4:38 AM
Ronald Setiawan
Surgery
Surgery is used to treat some intraocular melanomas but is not used to treat intraocular lymphoma. It is used less often than in the past, as the use of radiation therapy has grown. The type of surgery depends on the location and size of the tumor. Patients are under general anesthesia (in a deep sleep) during these operations, and they usually leave the hospital 1 or 2 days afterward. The operations used in treating people with melanoma include:
Iridectomy: Removal of part of the iris. This operation is used for very small iris melanomas.
Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. Small iris melanomas may be treated with this technique.
Iridocyclectomy: Removal of a portion of the iris and the ciliary body. This operation is also used for small iris melanomas.
Iridectomy: Removal of part of the iris. This operation is used for very small iris melanomas.
Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. Small iris melanomas may be treated with this technique.
Iridocyclectomy: Removal of a portion of the iris and the ciliary body. This operation is also used for small iris melanomas.
Resection: Doctors in some cancer centers may try to surgically resect (remove) a melanoma of the ciliary body or choroid. This can be done for small melanomas but is technically difficult.
Enucleation: Removal of the entire eyeball. This is used for some smaller melanomas and for larger melanomas (T4 or large T3 tumors), especially if other treatment options would destroy useful vision in the eye anyway. During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the eye would have. Within a few weeks, you visit an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye that has been made to match the size and color of the remaining eye. The artificial eye is a thin shell that fits over the orbital implant and under the eyelids. Once the eye is in place, it will be hard to tell it apart from the real eye.
Possible risks and side effects of surgery
All surgeries carry some risk, including the possibility of bleeding, infections, and complications from anesthesia. Surgery on the eye can lead to the loss of some or all of the vision in that eye. This may be immediate (as is the case after more extensive surgeries like enucleation) or it may develop later on. Of course, in some cases vision may have already been damaged or lost because of the cancer. Removal of the eyeball (enucleation) obviously can affect a person's appearance. As noted above, an artificial eye can be put in place to help minimize this.
Choroidal Melanomas
Treating these cancers depends on their size and how well the eye functions. The smaller the tumor, the less likely surgery will be needed unless the eye is badly damaged or vision is lost.
Small melanomas: There are often several options for treating small choroidal melanomas. Both you and your doctor should decide which option is best for you.
Medium-sized melanomas: These tumors can usually be treated by most approaches listed above with the exception of laser therapy or TTT (although TTT might be used after radiation). Once again, the choice of treatment is a decision that should involve both you and your doctor. Radiation and surgery appear to be about equally effective. Radiation offers the best chance of preserving eyesight, but some people who have radiation may eventually need surgery.
Large melanomas: These cancers are usually treated by surgery, which often needs to be more extensive than for smaller melanomas. Enucleation (removal of the entire eye) is the preferred surgery. Some doctors have begun treating large melanomas with plaque radiotherapy with fairly good results. The cure rate appears to be about as high as with surgery. This allows patients to avoid the cosmetic effect of losing their eye, but most patients still end up with poor vision in the eye.
Melanomas of the Iris
Melanomas of the iris are usually small, slow-growing tumors. One option for people with an early stage iris melanoma is to wait and see if it grows. A series of special photographs are taken to help monitor the tumor. If it begins to grow, treatment may consist of surgery or radiation therapy (in certain situations). If surgery is recommend, the amount of eye tissue to be removed depends on the extent of the cancer. Types of surgery for early iris melanomas include:
Ciliary body melanoma
These cancers can be treated with either surgical removal of the tumor, if it is small enough, or radiation therapy. In more advanced cases or if there is serious eye damage, enucleation may be needed.
Recurrent melanomas
Treating melanomas that recur (come back) after initial treatment depends on several factors, including where the cancer recurs and what type of treatment was used initially. Cancers that recur within the eye (intraocular recurrence) are usually treated by enucleation. Extraocular recurrences, like skin melanomas that recur at distant sites, are often hard to treat. Immunotherapy (drugs that boost the immune system) and/or chemotherapy are the most commonly used treatments. Surgery may be an option in rare cases if the recurrence is only in one spot. For more detailed information on treating advanced melanomas, see our separate document, Melanoma Skin Cancer.
