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Metastatic Optic Tumors - An Overview

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The spread of tumor cells from different parts of the body to the eye causes metastatic optic tumors. Read this article to know more.

Medically reviewed by

Dr. Aditi Dubey

Published At April 19, 2023
Reviewed AtApril 19, 2023

What Are Metastatic Optic Tumors?

The tumors that are formed in the eye as a result of metastasis are known as metastatic optic tumors. Metastasis is a process by which cancer cells spreads from the affected organ to other parts of the body, and when this happens to the eye, it is known as ocular metastasis. Ocular metastasis can be divided into:

  • Intraocular Metastasis- It is when cancer spreads to the intraocular structures (uveal tract, lens, aqueous humor, retina, vitreous body, etc.) of the eye.

  • Extraocular Metastasis- In this phenomenon, cancer spreads to the extraocular structures (orbit, conjunctiva, lacrimal system, eyelids, etc.) of the eye.

The most common form of ocular metastasis is intraocular metastasis and the source for it is the primary cancer of breasts in women and lungs in men, less common sources include the gastrointestinal tract, prostate, lymphoid, leukemia, thyroid, kidney, and skin.

Irrespective of their prevalence, metastatic optic tumors often get undetected because most ocular metastases are occult, asymptomatic, and do not cause loss of vision. They only become a concern when they affect vision, push the eye forward (proptosis), or are visible to the patient.

The frequent intraocular structure for metastasis is the choroid (choroidal metastasis) of the eye due to its abundant vascular supply. Choroidal metastasis occurs in up to ten percent of patients with systemic metastatic diseases (more than one organ) and is often asymptomatic.

However, ocular metastasis can affect the macula, optic nerve, or the anterior segment of the eye, resulting in vision loss and painful glaucoma. Prompt treatment with external beam radiation is the best chance for retention of the vision and the eye, but the clinician should also determine the primary source of metastasis to prevent a recurrence.

What Causes Metastatic Optic Tumors?

Metastases to the eye are a rare occurrence because most cancers in the body spread through the lymphatic system which is absent in the eye. The only way for cancer cells to reach the eye is through the hematogenous (blood) spread.

The ocular structures with the best vascular supply are the most likely ones to be affected, this includes the uveal tract-containing the choroid, the ciliary body, and the iris, followed by the retina and sclera.

The metastatic optic tumors are derivatives of primary cancers, hence they are identified by their source, the different primary cancers that have been known to cause orbital metastasis are-

  • Breast cancer.

  • Bronchogenic cancer.

  • Prostate cancer.

  • Gastrointestinal adenocarcinoma.

  • Thyroid carcinoma.

  • Renal cell carcinoma.

  • Neuroblastoma.

  • Ewing sarcoma.

  • Wilms tumor.

  • Leukemia.

  • Pancreatic adenocarcinoma.

  • Endometrial carcinoma.

  • Ovarian carcinoma.

  • Melanoma.

  • Urothelial carcinoma.

  • Non-Hodgkin lymphoma.

  • Seminoma of the testis.

What Are the Symptoms of Metastatic Optic Tumors?

The most common symptom is reduced visual acuity, other presenting symptoms are-

  • Diplopia (double vision).

  • Photophobia (eye discomfort in bright light).

  • Ptosis (drooping of the upper eyelid over the eye).

  • Blepharitis (inflammation of the eyelids).

  • Metamorphopsia (visual distortion in which straight lines appear curved).

  • Pain.

  • Flashes and floaters.

  • Mass lesion.

  • Uveitis (a form of eye inflammation).

  • Exophthalmos (bulging or protruding of eyeballs).

  • Secondary glaucoma.

  • Detached retina.

How Are Metastatic Optic Tumors Diagnosed?

Most patients with metastatic optic tumors have a known primary cancer and metastatic tumors in other parts of the body, careful medical history can uncover the signs and symptoms and if the ocular oncologist (eye cancer specialist) suspects ocular metastasis, they should examine both the eyes and orbits because ocular metastasis can be both bilateral and multifocal.

The patient should also be examined by an oncologist (cancer specialist) so that a complete metastatic survey is performed, this will detect other tumors in the body and also “stage” the patient.

