If You Have Eye Cancer
What is eye cancer?
Cancer can start any place in the body. Eye cancer starts in the eye. It starts when cells in the eye grow out of control and crowd out normal cells. This makes it hard for the eye to work the way it should.
Cancer cells can spread to other parts of the body. Cancer cells in the eye can sometimes travel to the liver and grow there. When cancer cells do this, it’s called metastasis (meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the eye.
Cancer is always named for the place where it starts. So when eye cancer spreads to the liver (or any other place), it’s still called eye cancer. It’s not called liver cancer unless it starts from cells in the liver.
Ask your doctor to use this picture to show you where the cancer is.
The main part of the eye is the round eyeball. It has 3 main layers:
- Sclera (SKLAIR-uh): the tough white covering that meets the cornea (cor-NEE-uh) in the front of the eye. The cornea is clear to let light into the eye.
- Uvea (YOU-vee-uh): the middle layer of the eyeball, which has 3 parts:
Iris: the colored part around the pupil (the opening that lets light in)
Choroid (KOR-oid): the thin layer that lines the eyeball and contains tiny blood vessels
Ciliary (SILL-lee-air-ee) body: contains the muscles that help the eye focus and cells the make fluid
- Retina (RET-in-uh): the inner layer at the back of the eye that focuses light and sends messages to the brain so we can see
The orbit is the tissues around the eyeball, like muscles and nerve.
Adnexal (add-NECKS-uhl) structures include the eyelids and tear glands.
Are there different kinds of eye cancer?
Cancers that start in the eyeball are called intraocular (in-truh-OCK-you-lur) cancers. There are 2 main types of eye cancer in adults:
- Intraocular melanoma (MEL-uh-NO-muh) tends to start in the uvea. These cancers are also called uveal melanomas.
- Primary intraocular lymphoma (lim-FOAM-uh) is often seen along with lymphoma of the brain. This is called primary central nervous system (CNS) lymphoma.
Your doctor can tell you more about the kind of eye cancer you have.
Questions to ask the doctor
- Why do you think I have cancer?
- Is there a chance I don’t have cancer?
- Would you please write down the kind of eye cancer you think I might have?
- What part of my eye is the cancer in?
- What will happen next?
How does the doctor know I have eye cancer?
Some signs of eye cancer are vision changes (things look blurry or you suddenly can’t see), floaters (seeing spots or squiggles), flashes of light, a growing dark spot on the iris, change in the size or shape of the pupil, and eye redness or swelling.
The doctor will ask you questions about your health and do an eye exam. You may be sent to an eye doctor called an ophthalmologist (OFF-thuhl-MAHL-uh-jist) for a more detailed eye exam.
Tests that may be done
If signs are pointing to eye cancer, tests will be done. Here are some of the tests you may need:
Ultrasound: For this test, a small wand is put against the eyelid or eyeball. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen.
Angiography (AN-jee-AH-gruh-fee): For this test, dye is put into the blood through a vein in the arm. Pictures of the back of the eye are then taken using a special light that makes the dye glow. This lets the doctor see the blood vessels inside the eye.
CT or CAT scan: This test uses x-rays to make detailed pictures of the inside of your body. It can be used to see if the cancer has spread.
Chest x-rays: X-rays may be done to see if the cancer has spread to your lungs.
MRI scan: This test uses radio waves and strong magnets instead of x-rays to make detailed pictures. This test is very good for looking at eye tumors and may be used to see if the cancer has spread.
PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. If you have an eye lymphoma, this test can help show if the cancer has spread.
Biopsy: In a biopsy (BY-op-see), the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is often not needed for eye melanoma because the doctor can tell it’s melanoma from the eye exam and imaging tests.
Lumbar puncture (spinal tap): For people with eye lymphoma, this test is used to look for cancer cells in the fluid that surrounds the brain and spinal cord (called cerebrospinal [suh-REE-bro-SPY-nuhl] fluid or CSF).
Questions to ask the doctor
- What tests will I need to have?
- Who will do these tests?
- Where will they be done?
- Who can explain them to me?
- How and when will I get the results?
- Who will explain the results to me?
- What do I need to do next?
How serious is my cancer?
If you have eye cancer, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage is based on how far the cancer has grown or spread through the eye. It also tells if the cancer has spread to other parts of your body.
Both eye lymphoma and melanoma can be a stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread past the eye.
Sometimes doctors use a COMS group staging system for eye melanoma. This system divides eye melanomas into small, medium, and large based on the size of the tumor.
Ask the doctor about the cancer stage and what it means for you.
Questions to ask the doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think I’ll live?
- What will happen next?
What kind of treatment will I need?
Treatment for eye cancer depends on the type and stage of the cancer.