Enucleation: Removal of the entire eyeball. This is used for some smaller melanomas and for larger melanomas (T4 or large T3 tumors), especially if other treatment options would destroy useful vision in the eye anyway. During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the eye would have. Within a few weeks, you visit an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye that has been made to match the size and color of the remaining eye. The artificial eye is a thin shell that fits over the orbital implant and under the eyelids. Once the eye is in place, it will be hard to tell it apart from the real eye.
Possible risks and side effects of surgery
All surgeries carry some risk, including the possibility of bleeding, infections, and complications from anesthesia. Surgery on the eye can lead to the loss of some or all of the vision in that eye. This may be immediate (as is the case after more extensive surgeries like enucleation) or it may develop later on. Of course, in some cases vision may have already been damaged or lost because of the cancer. Removal of the eyeball (enucleation) obviously can affect a person's appearance. As noted above, an artificial eye can be put in place to help minimize this.
Treatment of Intraocular Melanoma By Stage
The main factors in determining treatment for eye melanoma include the size and stage of the cancer, as well as the likelihood of saving vision. There is no major advantage in saving an eye if a small melanoma in a crucial place has completely destroyed vision. And doctors will not necessarily want to remove an eye that functions normally even if the tumor is large. Therefore, the statements below about treatment can only be general and may not apply to every situation. It is important to remember that patients who have had enucleation (removal of the eyeball) and those who have had radiation therapy respond similarly when asked about the quality of their lives after treatment. The most important outcome for these people was surviving this cancer.Choroidal Melanomas
Treating these cancers depends on their size and how well the eye functions. The smaller the tumor, the less likely surgery will be needed unless the eye is badly damaged or vision is lost.
Small melanomas: There are often several options for treating small choroidal melanomas. Both you and your doctor should decide which option is best for you.
- radiation therapy, such as brachytherapy, proton beam therapy, or stereotactic radiation therapy)
- laser therapy, including TTT
- surgery, which may require removing only the tumor or may need to be as extensive as enucleation (removing the entire eye). This may be necessary if the eye is severely damaged by the tumor (for example, causing severe glaucoma).
Medium-sized melanomas: These tumors can usually be treated by most approaches listed above with the exception of laser therapy or TTT (although TTT might be used after radiation). Once again, the choice of treatment is a decision that should involve both you and your doctor. Radiation and surgery appear to be about equally effective. Radiation offers the best chance of preserving eyesight, but some people who have radiation may eventually need surgery.
Large melanomas: These cancers are usually treated by surgery, which often needs to be more extensive than for smaller melanomas. Enucleation (removal of the entire eye) is the preferred surgery. Some doctors have begun treating large melanomas with plaque radiotherapy with fairly good results. The cure rate appears to be about as high as with surgery. This allows patients to avoid the cosmetic effect of losing their eye, but most patients still end up with poor vision in the eye.
Melanomas of the Iris
Melanomas of the iris are usually small, slow-growing tumors. One option for people with an early stage iris melanoma is to wait and see if it grows. A series of special photographs are taken to help monitor the tumor. If it begins to grow, treatment may consist of surgery or radiation therapy (in certain situations). If surgery is recommend, the amount of eye tissue to be removed depends on the extent of the cancer. Types of surgery for early iris melanomas include:
- iridectomy (removal of part of the iris)
- iridotrabeculectomy (removal of part of the iris, plus a small piece of the outer part of the eyeball)
- iridocyclectomy (removal of a portion of the iris and the ciliary body)
- enucleation (removal of the eyeball)
Ciliary body melanoma
These cancers can be treated with either surgical removal of the tumor, if it is small enough, or radiation therapy. In more advanced cases or if there is serious eye damage, enucleation may be needed.
Recurrent melanomas
Treating melanomas that recur (come back) after initial treatment depends on several factors, including where the cancer recurs and what type of treatment was used initially. Cancers that recur within the eye (intraocular recurrence) are usually treated by enucleation. Extraocular recurrences, like skin melanomas that recur at distant sites, are often hard to treat. Immunotherapy (drugs that boost the immune system) and/or chemotherapy are the most commonly used treatments. Surgery may be an option in rare cases if the recurrence is only in one spot. For more detailed information on treating advanced melanomas, see our separate document, Melanoma Skin Cancer.
Posted in: types of illnesses
0 komentar:
Post a Comment