After examination, the clinician will request any of the following investigations-

  • Photography - It is an important tool in the management of metastatic optic tumors. These tumors grow rather quickly, hence documentation regarding their size and location will help the clinician understand their growth rate, this also helps them to select the appropriate time for treatment.

A slit lamp camera is used for anterior segment tumors and specialized fundus autofluorescent (FAF) imaging is used to detect small multifocal tumors. Apart from these, intraocular angiograms are also used to determine the circulation pattern of the tumors.

  • Ultrasonography - It is used to evaluate the origin of metastatic orbital tumors, for example, intraocular metastases from breast cancer or lung cancer have a characteristic variable internal reflectivity that helps distinguish them from melanoma and hemangioma.

  • Computed Tomography (CT) - It helps to determine the cancer present within the bones that make up the orbit (the eye socket is made up of seven different kinds of bones).

  • Magnetic Resonance Imaging (MRI) - Helps to identify inflammation and compression of the optic nerve that is caused by the tumor. A subdivision of this technique is the MRA (magnetic resonance angiography), which is particularly useful to identify orbital vascular tumors and abnormalities.

  • Positron Emission Tomography (PET) - This imaging technique can evaluate the metabolic activity of tissues and is often combined with CT for initial tumor staging, evaluation of metastases with no known primary, and for rare ocular metastases.

  • High-frequency Ultrasound Imaging - When metastatic tumors extend into the front of the eye they cause thickening of the anterior uvea, anterior rotation of the iris, enlargement of the ciliary body, etc. High-frequency ultrasound imaging is the only to observe these changes.

What Is the Treatment for Metastatic Optic Tumors?

The goal of the treatment is to restore the vision and there is a wide range of treatment options that can achieve it. The choice depends on the origin of primary cancer, its extent, the location of the metastasis, the patient’s well-being, and life prognosis.

The chemotherapeutic agents used in breast and lung cancer are also effective for ocular metastases, a few examples are Tamoxifen, Anastrozole, Letrozole, etc. This effectiveness is one of the reasons why screening fails to detect ocular metastasis. The patient with a known primary cancer will be receiving chemotherapy for it which will also regress the metastatic optic tumors making them unnoticeable.

However, the downside of chemotherapy is its slow rate of regression, this is attributed to the blood-ocular barrier, which is a physical barrier between the local blood vessels and most parts of the eye. It stops substances including drugs from traveling across it.

Because of this, the next preferable treatment modality is radiotherapy, photodynamic therapy (PDT) to be exact. It is performed using the standard TAP (treatment of age-related macular degeneration with photodynamic therapy) protocol - 600 milliWatt per centimeter square delivered over 83 seconds followed by intravenous Verteporfin infusion. The visual activity gets rapidly restored over the next six weeks to eight weeks but the long-term complications of this therapy include optic neuropathy and radiation retinopathy.

Conclusion:

Metastatic optic tumors are relatively common malignancies seen in the adult population. Occular metastasis that causes these tumors is considered a poor prognostic sign for the underlying primary cancer because the former is only seen when the latter has disseminated to the other parts of the body. But with the recent advances in cancer treatment, it is imperative that attention be paid to ocular metastases which will become more prevalent with increasing long-term survival rates in cancer patients.

Frequently Asked Questions

1.

How Serious Can a Tumor Behind the Eye Get?

An intraocular or retrobulbar tumor, also known as a retrobulbar tumor, can range in severity according to the kind, size, and aggressiveness of the tumor. Such tumors can range in severity from benign and not life-threatening to perhaps life-threatening.
- Benign Tumors: Some tumors, like meningiomas or gliomas of the optic nerve, can be slow-growing and benign. Even though they might not be immediately life-threatening, if they are not addressed, they can nevertheless result in visual issues and other difficulties.
- Malignant Tumors: More worrisome are malignant tumors like retinoblastoma or uveal melanoma. Early detection and treatment are essential since these tumors can be aggressive and have the potential to spread to other regions of the body.
- Location and Symptoms: The location of the tumor behind the eye and the symptoms it produces, such as pain or bulging in the eye, can also have an impact on how dangerous it is. Complications from pressure on surrounding structures include vision loss and negative effects on quality of life.

