21st Century Adult Cancer Sourcebook: Intraocular (Eye) Melanoma - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Intraocular (Eye) Melanoma Patient Information
Chapter 2A: Intraocular (Eye) Melanoma Health Professional Information
Chapter 3A: Intraocular (Eye) Melanoma Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Intraocular (Eye) Melanoma Patient Information
Intraocular (Eye) Melanoma Treatment
Patient Version
Last Modified: 06/15/2010
General Information About Intraocular (Eye) Melanoma
ocular melanoma (AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called intraocular melanoma.
Key Points for This Section
* Intraocular melanoma is a disease in which malignant (cancer) cells form in the tissues of the eye.
* Age and sun exposure may increase the risk of developing intraocular melanoma.
* Possible signs of intraocular melanoma include a dark spot on the iris or blurred vision.
* Tests that examine the eye are used to help detect (find) and diagnose intraocular melanoma.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Intraocular melanoma is a disease in which malignant (cancer) cells form in the tissues of the eye.
Intraocular melanoma begins in the middle of 3 layers of the wall of the eye. The outer layer includes the white sclera (the "white of the eye") and the clear cornea at the front of the eye. The inner layer has a lining of nerve tissue, called the retina, which senses light and sends images along the optic nerve to the brain.
The middle layer, where intraocular melanoma forms, is called the uvea or uveal tract, and has 3 main parts:
* Iris
* The iris is the colored area at the front of the eye (the "eye color"). It can be seen through the clear cornea. The pupil is in the center of the iris and it changes size to let more or less light into the eye.
* Ciliary body
* The ciliary body is a ring of tissue with muscle fibers that change the size of the pupil and the shape of the lens. It is found behind the iris. Changes in the shape of the lens help the eye focus. The ciliary body also makes the clear fluid that fills the space between the cornea and the iris.
* Choroid
* The choroid is the layer of blood vessels that bring oxygen and nutrients to the eye. Most intraocular melanomas begin in the choroid.
Anatomy of the eye, showing the outside and inside of the eye including the sclera, cornea, iris, ciliary body, choroid, retina, vitreous humor, and optic nerve. The vitreous humor is a liquid that fills the center of the eye.
Intraocular melanoma is a rare cancer, but it is the most common eye cancer in adults.
Age and sun exposure may increase the risk of developing intraocular melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for intraocular melanoma include the following:
* Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
* Having a fair complexion, which includes the following:
* Fair skin that freckles and burns easily, does not tan, or tans poorly.
* Blue or green or other light-colored eyes.
* Older age.
* Being white.
Possible signs of intraocular melanoma include a dark spot on the iris or blurred vision.
Intraocular melanoma may not cause any early symptoms. It is sometimes found during a routine eye exam when the doctor dilates the pupil and looks into the eye. The following symptoms may be caused by intraocular melanoma or by other conditions. A doctor should be consulted if any of these problems occur:
* A dark spot on the iris.
* Blurred vision.
* A change in the shape of the pupil.
* A change in vision.
Glaucoma may develop if the tumor causes the retina to separate from the eye. If this happens, there may be no symptoms, or symptoms may include the following:
* Eye pain.
* Blurred vision.
* Eye redness.
* Nausea.
Tests that examine the eye are used to help detect (find) and diagnose intraocular melanoma.
The following tests and procedures may be used:
* Eye exam with dilated pupil: An examination of the eye in which the pupil is dilated (enlarged) with medicated eyedrops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is examined using an instrument that produces a narrow beam of light. This is sometimes called a slit-lamp exam. The doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
* Indirect ophthalmoscopy: An examination of the inside of the back of the eye using a small magnifying lens and a light.
* Ultrasound exam of the eye: A procedure in which high-energy sound waves (ultrasound) are bounced off the internal tissues of the eye to make echoes. Eye drops are used to numb the eye and a small probe that sends and receives sound waves is placed gently on the surface of the eye. The echoes make a picture of the inside of the eye. The picture, called a sonogram, shows on the screen of the ultrasound monitor.
* Transillumination of the globe and iris: An examination of the iris, cornea, lens, and ciliary body with a light placed on either the upper or lower lid.
