DOSSIER Eye cancer, causes & treatments

As an organ, the eye is not spared from cancer. Its complexity means that malignant tumors can involve and take shape through several structures in the eye. Eye cancer, while relatively rare, is poorly understood and therefore poorly detected. Faced with certain symptoms, it is advisable to be particularly vigilant. Certain behaviors can also promote it.

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

Eye cancer: not one, but many

Malignant eye tumors can affect the entire constitution of the eye , including the eyelids, conjunctiva, orbit and its appendages, and the eye itself. If most remain rare, they are rather serious and must be taken care of very quickly.

The most common eye cancer in adults is called uveal melanoma (or uveal melanoma). There are approximately 600 new cases each year in France. The tumor appears in the melanocytes, the cells that make melanin, the pigment responsible for the color of the eyes , but also of the skin and hair. Ocular melanoma arises inside the eyeball.

As for the symptoms, there are two main ones which should alert: the appearance of phosphenes (light signs always located in the same place) sometimes accompanied by black dots and the sudden drop in the amplitude or visual field.

If caught in time, it can be treated via radiotherapy or brachytherapy . If it is too late to treat the tumor, then the eyeball can be removed. Finally, this cancer is likely to cause metastases, often to the liver, which makes it particularly dangerous for other organs.

Another cancer, which is a little less common but which affects around 300 people a year, is called intraocular lymphoma . A few warning signs should also lead the patient to consult quickly. Especially when there is a gradual decline in visual acuity, and vision that is blurred, or even redness or inflammation that lasts.

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

In children, there is an eye cancer called retinoblastoma . This cancer affects the cells of the retina. It only affects children, because the tumor attacks the retina when it is not fully formed. This is the reason why the vast majority of these cases concern children under 3 years of age.

Screening by camera!

There are approximately 50 children affected each year in France by retinoblastoma. In its bilateral form (if it affects both eyes), it is most often a genetic mutation. The latter can prove to be hereditary , and the parents can also present this same mutation.

If so, fundus examination should be performed immediately after the child is born. But for lack of information, the identifiable symptoms can be neglected. Two of them are quite easily recognizable. These are unilateral early strabismus and leukocoria , which is a white or silver reflection in the pupil.

If in doubt, it is possible to screen for leukocoria using a simple camera. Indeed, you have to take pictures from different angles, with a flash, and without activating any red-eye correction. If there is a red eye and an eye with a silver reflection, it is necessary to consult.

Other rarer tumors

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

Finally, the orbit and the conjunctiva can also be the subject of 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 make it possible to make the link with eye cancer. Age, in particular, is one. The average age of those diagnosed is 55 years old. Eye cancer is much rarer in children, although we have seen that some cases may exist, and in people over 70 years old.

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

Some medical history is favorable for introcular melanoma. These are people who have experienced a nevus of Ota , hyperpigmentation of the eye or the skin around it. A Nevi , a congenital malformation of the skin, produced by excess pigmentation or dysplastic nevus syndrome, moles of particular shape and color.

As we have seen, eye cancer can also be favored by a family history, and in particular by a mutation in the BAP1 gene. This mutation can also be the cause of 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 a profession is very risky. In fact, the profession of welder offers a higher than average risk of being affected by eye cancer, more particularly intraocular melanoma . Ultraviolet exposure enhances it and this activity has been classified as a definite 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 booths and sunlamps can damage the eyes and promote basal cell and squamous cell carcinoma. The sun's rays, in the event of strong exposure, can lead to the same risk.

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

However, these conclusions remain to be confirmed.

Sources: Le Figaro , cancer-environnement.fr/