2.

How Does a Tumor on the Eye Appear?

Depending on the location, nature, and stage of development of the tumor, the appearance of an eye tumor can take many different forms. Ocular tumors can occur subtly or prominently, and they can be benign (non-cancerous) or malignant (cancerous). Small, painless lumps or bumps on the eyelids or inside the eye may be the first sign of a benign eye tumor. They could appear as pigmented lesions or as flesh-colored lesions. Initial symptoms of malignant ocular tumors like retinoblastoma or melanoma may be irregularly shaped, pigmented patches on the iris or the white of the eye (sclera). Larger, elevated, or discolored lumps can develop from these. When eye tumors are progressed, they may result in visual problems like double or blurred vision or even a noticeable mass in the eye socket.

3.

Is There Any Cure for Eye Tumors?

The kind, size, and stage of an eye tumor all influence the likelihood of a successful treatment. Monitoring rather than active therapy is frequently necessary for benign tumors like choroidal nevi. Surgery, radiation therapy, chemotherapy, or targeted therapies may all be required in the treatment of malignant eye cancers such as retinoblastoma or ocular melanoma. Although the effectiveness of treatment varies, some retinoblastoma instances, particularly those that are found early, can be cured. Metastatic ocular melanoma, on the other hand, is more difficult to treat and may necessitate continuous therapy because it has spread to other parts of the body. Early detection and better treatment outcomes depend on routine eye exams and rapid medical attention. Even while not all eye cancers are curable, advances in medicine provide patients with a better chance for a good recovery and vision preservation.

4.

Do Eye Tumors Spread?

Eye tumors, particularly ocular melanomas or retinoblastomas, can be alarming, although they typically have a lower risk of metastasizing than tumors in other parts of the body. Ocular melanomas, which develop in the melanocytes of the eye, can occasionally spread, primarily to the liver. Retinoblastomas, which are typically diagnosed in youngsters, have a lower propensity to spread if discovered and treated quickly. It is necessary to keep in mind that any tumor has the potential to metastasize and that regular monitoring and timely treatment are essential to prevent this. To preserve eyesight and stop the tumor from growing, early discovery and intervention by surgery, radiation therapy, or other treatment methods are crucial. 

5.

Are Tumors in the Eye Uncommon?

Even though they are less frequent than tumors in some other organs, eye tumors are not extremely uncommon. Depending on the nature and location of the tumor, different eye tumors have different prevalence rates. Although extremely uncommon, intraocular (within the eye) cancers such as retinoblastoma, uveal melanoma, or primary vitreoretinal lymphoma can develop, especially in youngsters and elderly adults. Squamous cell carcinoma and basal cell carcinoma, two types of eyelid and conjunctival tumors, are more common but still regarded as relatively uncommon when compared to other skin cancers.

6.

Which Cancer Commonly Metastasizes to the Eye?

Breast cancer is the most typical metastatic malignancy to the eye in women and lung cancer in men. Cancer cells have the ability to spread to various organs, including the eye, when they separate from the original breast tumor and enter the circulation or lymphatic system. Advanced breast cancer cases are more likely to have eye metastases, particularly to the choroid (the circulatory layer of the eye)

7.

What Are the Treatment Options for Eye Metastasis?

The specific course of treatment is determined by the type of original cancer, the degree of metastasis, the patient's general health, and the unique circumstances.
- Systemic Therapies: Addressing primary cancer is frequently the main treatment for eye metastases. Chemotherapy, targeted therapy, and immunotherapy are examples of systemic treatments.
- Radiation Therapy: Radiation therapy, which uses methods like external beam radiation or plaque brachytherapy, may be used to target and decrease the tumor while preserving eyesight when the metastasis is confined to the eye.
- Surgery: Depending on the situation, surgery may be required to treat consequences like retinal detachment or glaucoma or to remove the metastatic tumor.
- Local Therapies: Laser therapy, cryotherapy, or intraocular injections may be considered to treat minor, isolated metastatic lesions inside the eye.
Palliative Care: Palliative care focuses on symptom control, pain alleviation, and maintaining the highest possible quality of life.

8.

