Retinoblastoma is one of the most common eye cancers in infants and young children. It arises from the retina of the eye that is responsible for visual perception in the eye. In most cases, it occurs in one eye, known as unilateral retinoblastoma, and in some instances, both eyes can be affected, which is known as bilateral retinoblastoma. Retinoblastoma has the risk of spreading to the brain and the whole body through the optic nerve of the eye and the bloodstream, respectively. The myths and misconceptions along with the late diagnosis are the biggest reasons why we come across advanced cases in India, reducing the chances of survival. Otherwise, it is a completely curable eye cancer if detected early and treated in the right way.
RISK FACTORS FOR RETINOBLASTOMA IN CHILDREN
Some variations in the genes or genetic mutations are the risk factors for retinoblastoma. In about 40% of the cases, the genetic form is responsible for this type of cancer and affects very young children, especially those who are 1 year old or younger. The gene responsible for this rare form of cancer is known as RB1, which happens to be the link when retinoblastoma occurs in both eyes. However, the genetic form rarely results in damage to only one eye. Despite that, only 10-20% of the children with the disease have a family history associated with retinoblastoma. Another risk factor for retinoblastoma happens to be a young age. Most children diagnosed with the disease are below the age of five years, and several of them are even infants. Children of any race can develop this condition. However, the underserved communities face the worst outcomes due to inadequate healthcare facilities.
SIGNS AND SYMPTOMS ASSOCIATED WITH RETINOBLASTOMA
As the disease is most prevalent in young children and infants, the symptoms go unnoticed. Here are a few signs that one may look out for:
White Pupillary Reflex—In normal eyes, the pupil appears to be red when light is focused on it. However, in eyes with retinoblastoma, the pupil mostly appears white, which in actual is a white tumour, retinoblastoma.
Squint eye—the eye can be seen as squinting, turned inwards or outwards
Some other common symptoms are redness, pain, affected eyes appearing bigger, vision loss, bulging of the eyes, bleeding in the front of the eyes, and shrunken eyeballs.
Precautions and Treatment for Retinoblastoma
Retinoblastoma is not preventable. However, its severity can be reduced by regular eye examinations, especially among children who have a family history of the disease. This helps in the detection of the condition earlier and significantly increases the chances of saving the eye and survival. The treatment varies for different stages of the disease. The common treatments include:
Cryotherapy: During this procedure, an extremely cold liquid and instruments are used to freeze and destroy the abnormal tissue and tumour.
Laser therapy includes thermotherapy, where doctors use lasers to destroy cancer tumours with heat.
Chemotherapy: These drugs are mild and can be tolerated by children; they are injected through a vein or artery. The advancement in treatment modalities recently also includes injecting chemotherapy drugs directly into the arteries connected with tumour.
Radiation Therapy: This therapy kills the cancer cells and prevents them from multiplying. Doctors also recommend a type of radiation therapy called radioactive plaque therapy, where the radiation device is directly applied on top of the eye to treat the tumour.
Retinoblastoma is a curable childhood eye cancer if detected on time. It is important to take the symptoms seriously, undergo eye examinations, and consult an eye specialist in the event of any white reflex in the eye. The doctors, pediatricians, physicians, and general ophthalmologists should be trained and educated to be able to diagnose the condition on time, and referring the patients to retinoblastoma specialists and treatment centers makes it possible to give appropriate care, thereby improving the outcome.
The author is Head, Ocular Oncology, Dr Shroff Charity Eye Hospital