* Fluorescein angiography: A procedure to look at blood vessels and the flow of blood inside the eye. An orange fluorescent dye (fluorescein) is injected into a blood vessel in the arm. As the dye travels through blood vessels of the eye, a special camera takes pictures of the retina and choroid to detect any blockage or leakage.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
* The type of melanoma cells (how they look under a microscope).
* The size of the tumor.
* Which part of the eye the tumor is in (the iris, ciliary body, or choroid).
* Whether the tumor has spread within the eye or to other places in the body.
* The patient's age and general health.
* Whether the tumor has recurred (come back) after treatment.
In patients with small tumors that have not spread, intraocular melanoma can be cured and vision can usually be saved.
Glossary Terms
angiography (an-jee-AH-gruh-fee)
* A procedure to x-ray blood vessels. The blood vessels can be seen because of an injection of a dye that shows up in the x-ray.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood vessel (blud VEH-sel)
* A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
choroid (KOR-oyd)
* A thin layer of tissue that is part of the middle layer of the wall of the eye, between the sclera (white outer layer of the eye) and the retina (the inner layer of nerve tissue at the back of the eye). The choriod is filled with blood vessels that bring oxygen and nutrients to the eye.
ciliary body (SIH-lee-ayr-ee ...)
* A part of the middle layer of the wall of the eye. The ciliary body includes the ring-shaped muscle that changes the size of the pupil and the shape of the lens when the eye focuses. It also makes the fluid that fills the eye.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
cornea (KOR-nee-uh)
* The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside.
cure (kyoor)
* To heal or restore health; a treatment to restore health.
dilate (DY-layt)
* To widen or enlarge an opening or hollow structure beyond its usual size, such as the pupil of the eye or a blood vessel.
eye cancer (i KAN-ser)
* Cancer that forms in tissues of and around the eye. Some of the cancers that may affect the eye include melanoma (a rare cancer that begins in cells that make the pigment melanin in the eye), carcinoma (cancer that begins in tissues that cover structures in the eye), lymphoma (cancer that begins in immune system cells), and retinoblastoma (cancer that begins in the retina and usually occurs in children younger than 5 years).
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
intraocular melanoma (IN-truh-AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called ocular melanoma.
iris (I-ris)
* The colored tissue at the front of the eye that contains the pupil in the center. The iris helps control the size of the pupil to let more or less light into the eye.
lens (lenz)
* A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
monitor (MAH-nih-ter)
* In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).
nausea
* A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
nerve (nerv)
* A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
nutrient (NOO-tree-ent)
* A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.
ophthalmoscope (of-THAL-moh-skope)
* A lighted instrument used to examine the inside of the eye, including the retina and the optic nerve.
optic nerve (OP-tik nerv)
* The nerve that carries messages from the retina to the brain.
oxygen (OK-sih-jen)
* A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
pupil (PYOO-pil)
* The round opening in the center of the iris (the colored tissue that makes the "eye color" at the front of the eye). The pupil changes size to let light into the eye. It gets smaller in bright light and larger as the amount of light decreases.
recur
* To come back or to return.
retina (REH-tih-nuh)
* The light-sensitive layers of nerve tissue at the back of the eye that receive images and sends them as electric signals through the optic nerve to the brain.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
sclera (SKLER-uh)
* The white layer of the eye that covers most of the outside of the eyeball.
sonogram (SAH-noh-gram)
* A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND)
* A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
uvea (YOO-vee-uh)
* The middle layer of the wall of the eye. The uvea has 3 main parts: (1) the choroid (the tissue layer filled with blood vessels); (2) the ciliary body (the ring of muscle tissue that changes the size of the pupil and the shape of the lens); and (3) the iris (the colored part of the eye). Also called uveal tract.
Stages of Intraocular (Eye) Melanoma
Key Points for This Section
* After intraocular melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the eye or to other parts of the body.
* The following sizes are used to describe intraocular melanoma:
* Small
* Medium
* Large
* Diffuse
* There are three ways that cancer spreads in the body.
* Intraocular melanoma may spread to nearby tissues or to other parts of the body.
After intraocular melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the eye or to other parts of the body.
