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Eye Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Eye Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Eye cancer is a general term used to describe many types of tumors that can start in various parts of the eye. It occurs when healthy cells in or around the eye change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign or cancerous. A benign tumor means the tumor can grow but will not spread. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. Cancer that forms in the eyeball is called an intraocular (inside the eye) malignancy.

Medical doctors who specialize in the diseases and function of the eye are called ophthalmologists or “eye MDs”. These doctors can diagnose and treat intraocular melanoma (see below). Optometrists are another type of eye doctor. They prescribe eyeglasses and contact lenses. They are not medical doctors and are not trained to treat intraocular cancer.

Parts of the eye

The eye is the organ that collects light and sends messages to the brain to form a picture. The three main parts of the eye are:

  • Eyeball

  • Orbit (eye socket)

  • Adnexal (accessory) structures, such as the eyelid and tear glands

The outer part of the eye is made up of the sclera, retina, and uvea. The sclera is the outer wall of the eyeball. The retina is a thin-layered structure that lines the eyeball and sends information from the eye to the brain. The uvea nourishes the eye. Both the retina and the uvea contain blood vessels.

The uvea consists of the following:

  • Iris: The colored part of the eye that controls the amount of light entering the eye

  • Ciliary body: Muscular tissue that produces the watery fluid in the eye and helps the eye focus

  • Choroid: The layer of tissue underneath the retina that contains connective tissue and melanocytes, which are pigmented (colored) cells, and nourishes the inside of the eye. The choroid is the most common site for a tumor.

Types of intraocular cancer

The most common intraocular cancer in adults is uveal metastases, which is cancer that has spread to the uvea from another place in the body. This is called secondary cancer. This guide is about primary intraocular cancer, meaning that the tumor started in the eye, not somewhere else in the body.

Melanoma is the most common type of primary intraocular cancer in adults. It begins when cells called melanocytes grow uncontrollably. Intraocular melanoma is also called uveal melanoma.

Other, less common types of an intraocular tumor include:

  • Intraocular lymphoma is lymphoma that begins in the eyeball. This condition is rare and can be difficult for doctors to diagnose. Many doctors consider intraocular lymphoma to be a type of central nervous system lymphoma. Most intraocular lymphomas are non-Hodgkin lymphoma.

  • Retinoblastoma is a rare form of childhood eye cancer.

  • Hemangioma is a benign tumor of the choroid and retina that starts in the blood vessels.

Other, rare cancers of the eye include:

  • Conjunctival melanoma is a tumor of the conjunctiva, which is a membrane that lines the eyelid and eyeball. If it is not treated, it can spread to the lymph nodes, which are tiny, bean-shaped organs located throughout the body that fight disease. A conjunctival melanoma tends to recur (come back after treatment) on the eye’s surface and looks like dark spots on the eye. Doctors often perform a biopsy on a spot that appears to be conjunctival melanoma. A biopsy is the removal of a sample of the tissue for examination under a microscope.

  • Eyelid carcinoma (basal or squamous cell) is a variation of skin cancer. This tumor may be surgically removed and is usually not dangerous if it is treated early.

  • Lacrimal gland tumor is a benign or malignant tumor of the glands that produce tears.

The next section in this guide is Statistics and it helps explain how many people are diagnosed with primary intraocular cancer and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Cancer that starts in the eye is called primary eye cancer. It is an uncommon disease. Cancer that has spread to the eye from another place in the body (secondary eye cancer) is more common than primary eye cancer. The statistics below are about primary eye cancer.

This year, an estimated 2,810 adults (1,510 men and 1,300 women) in the United States will be diagnosed with primary intraocular cancer.

Most new cases of primary intraocular cancer this year will be melanoma. Although the number of new diagnoses and deaths from skin melanoma has been increasing during the past 30 years, the number of new intraocular melanoma cases has remained constant during this time. Lymphoma is the second most common type of primary intraocular cancer.

It is estimated that 280 deaths (150 men and 130 women) from primary intraocular cancer will occur this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with eye cancer depends on the size and location of the tumor and the type of cancer diagnosed. Overall, 3 out of 4 people with eye melanoma survive for at least 5 years.

