SPECIAL REPORT: Eye Cancer, Causes & Treatments

As an organ, the eye is not immune to cancer. Its complexity means that malignant tumors can affect and develop in several structures within the eye. While relatively rare, eye cancer is poorly understood and, consequently, often underdiagnosed. It is important to be particularly vigilant in the presence of certain symptoms. Certain behaviors can also increase the risk of developing the disease.

Through this dossier, we will try to learn more about eye cancer , its causes, and ways to treat it.

Eye cancer: not one, but several

Malignant tumors of the eye can affect any part of the eye , including the eyelids, conjunctiva, orbit and its surrounding structures, and the eye itself. While most remain rare, they are quite serious and require very rapid treatment.

The most common eye cancer in adults is called uveal melanoma (or melanoma of the uvea). There are approximately 600 new cases each year in France. The tumor develops in melanocytes, the cells that produce melanin, the pigment responsible for the color of the eyes , as well as skin and hair. Ocular melanoma originates inside the eyeball.

As for symptoms, there are two main ones that should raise concern: the appearance of phosphenes (light signs always located in the same place) sometimes accompanied by black spots and the sudden decrease in the amplitude or field of vision.

If caught early, it can be treated with radiation therapy or brachytherapy . If it is too late to treat the tumor, the eyeball may need to be removed. Finally, this cancer is likely to metastasize, often to the liver, making it particularly dangerous for other organs.

Another cancer, somewhat less common but affecting approximately 300 people per year, is called intraocular lymphoma . Here too, certain warning signs should prompt the patient to seek medical help quickly. These include a gradual decrease in visual acuity, blurred vision, or persistent redness or inflammation.

Treatment is possible and will depend on the diagnosis. Indeed, most often, lymphoma is linked to cerebral lymphoma.

In children, there is a type of eye cancer called retinoblastoma . This cancer affects the cells of the retina. It only affects children because the tumor attacks the retina before it is fully formed. This is why the vast majority of these cases occur in children under 3 years old.

Screening by camera!

In France, approximately 50 children are diagnosed with retinoblastoma each year. In its bilateral form (affecting both eyes), it is most often caused by a genetic mutation. This mutation can be hereditary , and the parents may also carry it.

If this is the case, a fundus examination should be performed immediately after the child's birth. However, due to a lack of information, identifiable symptoms can be overlooked. Two of these are quite easily recognizable: early unilateral strabismus and leukocoria , which is a white or silvery reflection in the pupil.

If you suspect leukocoria, you can detect it using a simple camera. Take photos from different angles, with a flash, and without using any red-eye correction. If you notice one red eye and one eye with a silvery sheen, you should consult a doctor.

Other, rarer tumors

Less well-known tumors can affect the eye and its surrounding structures. Among them are eyelid tumors, which are actually basal cell carcinomas, the most common type of skin cancer. There is also squamous cell carcinoma , rarer and more aggressive, which can also affect the eyelids.

Finally, the orbit and conjunctiva can also be affected by tumors, melanomas, and lymphomas. All are quite rare but relatively serious. Therefore, early and appropriate treatment is essential.

Known risk factors for eye cancer…

Several factors can be linked to eye cancer. Age, in particular, is one of them. The average age of people diagnosed is 55. Eye cancer is much rarer in children, although some cases have been observed, and in people over 70.

Skin and eye color are also proven risk factors. People with fair skin and light eyes are more likely to be affected than those with darker skin and eyes. However, there is no proven link with sex. This cancer can affect both men and women.

Certain medical histories are conducive to introductory melanoma. These include individuals who have had a nevus of Ota , a hyperpigmentation of the eye or the skin around it; a nevi , a congenital skin malformation caused by excess pigmentation; or dysplastic nevus syndrome, characterized by moles with unusual shapes and colors.

As we have seen, eye cancer can also be influenced by family history, particularly by mutations in the BAP1 gene. This mutation can also cause other cancers, such as kidney cancer.

People infected with HIV are more likely to develop lymphoma of the eye and squamous cell carcinoma of the conjunctiva.

Finally, it should be noted that one profession is very high-risk. Indeed, the welding profession carries a higher than average risk of developing eye cancer, particularly intraocular melanoma . Exposure to ultraviolet radiation exacerbates this risk, and this activity has been classified as a known carcinogen for eye cancer.

…and suspected

Other behaviors, such as tanning, whether artificial or natural, are suspected of increasing the risk of certain eye cancers. Ultraviolet rays from tanning beds and sunlamps can damage the eyes and promote basal cell and squamous cell carcinomas. Sunlight, in cases of high exposure, can pose a similar risk.

Finally, it has been discovered that some industrial workers exposed to products such as polychlorinated biphenyls (PCBs) may have an increased risk of developing eye cancer. This could also be the case for professionals in the aviation sector , pilots and front-line commercial flight attendants, who are exposed to high levels of ultraviolet radiation.

These conclusions, however, remain to be confirmed.

Sources: Le Figaro , cancer-environnement.fr/