Eye Cancer- Orbit and Pterygium – Flashcards

-Graves' Disease -Orbital Pseudotumor -Pterygium

-Ocular Melanoma -Orbital Lymphomas -Metastasis to the Orbit

Graves' disease -More common in females than males -Occurs most often in middle ages (30-50) -Autoimmune disorder Melanoma is the most common primary intraocular malignancy -Average age is 55 -Metastatic disease to orbit is rare but more common than primary eye cancer -usually from breast or lung Primary intraocular cancer -2015 estimated in US, 2,580 adults (1,360 men and 1,220 women). -It is estimated that 270 deaths (140 men and 130 women) will occur this year. -Cancer that has spread to the eye from another place in the body (secondary eye cancer) is more common than primary eye cancer

Caused by inflammation of extraocularmuscles and orbital tissues -Exophthalmos, opthalmoplegia, oculopathy, periorbitalswelling, corneal ulceration, optic nerve compression and opticatrophy

Pain, conjunctiva redness, chemosis, edema, exophthalmoses, restriction of eye movement Can cause optic nerve atrophy, disc edema and vision loss

Conjunctival growth over the sclera & cornea. -Causes visual and cosmetic impairment. -Common on nasal side of eye

Mass, Proptosis, Swelling, Inflammation, Diplopia, Pain

Eyelid -x-rays can detect bony invasion -incisional or excisional biopsy mandatory -Melanoma -biopsy not acceptable due to orbital spread -noninvasive imaging: CT, MRI, Nuclear Medicine, Ultrasound, opthalmoscopic exam

Melanoma -Can involve any organ via hematogenous spread, usually the liver -Lymphatic spread can occur, but not as common

surgical excision -recurrence rate is 20 -40% Beta plaque irradiation postop can reduce recurrence rate to <5% -Strontium 90/yttrium-surface applicator -More commonly done after a recurrence -The second recurrence rate is 6% Can also use chemo or transplant for the recurrence -mitomycinC, thiotepa, flourouracil

Pterygium-decrease recurrence to less 5% Preferably within 24 hours of surgery, sterile plaque surface is placed in direct contact -10 -15 seconds delivers 5 -6 Gy surface dose -3 factions to 15 Gy w/ strontium 90 up to 10 Gy/60 Gy

Melanoma -surgery (enucleation), RXT Lymphoma -chemo and RXT Graves Disease -steroids, surgery, RXT Orbital Pseudotumor -steroids, RXT Orbital Metastasis -RXT

No lymphatics in the choroid Metastasis occur hematogenously unless local invasion 125 I of sufficient diameter to allow for a 2-3 mm margin. 100 Gy is given to the apex of 5-10 mm. 100 Gy at 5 mm is give for tumors 2.5 -5mm. Lesions contiguous with optic disk cannot be done due to radiation damage to optic nerve. Melanomas arising in the iris or ciliary body cannot be done due to damage to lens and cornea

45* wedged pair 4-6 MV 1.8/25-30 Gy for low or intermediate grade 2/40 Gy for high grade Corneal dose is diminished if eye is open during treatment

6-9 MeV electron beam Diameter to encompass conjunctiva Lens shielding a must -12 mm circular lead shield at least 4 mm thick 2 Gy per FX=30 Gy

Rare, but may appear with CNS lymphoma Diffuse large cell found in immunosuppressed patients Field includes posterior 2/3 of eye 1.8 -2.0/40 -50 Gy Average survival is 12 months

RXT for pts in whom steroids are contraindicated Efficacy of RXT related to radiation sensitivity of cellular infiltrates in the extraocularmuscles and retroorbitalconnective tissue Opposed pair using 4-6 MV Encompass both retrobulbarvolumes Anterior edge of beam at lateral bony canthus asymmetric jaws, or angle 5-7* posterior MIDLINE dose is 2 Gyper day, may produce initial swelling 20 GY total dose which will cause cataracts, so both lenses must be shielded

Nongranulomatousinflammatory disease 4 x 4 Electron beam with lens shield 9-16 MeV 10 -30 Gy

Metastasis uncommon to orbit, but metastatic tumors are the most common intraocular malignancy Commonly seen from breast cancer 4 x 4 field encompassing posterior portion of globe (posterior to lens) lateral beams using electron or 4-6 MV if treating both eyes Posterior angle to avoid contralateral lens 2-3/30-40 Gy will improve vision

Dry eye cataract formation blindness Dose to produce cataract is 2 Gy

lens 5 Gy retina 50 Gy cornea 50 GY optic chiasm & optic nerve 50 Gy

1. lens 2. conjunctiva 3. cornea 4. uvea 5. retina 6. optic nerve

Generally about 75-80% of people with eye melanoma survive for at least 5 years. -Accurate survival rates for eye melanomas based on a specific stage are hard to determine because these cancers are fairly rare. Eye lymphoma is rare, so statistics for this cancer are hard to find. -Patients without HIV whose lymphoma was confined to the eye, about half of the patients were still alive 5 years after diagnosis.