When melanoma does not spread outside the eye, the 5-year relative survival rate is about 80%. If the melanoma has spread to distant parts of the body, the 5-year relative survival rate is about 15%.

Iris melanoma is rare and does not usually spread. The 5-year relative survival rate for people with iris melanoma is the highest of the different types.

Choroidal melanoma is the most common type of intraocular melanoma.

  • The 5-year relative survival rate for people with small choroidal melanoma is 84%.
  • The 5-year relative survival rate for people with medium choroidal melanoma is 68%.
  • The 5-year relative survival rate for people with large choroidal melanoma is 47%.

Ciliary body melanoma is rare. The 5-year relative survival rates are hard to determine for this type of melanoma, although it generally has a poorer prognosis (chance of recovery) than choroidal melanoma because it is typically diagnosed at a more advanced stage.

Eye lymphoma. Because eye lymphoma is very uncommon, accurate survival statistics are not available. However, in 1 study involving people diagnosed with lymphoma that was only located in the eye, about half (50%) were still alive 5 years after being diagnosed. However, many people are diagnosed with eye lymphoma after it has already spread to the brain, which has a worse prognosis.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with eye cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2016; the National Cancer Institute; Houle, Virginie, et al. “AIRP Best Cases in Radiologic-Pathologic Correlation: Choroidal Melanoma,” RadioGraphics 2011 31: 1231-1236, http://radiographics.rsna.org/content/31/5/1231.fulland the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.

Eye Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find a basic drawing about the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

The next section in this guide is Risk Factors and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing eye cancer:

  • Age. People over age 50 are most likely to be diagnosed with primary intraocular melanoma. In fact, the average age of diagnosis is 55. It is rare in children and people over age 70.

  • Race. Primary intraocular melanoma is more common in white people and less common in black people.

  • Gender. Intraocular melanoma affects about equal numbers of men and women.

  • Individual history.People with the following medical conditions have a higher risk of developing primary intraocular melanoma:

    • Ocular or oculodermal melanocytosis, which is a pigmentation of the eye or skin around the eye; it is also called nevus of Ota

    • Nevi, or spots like moles in the eye

    • Dysplastic nevus syndrome, which is a condition marked by multiple flat moles that are irregular in shape or color

  • Family history. Intraocular melanoma can run in families, although it is rare. Usually, it is due to a mutation or change in a gene called BAP1, which is mostly linked with metastatic uveal eye cancer. This gene change is also seen in other cancer types, such as kidney cancer and mesothelioma.

  • Other factors. Some studies have suggested that sunlight or certain chemicals may be a risk factor for intraocular melanoma. However, the data are not conclusive about this association.

People with a combination of these risk factors may benefit from seeing an ophthalmologist for a yearly examination and protecting their eyes from ultraviolet (UV) radiation with sunglasses. Anyone who finds unusual moles or other skin growths around the eye or elsewhere on the body should see a dermatologist, a doctor specializing in skin diseases. This is especially important if there is a family history of melanoma.

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with intraocular melanoma often have no symptoms. Many times, an ophthalmologist finds the melanoma during a regular eye examination. The most common symptom is painless loss of vision.

People with eye cancer may experience the following symptoms or signs. Sometimes people with eye cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Having trouble seeing

  • Losing part of the field of vision

  • Seeing flashes of light

  • Seeing spots, squiggly lines, or floating objects (floaters)

  • Having a dark spot on the iris. Unlike choroidal and ciliary body melanoma, iris melanoma can sometimes be seen because it looks like dark spots on the eye.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. However, for eye melanoma, a diagnosis can often be made without a biopsy. Imaging tests may be used to find out whether the cancer has spread.

The doctor may also suggest other tests that will help make a diagnosis. Not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Signs and symptoms

  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose eye cancer:  

  • Eye examination. Most cases of melanoma are found during a regular eye examination. The doctor will examine the eye with a lighted instrument called an ophthalmoscope and a slit lamp, which is a microscope with a light attached to it.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the eye.