Does Eye Tumor Spread Real Quick?

In contrast to several other cancers, eye cancer, sometimes referred to as ocular melanoma or intraocular malignancy, typically does not spread quickly. Because most eye tumors grow slowly, they typically take a long time to manifest. It's important to remember that eye cancer might behave differently based on its precise form, where it is located within the eye, and individual scenarios.

9.

Is It Possible to Cure Eye Cancer?

The most prevalent kinds of intraocular malignancy are retinoblastoma and uveal melanoma. The type of cancer, its stage of diagnosis, and the patient's general health are only a few of the variables that affect whether eye cancer can be cured. Rare childhood eye cancer called retinoblastoma is treatable, especially if caught early. Chemotherapy, radiation therapy, or eye removal (enucleation) are all possible forms of treatment. On the other hand, uveal melanoma poses a more difficult situation. Advanced cases frequently result in metastasis, making the cancer less treatable even though early detection and therapy can be beneficial. Radiation therapy or surgically removing the damaged eye (enucleation) are the main forms of treatment. Uveal melanoma is more challenging to treat once it has progressed outside of the eye.

10.

How Long Can One Live After Eye Cancer?

It is possible to live a long life after receiving a diagnosis of eye cancer, but it depends on a number of variables, such as the type and stage of the cancer, the treatment received, and the patient's general health. Ocular melanoma, or eye cancer, is uncommon but treatable if caught early. Localized ocular malignancies can frequently be treated with surgical procedures, radiation therapy, or laser therapy. The prognosis may be favorable if the cancer is contained to the eye and does not spread to other organs.

11.

Where Does an Eye Tumor Develop?

Ocular tumors, often known as eye tumors, can start in several locations within the eye. Although the precise causes can vary, they often begin as a result of genetic changes in the eye's cells. Here is a brief description of how ocular tumors might develop:
Retinoblastoma is an uncommon kind of eye cancer that mainly affects the retina of young patients. A mutation in the RB1 gene, which regulates cell proliferation, is frequently the cause of it. Uveal melanoma, a kind of eye melanoma, is known to be associated with both genetic abnormalities and UV radiation exposure. It frequently begins in the uvea's pigmented cells. In addition to the orbit around the eye, the conjunctiva of the eye can also develop cancers (conjunctival tumors). These may be brought on by a number of things, such as long-term inflammation, exposure to chemicals, or hereditary predisposition.

12.

Will Eye Tumors Hurt?

Depending on the type, location, and stage of the eye tumor, it may not hurt at all or it may hurt to varying degrees. Benign conjunctival nevi are one type of eye tumor that may not even be painful, and they frequently go undiagnosed until they are found during routine eye exams. If a malignant eye tumor becomes large enough to impose pressure on the eye or its supporting structures, such as an ocular melanoma, it may become painful. These tumors may cause symptoms such as eye redness, altered vision, and discomfort in their advanced stages. 

13.

Which Body Part Does Melanoma of the Eye Metastasize To?

Ocular melanoma, often known as eye melanoma, can spread to several body parts, most frequently the liver. In a considerable portion of cases of ocular melanoma, the liver serves as the primary site of metastasis. Lungs, bones, skin, and, less frequently, the brain are additional metastasis-prone organs. Every patient with ocular melanoma has a different chance of developing metastases, and not every patient will develop this type of dissemination. To decrease the risk of metastasis and enhance the prognosis, early detection, and prompt treatment are essential. In order to identify and treat metastatic illness in its earliest stages, persons with a history of ocular melanoma require routine screening and follow-up care.

14.

Is It Possible to Remove Optic Nerve Tumor?

Given the importance of the optic nerve, which is in charge of sending visual information from the eye to the brain, full surgical excision of an optic nerve tumor is frequently difficult. Surgery has the potential to harm the optic nerve, which could result in permanent vision loss. Radiation therapy, chemotherapy, or a combination of these treatments may be used to treat some benign tumors close to the optic nerve. Malignant optic nerve tumors frequently need a more involved course of therapy that includes surgery, radiotherapy, and sometimes further treatments.
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Dr. Aditi Dubey
Dr. Aditi Dubey

Ophthalmology (Eye Care)

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