If we are told about cancer, predictably one of the last areas where we think it can take place is in or around the eyes. But cancer is like that, and it’s a disease that can start anywhere in our body when cells start to grow out of control.
The doctor Francisco Javier González, specialist in the Ophthalmology Service of the Rey Juan Carlos University Hospital, in Móstoles, and author of the blog ‘En un abrir y cerrar de ojos’points out in this regard that, although oncological pathology is rare in this specialty, there are some malignant tumors that can settle in the eye and also in the ocular appendages (eyelids, lacrimal system…).
According to North American Cancer Society, among the main signs of cancer in the eyes would be the appreciation of spots or specks in the vision; changes in vision, such as blurred vision or sudden loss of vision; change in pupil size; flashes of light; or a dark spot in the iris that gets bigger over time.
Malignant ocular tumors
Dr. González points out that tumors can also develop in the eyeball itself or in the conjunctiva: “The eyeball has three layers which, from outside to inside, are the sclera, the uvea and the retina. Surrounding the anterior half of the globe, and in intimate relation with the eyelids, is the conjunctiva, where we can occasionally find epidermoid carcinomas which, if it behaves in an invasive way, can pose a serious problem and for which, in addition to surgery, local chemotherapy with topical eye drops is required”.
The specialist points out that the uvea is a highly vascularized layer of the eyeball, so malignant tumors that take place in this structure are potentially dangerous, as they have a strong tendency to migrate to other parts of the body, highlighting among all the primary ocular melanoma (uveal), “which takes the palm as the main exponent”.
It should be noted with regard to this malignant tumor that, unlike cutaneous melanomas, its diagnosis is more difficult, since it is in a part of the body hidden from the naked eye. For the same reason – the rich vascularization of the uvea – this ocular structure is a relatively frequent point of metastasis of other cancers of the body, such as those of the breast or lung.
Finally, in the innermost layer of the eye, in the retinaits cells can also become malignant, in a tumor known as ‘retinoblastoma’.
“This has a particularly bad reputation for typically appearing in childhood, as it has a very strong genetic and hereditary nature, but with early treatment the survival rate of this malignant tumor is over 90%,” says the specialist at the Rey Juan Carles University Hospital.
“That’s why it’s essential to make a precise and accurate diagnosis at the least advanced stage possible to, in addition, try to preserve the vision and anatomy of the affected eye,” he adds.
Malignant tumors of the orbit
On the other hand, Dr. González refers to all those tumors that can develop in the orbit of the skull or “receptacle of the eye”, the eye muscles and the periocular fat that serves as a cushion for this delicate system.
“In the orbit also sits an important anatomical structure, the lacrimal gland, which is located on the upper and outer part (like below the tail of the eyebrow). Occasionally, they may appear malignant tumors derived from the lacrimal glandwhich are manifested by a growth of the same that can ‘push’ the eye outwards, causing what we know as ‘proptosis’ or ‘exophthalmos’ (“jumpy eye”) unilaterally, a unique clinical sign”, details the specialist
On the other hand, he points out that some can manifest in the orbit lymphomas that need a systemic study by oncohematologists and that can respond to treatment with chemotherapy without the need for surgery.
“Other tumors that can settle in the orbit may have a less aggressive behavior, or result in a better vital prognosis, such as cavernous hemangiomas or optic nerve tumors (meningiomas or gliomas) which, however, can significantly affect vision in the affected eye”, adds this expert.
Malignant tumors of the eyelids
Finally, the professional of the Ophthalmology Service of the Rey Juan Carlos University Hospital mentions those cancerous formations that take place in the eyelid skinprecisely “one of the areas where malignant tumors settle more frequently”.
“We must bear in mind that the skin of the eyelid is very exposed to solar radiation, which is carcinogenic. In addition, it is an area of the face on which we often forget to apply sun creams, and not everyone is in the habit of using appropriate sunglasses”, he adds.
At the same time, highlights Dr. González that the most frequent malignant tumor of the eyelids is the basal cell carcinomaa skin tumor derived from the basal layer of the epidermis and capable of locally invading a progressively large area, although fortunately it has little ability to metastasize at a distance.
“It usually behaves like a lump or an ulcer that grows slowly, but continuously, and forms crusts that, after falling off, can ulcerate again. It is more common in the lower eyelid and the inner corner, or the so-called ‘lacrimal’ area”, he explains. “Treatment is surgical and generally has a good prognosis.”
Other malignant tumors of the eyelids and which behave in a more aggressive manner, even being able to affect the patient’s survival by being able to migrate to distant areas, are the epidermoid carcinoma or sebaceous cell carcinoma.
Finally, he warns that in this periocular area, despite being much less frequent than in other skin locations, the “dreaded melanoma: Faced with a freckle that grows, changes color or presents features of asymmetry or irregular edges, it is advisable to consult the ophthalmologist and/or the dermatologist”, warns the specialist.