  • Fluorescein angiography. This procedure takes a picture of the blood vessels in the eye. A fluorescent dye called fluorescein is injected into the patient’s arm. The dye moves through the body and into the blood vessels in the back of the eye. The doctor then takes several, quick pictures of the eye. Fluorescein angiography may be used to rule out eye problems other than cancer. Indocyanine green angiography is a similar test that uses a different dye, called indocyanine green.

  • Fine needle biopsy. This procedure removes tumor cells from the eye with a needle. This allows the doctor to look at the cells under a microscope. Because doctors can correctly diagnose more than 95% of intraocular melanoma without a biopsy, this procedure is not needed for most people. Furthermore, patients who receive radiation treatment (see the Treatment Options section) will not be able to have a biopsy in the future.

  • Cytogenetics and gene expression profiling. Your doctor may recommend this type of test to help gather more information about your prognosis (chance of recovery) and treatment options. Cytogenetics or gene expression profiling tests are done using a tissue sample removed during either a biopsy or surgery. Or, in some situations, on an older tissue sample that was previously removed and preserved.

    Sometimes eye tumors are categorized by “class 1” or “class 2” tumors. Depending on the chromosomes in the genes, this can help determine the risk of the cancer spreading.

    Cytogenetics is the analysis of a cell’s chromosomes (strands of DNA), including the number, size, shape, and arrangement of the chromosomes. Gene expression profiling is a test that identifies specific genes, proteins, and other factors unique to the tumor. Results of these tests may affect your treatment options. Talk with your doctor about the risks and benefits of having one of these tests and what the results could mean for your care. Additional information about these tests can be found in the Stages and Grades section.

  • Tests for metastases and risk of metastases. A tumor that starts in the eye can spread through the blood to other parts of the body, most commonly the liver. The doctor may see if the tumor has spread to the liver by testing the levels of liver enzymes in the person’s blood or through a computed tomography (CT or CAT) scan or an ultrasound of the liver.

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Magnetic resonance imaging (MRI). Another test used for metastasis is the magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Positron emission tomography (PET) scan. The doctor may also order a positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into a patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. The doctor may also recommend a chest x-ray to check if the cancer has spread to the lung

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. This section also covers grading which describes the composition of cells. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished.

Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors can use to describe the stage is the TNM system. Medical oncologists use this system, but your ophthalmologist may not. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are four stages: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Some ophthalmologists may not use the TNM system to stage an intraocular tumor. However, they still consider the size of the tumor and how it is affecting a person’s vision when deciding on a treatment plan.

In eye cancer, T for an iris melanoma is described differently than T for choroidal and ciliary body melanomas. N and M are described the same for iris, choroidal, and ciliary body melanomas.

Here are more details on each part of the TNM system for eye cancer:

Tumor (T)

Using the TNM system, the “T” plus a letter and/or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. The following classifications are the same for any type of intraocular melanoma:

TX: The primary tumor cannot be evaluated.

T0: There is no tumor in the eye.

Iris melanoma

An iris tumor is classified as T1, T2, T3, or T4. Some stages are divided into smaller groups that help describe the tumor in even more detail.

T1: The tumor is limited to the iris.

T1a: The tumor is in one quadrant (one-fourth) or less of the iris.

T1b: The tumor is in more than one quadrant of the iris.

T1c: The tumor is only in the iris, but there is melanomalytic glaucoma. This means that a buildup of certain cells in the eye blocks the flow of fluid in the eye, causing pressure.

T2: The tumor has joined or grown into the ciliary body and/or choroid.

T2a: The tumor has joined or grown into the ciliary body and/or choroid with melanomalytic glaucoma.

T3: The tumor has joined or grown into the ciliary body and/or choroid and extends to the sclera (outer wall of the eyeball).

T3a: The tumor has joined or grown into the ciliary body and/or choroid and extends to the sclera in association with melanomalytic glaucoma.

T4: The tumor has spread to the outside of the eyeball, the optic nerve, or to the eye socket. This is called extraocular extension.

