as possible.

Try to arrange the appointments, so that your child can have a set nap time each day. They have the routine of meal time. Allow time for the game when the child feels to the height. If your child has to spend time in the hospital, bring items from home that will help your child feel more comfortable.

Ask your health care team about other ways to comfort your child during the treatment. Some hospitals have recreation therapists or child life specialists who can share tips and resources.

Preparing for your appointment

Start by making an appointment with your child's doctor or other health professional if your child has any of the signs or symptoms that worry you. If an eye problem is suspected, you may be referred to a physician who diagnosis and treats disorders of the eyes. This doctor is called an ophthalmologist. If retinoblastoma is suspected that your child can see a doctor who specializes in the treatment of cancer in the eye. This doctor is called an ocular oncologist.

Because appointments can be brief, it is a good idea to be prepared. Here's some information to help you prepare.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your child's diet.
  • Make a note of the symptoms your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent changes in your child's life.
  • Make a list of all medications, vitamins or supplements that you are taking your child.
  • Have a family member or friend. Sometimes it can be difficult to remember the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask your child's doctor.

Prepare a list of questions to help you make the most of their time with their child's health care professional. A list of questions from most important to least important in case time runs out. For retinoblastoma, some basic questions to ask include:

  • What kind of evidence does my child need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • Should my child see a specialist?

In addition to the questions you have prepared, do not hesitate to ask questions during your appointment.

What to expect from your child's doctor

Your child's healthcare provider is likely to ask a series of questions. Be prepared to answer some questions about your child's health and symptoms, such as:

  • Has your child ever had cancer before?
  • Does your family have a history of cancer?
  • Does your child have siblings? How old are they? Have you ever had an eye exam?
  • When did your child begin to experience the symptoms?
  • Have your child's symptoms been continuous or occasional?
  • How severe are the symptoms of your child?
  • What, if anything, seems to improve the symptoms of your child?
  • What, if anything, appears to worsen the symptoms of your child?
Symptoms and treatment of Retinoblastoma