The process used to find out if cancer has spread within the eye or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
* Gonioscopy: An examination of the front part of the eye between the cornea and iris. A special instrument is used to check for blockages in the area where fluid drains out of the eye.
* Ultrasound biomicroscopy: A procedure that uses high-energy sound waves to measure small tumors. The amount of detail is about the same as that of a low-power microscope. Tumors can be examined this way for shape, thickness, and signs that they have spread to nearby tissue.
* Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
* Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign the cancer has spread to the liver.
* Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the liver, and make echoes. The echoes form a picture of body tissues called a sonogram.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the liver or brain, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Sometimes pictures of the tumor are taken over a period of time and compared to see if the tumor has grown.
The following sizes are used to describe intraocular melanoma:
Small
The tumor is at least 5 millimeters in diameter and from 1 to 3 millimeters thick.
Medium
The tumor is less than 16 millimeters in diameter and from 2 to 10 millimeters thick.
Large
The tumor is at least 16 millimeters in diameter or more than 10 millimeters thick.
Diffuse
The tumor is flat and grows widely across the uvea.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Intraocular melanoma may spread to nearby tissues or to other parts of the body.
If intraocular melanoma spreads to the optic nerve or nearby tissue of the eye socket, it is called extraocular extension. Intraocular melanoma may also be metastatic and spread to the liver, lung, or bone, or to areas under the skin.
Glossary Terms
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
* A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray (chest EX-ray)
* An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
cornea (KOR-nee-uh)
* The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
diameter (dy-A-meh-ter)
* The length of a straight line that extends from one edge of a tumor or other object, through its center and to the opposite edge. It is usually used to measure the size of round or spherical shapes.
extraocular (EK-struh-AH-kyoo-ler)
* Located outside the eye.
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
gonioscopy (GOH-nee-OS-koh-pee)
* A procedure in which a gonioscope (special lens) is used to look at the front part of the eye between the cornea (the clear layer) and the iris (the colored part of the eye). Gonioscopy checks for blockages in the area where fluid drains out of the eye.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
intraocular melanoma (IN-truh-AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called ocular melanoma.
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
iris (I-ris)
* The colored tissue at the front of the eye that contains the pupil in the center. The iris helps control the size of the pupil to let more or less light into the eye.
liver (LIH-ver)
* A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
liver function test (LIH-ver FUNK-shun ...)
* A blood test to measure the blood levels of certain substances released by the liver. A high or low level of certain substances can be a sign of liver disease.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph vessel (limf ...)
* A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
* The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
metastatic (meh-tuh-STA-tik)
* Having to do with metastasis, which is the spread of cancer from the primary site (place where it started) to other places in the body.
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
millimeter (MIH-luh-MEE-ter)
* A measure of length in the metric system. A millimeter is one thousandth of a meter. There are 25 millimeters in an inch.
optic nerve (OP-tik nerv)
* The nerve that carries messages from the retina to the brain.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
sonogram (SAH-noh-gram)
* A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
staging (STAY-jing)
* Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND)
* A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
uvea (YOO-vee-uh)
* The middle layer of the wall of the eye. The uvea has 3 main parts: (1) the choroid (the tissue layer filled with blood vessels); (2) the ciliary body (the ring of muscle tissue that changes the size of the pupil and the shape of the lens); and (3) the iris (the colored part of the eye). Also called uveal tract.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Recurrent Intraocular (Eye) Melanoma
Recurrent intraocular melanoma is cancer that has recurred (come back) after it has been treated. The melanoma may come back in the eye, or in other parts of the body.
Treatment Option Overview
Key Points for This Section
* There are different types of treatments for patients with intraocular melanoma.
* Five types of standard treatment are used:
* Surgery
* Watchful Waiting
* Radiation therapy
* Photocoagulation
* Thermotherapy
* New types of treatment are being tested in clinical trials.
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatments for patients with intraocular melanoma.
Different types of treatments are available for patients with intraocular melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Five types of standard treatment are used:
Surgery
Surgery is the most common treatment for intraocular melanoma. The following types of surgery may be used:
* Local tumor resection: Surgery to remove the tumor and a small amount of healthy tissue around it.