T4a: The tumor has spread less than 5 millimeters (mm) outside of the eye.

T4b: The tumor has spread more than 5 mm outside of the eye.

Ciliary body and choroid melanoma

A tumor in the ciliary body and choroid is also classified as T1, T2, T3, or T4 based on the size of the tumor, which is measured in optic disc diameters or mm. The tumor is measured for both width and height (also called thickness). A tumor is given a classification according to the table below, based on its width and height.

Your doctors may use and refer to this classification, called a category, even more than the stage. This is because the size and thickness of the tumor (the T) is most important for finding out a patient’s prognosis.

Size Category Classification Table for Ciliary Body and Choroid Melanoma

Thickness (mm)

Category

 

 

 

 

 

 

Thicker than 15 mm

 

 

 

 

4

4

4

12.1 to 15.0

 

 

 

3

3

4

4

9.1 to 12.0

 

3

3

3

3

3

4

6.1 to 9.0

2

2

2

2

3

3

4

3.1 to 6.0

1

1

1

2

2

3

4

Less than 3.0

1

1

1

1

2

2

4

Largest basal diameter (mm)

Less than 3.0 mm

3.1 to 6.0 mm

6.1 to 9.0 mm

9.1 to 12.0 mm

12.1 to 15.0 mm

15.1 to 18.0 mm

Larger than 18.0 mm

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois.

T1: The tumor is size category 1. 

T1a: The tumor is size category 1 and does not involve the ciliary body or other parts of the eye.

T1b: The tumor is a category 1 and involves the ciliary body.

T1c: The tumor is size category 1 that does not involve the ciliary body. But, there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball. This is called extraocular spread.

T1d: The tumor is a size category 1 that involves the ciliary body with extraocular spread less than 5 mm.

T2: The tumor is size category 2.

T2a: The tumor is size category 2 and does not involve the ciliary body or other parts of the eye.

T2b: The tumor is size category 2 and involves the ciliary body.

T2c: The tumor is size category 2 that does not involve the ciliary body. But, there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

T2d: The tumor is size category 2 that involves the ciliary body with extraocular spread less than 5 mm.

T3: The tumor is size category 3.

T3a: The tumor is size category 3 and does not involve the ciliary body or other parts of the eye.

T3b: The tumor is size category 3 and involves the ciliary body.

T3c: The tumor is size category 3 that does not involve the ciliary body. But, there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

T3d: The tumor is size category 3 that involves the ciliary body with extraocular spread less than 5 mm.

T4: The tumor is size category 4.

T4a: The tumor is size category 4 and does not involve the ciliary body or other parts of the eye.

T4b: The tumor is size category 4 and involves the ciliary body.

T4c: The tumor is size category 4 that does not involve the ciliary body. But, there is a very small area (5 mm or less in diameter) of visible spread beyond the eyeball.

T4d: The tumor is size category 4 that involves the ciliary body with extraocular spread less than 5 mm.

T4e: The tumor is any size category with extraocular spread of more than 5 mm in diameter.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the eye are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. N is described the same for melanomas of the iris, ciliary body, and choroid.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no regional lymph node metastasis.

N1: There is regional lymph node metastasis.

Metastasis (M)

The “M” in the TNM system indicates whether the cancer has spread from the eye to other parts of the body, called distant metastasis. M is described the same for iris, ciliary body, and choroidal melanomas.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no distant metastasis.

M1: There is metastasis to other parts of the body.

M1a: There is metastasis to other parts of the body and the largest metastasis is 3 centimeters (cm) or less in diameter.

M1b: There is metastasis to other parts of the body and the largest metastasis is between 3.1 cm and 8 cm in diameter.

M1c: There is metastasis to other parts of the body and the largest metastasis is larger than 8 cm in diameter.

Grade and Histopathology

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together.

