We should not ignore retinoblastoma

Retinoblastoma is the most frequently occurring eye cancer in children. It is a tumour that originates in the retina-- this is a thin layer in the back of the eye that helps us to see. Here are our top five reasons explaining why we shouldn’t ignore retinoblastoma.

Retinoblastoma uncommon can affect any child

“Eye cancer in a child? You must be joking doctor!” exclaimed Subhash father of a three-month-old Priya who had retinoblastoma in both eyes. As an ocular oncologist, this is a difficult situation we encounter in our clinics while breaking the bad news to parents with children who have eye cancer. Retinoblastoma affects one in 16,000- 18,000 live births. Worldwide 8,000 new cases are reported each year, of which more than 1,400 cases are from India. It also accounts for 3% of all childhood cancers. Most of these patients (90%) are less than three years of age.

Early diagnosis and treatment can save lives

The two most common presenting symptom of the disease are white reflex in a child’s eye and squinting of the eye. The other uncommon symptoms may be that the child has a big or small eye, red-eye, or swollen eyelids. It is of utmost importance that the child is checked by an eye cancer specialist as soon as he develops any of these symptoms.

Retinoblastoma is curable if detected early and treated appropriately. Parents play a very important role in the early diagnosis of retinoblastoma. The improvement in diagnosis and treatment of eye cancer has increased the survival rates and most patients survive the disease. The treatment of retinoblastoma depends on the stage at which the child presents to us. Different forms of therapy are available. For smaller tumours, laser or freezing therapy (cryotherapy) usually suffices. For larger tumours, the available modalities are intravenous (drip) chemotherapy, eye injection chemotherapy, rarely radiotherapy. Thus, spreading awareness will help in early diagnosis and appropriate treatment of this deadly cancer.

Whenever we are treating cancer there are three goals that we want to achieve- First, save a life. Second, save the eye. Third, save vision of the patient, in that order. So, despite our best efforts to save lives in a significant percentage of patients eye removal surgery is required. This is more true for the developing nations where delayed presentation, incorrect diagnosis, poor compliance to treatment owing to poor access to health care facilities, financial constraints, cultural belief systems are the major hurdles to successful therapy.

Whenever retinoblastoma is left untreated, the tumour is likely to spread outside the eye, to the brain and different parts of the body and can cause life risk to the patient. The five-year survival rate of patients with retinoblastoma in India is around 90%.

Long term follow up is important to detect tumour recurrence and non-eye cancers

Concerns of eye tumour recurrence and late treatment-related complications justify the long-term follow-up of retinoblastoma survivors. These patients are at an increased risk of second tumours like sarcoma, lymphoma, leukaemia which again requires early diagnosis and prompt treatment.

(The writer is consultant at an eye cancer institute in Vijayawada)