* Enucleation: Surgery to remove the eye and part of the optic nerve. This is done if the tumor is large and vision cannot be saved. The patient may be fitted for an artificial eye after enucleation.
* Exenteration: Surgery to remove the eye and eyelid, and muscles, nerves, and fat in the eye socket. The patient may be fitted for an artificial eye or facial prosthesis after exenteration.
Watchful Waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. A series of pictures is taken over time to keep track of changes in the size of the tumor and how fast it is growing.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Localized plaque radiation therapy is a type of internal radiation therapy that may be used for tumors of the eye. Radioactive seeds are attached to a disk, called a plaque, and placed directly on the wall of the eye where the tumor is located. The side with the seeds faces the eyeball and delivers radiation to the eye. The plaque, which is often made of gold, helps protect nearby tissues from radiation damage.
Charged-particle radiation therapy is a type of external radiation therapy. A special radiation therapy machine aims tiny, invisible particles, called protons or helium ions, at the cancer cells to kill them with little damage to nearby normal tissues. Charged-particle radiation therapy uses a different type of radiation than the x-ray type of radiation therapy.
Gamma Knife radiosurgery may be used for some melanomas. This non- surgical treatment aims tightly focused gamma rays directly at the tumor so there is little damage to healthy tissue. Gamma Knife is a type of stereotactic radiosurgery.
Photocoagulation
Photocoagulation is a procedure that uses laser light to destroy blood vessels that supply nutrients to the tumor, causing the tumor cells to die. Photocoagulation may be used to treat small tumors. This is also called light coagulation.
Thermotherapy
Thermotherapy is the use of heat to destroy cancer cells. Thermotherapy may be given using:
* A laser beam aimed through the dilated pupil or onto the outside of the eyeball.
* Ultrasound.
* Microwaves.
* Infrared radiation (light that cannot be seen but can be felt as heat).
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site 1.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Terms
blood vessel (blud VEH-sel)
* A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
catheter (KA-theh-ter)
* A flexible tube used to deliver fluids into or withdraw fluids from the body.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
charged-particle radiation therapy (… PAR-tih-kul RAY-dee-AY-shun THAYR-uh-pee)
* A type of external radiation therapy that uses a special machine to make invisible, high-energy particles (protons or helium ions) that kill cancer cells. This type of radiation may cause less damage to nearby healthy tissue than radiation therapy with high-energy x-rays.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
condition (kun-DIH-shun)
* In medicine, a health problem with certain characteristics or symptoms.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
dilate (DY-layt)
* To widen or enlarge an opening or hollow structure beyond its usual size, such as the pupil of the eye or a blood vessel.
enucleation (EE-NOO-klee-AY-shun)
* In medicine, the removal of an organ or tumor in such a way that it comes out clean and whole, like a nut from its shell.
exenteration (eg-ZEN-teh-RAY-shun)
* Surgery to remove organs within a body cavity.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
follow-up (FAH-loh-up)
* Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
Gamma Knife therapy (GA-muh nife THAYR-uh-pee)
* A treatment using gamma rays, a type of high-energy radiation that can be tightly focused on small tumors or other lesions in the head or neck, so very little normal tissue receives radiation. The gamma rays are aimed at the tumor from many different angles at once, and deliver a large dose of radiation exactly to the tumor in one treatment session. This procedure is a type of stereotactic radiosurgery. Gamma Knife therapy is not a knife and is not surgery. Gamma Knife is a registered trademark of Elekta Instruments, Inc.
gamma ray (GA-muh ...)
* A type of high-energy radiation that is different from an x-ray.
internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.
intraocular melanoma (IN-truh-AH-kyoo-ler MEH-luh-NOH-muh)
* A rare cancer of melanocytes (cells that produce the pigment melanin) found in the eye. Also called ocular melanoma.
laser (LAY-zer)
* A device that forms light into intense, narrow beams that may be used to cut or destroy tissue, such as cancer tissue. It may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery. Lasers are used in microsurgery, photodynamic therapy, and many other procedures to diagnose and treat disease.
local cancer (LOH-kul KAN-ser)
* An invasive malignant cancer confined entirely to the organ where the cancer began.