If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

After a biopsy or when the tumor is surgically removed, doctors may look at the types of cells that are in the tumor; this is called histopathology. Three types of histopathology patterns may be present in the tumor:

  • Spindle cell melanoma (the cells are longer and tapered at the ends)

  • Epithelioid melanoma (the cells are oval-shaped)

  • Mixed cell melanoma (both spindle and epithelioid)

Generally, a tumor made up of spindle cells has a better prognosis than a tumor made up of epithelioid cells. The tumor is given a grade (G) to describe the composition of its cells. A lower grade generally indicates a better prognosis than a higher grade.

GX: Grade cannot be evaluated

G1: A spindle cell melanoma

G2: A mixed cell melanoma

G3: An epithelioid melanoma

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage I: The tumor is size category 1 and does not involve the ciliary body or other parts of the eye, nor has it spread to the regional lymph nodes or to other areas of the body (T1a, N0, M0).

Stage IIA: The tumor is either a size category 1 that may or may not involve the ciliary body, with or without extraocular extension, or it is a size category 2 that does not involve the ciliary body. There is no spread to the regional lymph nodes or to other areas of the body (T1b, T1c, T1d, or T2a; N0, M0).

Stage IIB: The tumor is either a size category 2 that involves the ciliary body but has not spread beyond the eyeball, or it is a size category 3 that has not spread to the ciliary body or eyeball. It has not spread to the regional lymph nodes or to other areas of the body (T2b or T3a; N0, M0).

Stage IIIA: Stage IIIA describes any one of these conditions:

  • A tumor of size category 2 with extraocular spread to a diameter of 5 mm or less, with or without ciliary body involvement that has not spread to the lymph nodes or to other parts of the body (T2c or T2d, N0, M0)

  • A tumor of size category 3 that may or may not involve the ciliary body, with or without extraocular spread to a diameter of 5 mm or less, but hasn’t spread to the lymph nodes or to other parts of the body (T3b or T3c, N0, M0)

  • A tumor of size category 4 that does not involve the ciliary body and has not spread to the lymph nodes or to other parts of the body (T4a, N0. M0)

Stage IIIB: Stage IIIB describes any one of these conditions:

  • The tumor is a size category 3 with ciliary body involvement and extraocular spread that has not spread to the lymph nodes or to other parts of the body (T3d, N0, M0).

  • The tumor is a size category 4 with or without ciliary body involvement that may or may have spread outside the eyeball. It has not spread to the regional lymph nodes or to other areas of the body (T4b or T4c, N0, M0).

Stage IIIC: The tumor is a size category 4 that involves the ciliary body and has spread outside the eyeball. However, it has not spread to the regional lymph nodes or to other areas of the body (T4d or T4e; N0, M0).

Stage IV: This stage describes a tumor of any size that has spread to the lymph nodes and/or to other parts of the body outside of the eye (any T, N1, M0; or, any T, any N, M1).

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. Please note that AJCC’s Eighth Edition (2017) has been released; related changes to the information provided above are underway. Please check back soon for updated staging definitions or talk with your doctor about whether these changes affect your diagnosis..

COMS Tumor Classifications

Instead of describing using the TNM system, eye tumors can be classified by these guidelines from the Collaborative Ocular Melanoma Study (COMS).

  • Small: 1 mm to 3 mm in height and 5 mm to 16 mm in diameter

  • Medium: 3.1 mm to 8 mm in height and not more than 16 mm in diameter

  • Large: More than 8 mm in height and more than 16 mm in diameter

Recurrent

Recurrent cancer is cancer that has come back after treatment. It may return in the eye or in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option.

A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies.

Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

Many people with intraocular melanoma are treated by more than one specialist with more than one type of treatment. This is called a multidisciplinary team approach. For example, patients who receive radiation therapy to the eye may need to also talk with an ophthalmologist or plastic surgeon to make sure the eye can still function after treatment.

Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Patients should have a sense that their doctors have a coordinated plan of care and are communicating effectively with one another. If patients do not feel that the team is communicating effectively with them or each other about the goals of treatment and the plan of care, patients should discuss this with their doctors or seek additional opinions before treatment.

Descriptions of the most common treatment options for eye cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

The main goals for treating intraocular melanoma are to reduce the risk of the tumor spreading and to maintain the health and vision of the patient’s eye, if possible.