Radiation (RAY-dee-A-shun) is the main treatment for most people, but other treatments might be needed too. If a very small melanoma is suspected, treatment may not be needed. The doctor may closely watch the tumor and start treatment only if it starts to grow. The treatment plan that’s best for you will depend on:
- The stage of the cancer
- Where the cancer is in your eye
- The chance that a type of treatment will cure the cancer or help in some way
- Your age and overall health
- Your feelings about the treatment and how it might change the way you see
Radiation uses high-energy rays (like x-rays) to kill cancer cells. It’s a common treatment for eye cancer. There are different ways to give radiation treatments.
Radiation is often given by putting tiny seeds of radiation on the eyeball near the tumor. This is called brachytherapy (BRAKE-ee-THAIR-uh-pee) or plaque (plak) therapy.
Radiation can be aimed at the eye from a machine outside the body. This is called external beam radiation.
Side effects of radiation treatments
If your doctor suggests radiation treatment, ask about what side effects might happen. The most common side effect of radiation is eye damage. The damage may change the way you see through that eye.
Most side effects get better after treatment ends. Some might last longer. Others may happen right away. Talk to your cancer care team about what you can expect during and after treatment. There may be ways to ease side effects.
Lasers are focused beams of light that can be used to heat and kill cancer cells. This treatment can be used to treat some eye melanomas. Sometimes laser treatments are used along with radiation therapy for eye melanoma.
Side effects of laser treatments
Laser treatments can damage the eye and change the way you see through that eye. Talk to your cancer care team about what you can expect during and after treatment.
Surgery for eye cancer
Surgery (SUR-jur-ee) may be used to treat some eye melanomas, but it’s not used for eye lymphoma.
There are many kinds of surgery. The type used depends on where the cancer is and how big it is. Some types of surgery can change the way you see. Some may take out the eyeball and nearby tissues.
Ask your doctor what type of surgery you will need. Every type has pros and cons. Find out if there will be changes in how you see through that eye or how the eye looks.
Side effects of surgery
Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with eye cancer should be able to help you with any problems that come up.
Chemo (KEY-mo) is the short word for chemotherapy (KEY-mo-THAIR-uh-pee), the use of drugs to fight cancer. The drugs are often given through a needle into a vein. These drugs go into the blood and spread through the body. Chemo can also be put right into the eye. Chemo may be used to treat eye lymphoma. It’s less often used for eye melanoma.
Chemo is often given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.
Side effects of chemo
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems tend to go away after treatment ends.
There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.
Targeted and immune therapy drugs
Targeted drugs are made to work mostly on the changes in cells that make them cancer. Immune therapy drugs help the body’s immune system fight the cancer. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t.
Side effects of targeted and immune therapy drugs
Side effects depend on which drug is used. These drugs often make you feel sick to your stomach and cause chills, fever, rashes, and headaches. Most side effects go away after treatment ends.
There are ways to treat most of the side effects caused by targeted and immune therapy drugs. If you have side effects, talk to your cancer care team so they can help.
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.
If you would like to be in a clinical trial, start by asking your doctor if your clinic or hospital takes part in clinical trials. You can also call our clinical trials matching service at 1-800-303-5691 or go online at www.cancer.org/clinicaltrials to find studies near you.
Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.
What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.
Questions to ask the doctor
- What treatment do you think is best for me?
- What’s the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- What will these treatments be like?
- What’s the goal of these treatments?
- Will treatment change the way I see through my eye or the way my eye looks?
- What other side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- What’s the next step?
What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed.
Be sure to go to all of these follow-up visits. Your doctors will ask about symptoms, do physical exams, and may do tests to see if the cancer has come back. The doctor may also check how well you can see.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.
Biopsy (BY-op-see): Taking out a small piece of tissue to see if there are cancer cells in it.
Central nervous system (CNS): The brain and the spinal cord, which serve as the main “processing center” for all of the nervous system.
Cerebrospinal (suh-REE-bro-SPY-nuhl) fluid (CSF): The clear liquid that surrounds and cushions the brain and spinal cord.
Intraocular cancer (in-truh-OCK-you-lur CAN-sur): Cancer that starts in the eyeball.
Lymphoma (lim-FOAM-uh): Cancer that starts in cells that are part of the immune system.
Melanoma (MEL-uh-NO-muh): Cancer that starts in cells called melanocytes. These cells make the pigment melanin which gives color to the skin and eyes.
Metastasis (muh-TAS-tuh-sis): Cancer cells that have spread from where they started to other places in the body.
Monoclonal antibody (MA-nuh-KLO-nuhl AN-tih-BAH-dee): A man-made version of an immune system protein that’s made to lock onto cancer cells.
Ocular oncologist (OCK-you-lur on-KAHL-uh-jist): A doctor (usually an ophthalmologist) who has special training to treat cancers of the eye.
Ophthalmologist (OFF-thuhl-MAHL-uh-jist): A doctor who treats eye problems.
Last Medical Review: December 9, 2014 Last Revised: February 5, 2016