Active surveillance/observation

The doctor may recommend this approach if the intraocular melanoma is small or slow-growing and/or if treating the cancer would cause more discomfort than the disease itself. For example, this approach may be appropriate for people without any symptoms, older or seriously ill people, or people with a tumor in their only useful eye.

The patient is monitored closely, and active treatment begins if the tumor shows signs of becoming more aggressive or spreading. This approach may also be called observation, watchful waiting, or watch-and-wait. If the tumor grows bigger than 10 mm in diameter or 2 mm to 3 mm in height (thickness), then the doctor and the patient may decide to proceed with active treatment.

Some people may be uncomfortable waiting and be worried that the cancer should be treated right away. Because treating the cancer has side effects, some of which can be harmful to the eye, doctors may recommend not treating a smaller tumor until it starts to grow or shows high-risk features. Talk with the doctor about how often your eye should be checked.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. This is also called surgical resection. Eye surgery is typically performed by an ophthalmologist. Surgery to the eye is quite common in the treatment of intraocular melanoma. During surgery, the ophthalmologist will remove parts or all of the affected eye depending on the size and spread of the tumor.

Surgical options include:

  • Iridectomy: Removal of part of the iris

  • Iridocyclectomy: Removal of part of the iris and ciliary body

  • Sclerouvectomy/endoresection: Surgery to remove the choroidal tumor while keeping the eye

  • Enucleation: Removal of the eye

In some cases, surgery may also be used to place a radioactive disc for internal radiation therapy, also called brachytherapy. More information about radiation therapy is below.

The potential side effects of eye surgery are similar to that of any surgery, including a risk of infection, problems from the general anesthesia (the medication used during surgery), and pain. With total removal of the eye, there is a slight risk that the tumor could come back in the orbit.

Many patients want to know immediately whether the surgery was successful. However, the success of an operation is hard to tell right away. It may take months before the doctors can determine if all of the cancer cells were removed during surgery.

Learn more about the basics of cancer surgery.

Having an eye removed

Sometimes the only choice a doctor has in treating intraocular melanoma is to remove the eye. Because of this visual loss, a person with one eye may have trouble with depth perception. Most people adjust to these differences.

Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis (artificial eye). The prosthesis will look and behave almost the same as a natural eye. For example, the artificial eye will move along with the person’s remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.

If enucleation is required, talk with your doctor about a prosthesis as soon as possible. It may take many weeks for you to receive one. Also, ask about support services that may be available to you to help adjust physically and emotionally to the loss of an eye. Learn more about rehabilitation.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Traditional external-beam radiation therapy may be given after enucleation or as a palliative treatment (see below).

When radiation treatment is given using implants, it is called internal radiation therapy, brachytherapy, or plaque therapy. For this treatment, the ophthalmologist places a radioactive disc, sometimes called a plaque, near the tumor.

Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

Using radiation therapy to treat the tumor may result in some vision loss or other complications, so doctors may recommend other treatments first. However, treatment for eye cancer using radiation therapy is continually improving. Talk with your doctor about the risks and benefits of the different types of radiation therapy.

Radiation therapy may result in a variety of side effects, so it is important to talk with your ophthalmologist about what to expect. The extent of side effects depends on the type and dose of radiation therapy the person receives, where the tumor is located, and the patient’s general health. For larger tumors, there is more risk for side effects or complications from radiation therapy. The side effects may not show up right away. So let your doctor know is a problem arises. Be sure to ask what problems and signs to watch out for after being treated with radiation therapy.

Common side effects include:

  • Cataracts. A cataract is when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person’s eyesight, it may be surgically removed.

  • Loss of eyelashes and/or a dry eye. These side effects can occur with external-beam radiation therapy and proton-beam radiation therapy.

The following side effects are less common and can cause a loss of vision:

  • Radiation retinopathy: The development of abnormal blood vessels in the retina

  • Radiation optic neuropathy: Optic nerve damage

  • Neovascular glaucoma: A painful condition where new blood vessels develop and block the outflow of fluid from the eye

  • Loss of eye: If there is significant damage to the eye from radiation therapy, the eye may need to be removed.

Learn more about the basics of radiation therapy.

Laser therapy

This procedure uses heat in the form of a laser to shrink a smaller tumor. It may also be called thermotherapy or transpupillary thermotherapy (TTT). This treatment potentially has fewer side effects than surgery or radiation therapy. Laser therapy may also be combined with radiation therapy.

Treatment by disease and stage

Below is an outline of the common treatments used depending on the type and stage of the eye cancer. In addition to standard treatments, patients are encouraged to talk with their doctors about clinical trials that are open to them, no matter the type or stage of the tumor.

Iris melanoma

Iris melanoma is not generally actively treated unless the tumor begins to grow, although there can be exceptions. The following are examples of common treatment options:

  • Active surveillance/observation

  • Surgery—iridectomy

  • Radiation therapy (proton therapy or brachytherapy)

  • Enucleation, if the tumor is too large to remove or it spreads beyond the eye

Small choroidal and ciliary body tumor

The following are some treatment options for a small choroidal or ciliary body tumor:

  • Active surveillance/observation

  • Radiation therapy (proton therapy or brachytherapy)

  • Laser therapy

  • Surgical resection (removal of the tumor) and/or enucleation

Careful observation is a common treatment plan, although patients and their doctors may choose another option depending upon the location of the tumor or whether the tumor begins to grow.

Medium choroidal and ciliary body tumor

The two most common treatment options for medium-sized choroidal and ciliary body melanoma are radiation therapy (proton therapy or brachytherapy) and enucleation. It is believed that there is no difference in survival rates between these two treatment methods for a medium-sized choroidal tumor.

Other treatment options for a medium-sized tumor may include surgery to remove the tumor or enrolling in a clinical trial (see Latest Research).

In addition, the combination of laser therapy and radiation therapy (sometimes called “sandwich therapy”) is being used more frequently to treat this type of tumor.

Large choroidal and ciliary body tumor

For a large tumor, enucleation is the usual treatment. Results of the Collaborative Ocular Melanoma Study (COMS) revealed that patients had similar survival rates whether they received radiation therapy before enucleation or had their eye removed with no prior radiation treatment. Enrolling in a clinical trial may be another option for people with large choroidal and ciliary body tumors, as is additional brachytherapy.

Extraocular extension melanoma

If the tumor has spread to the outside of the eye, optic nerve, or eye socket, the doctor may recommend removal of the eye. Or, the doctor may perform a modified enucleation, which is the removal of the eyeball and adjacent structures. In some cases, the doctor may decide to remove the entire eye and the adjacent structures in a process called an exenteration. If the spread is small, some doctors will try to save the eye by removing the outer part of the tumor and treating the eye with radiation therapy.

Talk with your doctor about possible treatment options, potential side effects, and clinical trials open to you before choosing a treatment plan.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment. Palliative care can also help if treatment involves changes to your face to help you find emotional support to cope with such changes to your appearance.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible.

Learn more about palliative care

Metastatic intraocular melanoma

If cancer has spread to another location in the body, it is called metastatic cancer. For example, metastatic intraocular melanoma can spread from the eye to other parts of the body, such as the liver. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan.

Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes treating the disease in the affected organ or enrolling in a clinical trial. Palliative care will also be important to help relieve symptoms and side effects. For patients with intraocular melanoma, it is important to find a doctor who is familiar with this disease because it can be very different from metastatic melanoma of the skin.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery or radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with eye cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

For instance, one clinical trial that has shaped how intraocular melanoma is treated is called COMS.

Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result.

Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating eye cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with eye cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Specifically for eye cancer, placebos are not often used. Eye cancer trials usually compare standard therapy and different combinations or new drugs. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects.

Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for eye cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Eye Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about eye cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Targeted therapy for melanoma. Researchers are studying the genes, proteins, and other factors that may be involved in the development of intraocular melanoma. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.

    Recent studies show that not all tumors have the same targets. Many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. In particular for eye cancers, MEK inhibitors are a type of targeted therapy being actively researched. Learn more about the basics of targeted treatments.

  • Tumor Markers. Researchers are also looking for markers, or specific substances in the blood, that may tell the doctor if the tumor has spread to other parts of the body.

  • Immunotherapy. Immunotherapy is also called biologic therapy, which is designed to boost the body’s natural defenses to fight cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Monoclonal antibodies, which specifically target and kill cancer cells, are a type of immunotherapy being tested in clinical trials. Learn more about immunotherapy.

  • Improved radiation therapy. Many hospitals and cancer centers offer methods that focus radiation therapy to the tumor to help reduce damage to the rest of the eye. One of these methods, called intensity-modulated proton therapy (IMPT), is being used for some types of eye cancer.

  • Chemotherapy. Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.  

    Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

    For patients with metastatic uveal melanoma, adjuvant therapy (additional treatment after the primary treatment, such as chemotherapy after surgery) is being tested in clinical trials.

  • Treating liver metastases. Because intraocular melanoma commonly metastasizes to the liver, many people need treatment to the liver. A technique called chemoembolization allows doctors to separate the blood supply of the liver from the rest of the body and then deliver chemotherapy directly to the liver. However, the use of this treatment varies and is still being researched. Talk with your doctor for more information.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current eye cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding eye cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Side Effects and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment. 

Common side effects from each treatment option for intraocular melanoma are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with eye cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. The follow-up care plan for people with intraocular melanoma will depend on the treatment they received. In general, people who have had intraocular melanoma should have regular checkups throughout their lifetime.

People who have had radiation therapy or have decided to choose active surveillance should be monitored closely, about every three to six months. Patients who have had the eye surgically removed should receive a yearly eye examination, and doctors should monitor the orbit closely for the next two to three years.

All people treated for intraocular melanoma need to be monitored to watch for any sign that the cancer may have spread to other areas of the body. This process may include a physical examination, blood work, and imaging tests, such as a chest x-ray, ultrasound, CT scan, or PET scan, every 6 to 12 months. Your doctor can work with you to decide on an appropriate follow-up care plan.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. For eye cancer a recurrence even after five years is possible. Between 6-12 months, it’s important to check for recurrence or metastasis. Imaging tests recommended may include looking for cancer in the liver. It’s important to talk with your doctor about how often you should be checking to see if the cancer has come back.

During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.

  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from eye cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you.

You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of eye cancer do I have?

  • Where exactly is the tumor located?

  • What stage is the eye cancer? What grade is it? What does this mean?

  • What is the likelihood that the cancer is metastatic?

  • Can you explain my pathology report (laboratory test results) to me?

  • Do you recommend any additional diagnostic tests, such as cytogenetics or gene expression profiling?

  • Who can help me interpret the results of this test(s)?

  • Do I need treatment right away?

Questions to ask about choosing a treatment and managing side effects

  • What experience do you have in treating patients with this type of cancer?

  • What are my treatment options?

  • What clinical trials are open to? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Is loss of vision a possible side effect? If so, when could vision changes occur?

  • Who will be part of my health care team, and what does each member do?

  • Who will be coordinating my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

  • What support services are available to me? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have? Why?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term side effects of having this surgery?

  • Will I have problems with my vision afterwards, either immediately or in the long term?

Questions to ask about loss of an eye, if needed

  • How do I adjust to only having one eye?

  • How long will it take me to recover physically?

  • What rehabilitation services are available to help me cope with this?

  • How soon can I get a prosthesis (artificial eye)?

  • When do I get a permanent prosthesis?

  • How do I care for my prosthesis?

Questions to about having radiation therapy

  • What kind of radiation therapy will I receive?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What does the preparation for this treatment involve?

  • What is the likelihood of having radiation damage to my eye?

  • What is the risk of vision loss?

  • What other side effects can I expect from this treatment?

  • What are the possible long-term effects of having this treatment

  • What can be done to relieve the side effects?

Questions to ask about follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Eye Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Eye Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Eye Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.