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Treatment decisions

Find out how your doctor decides which treatment you need and the types of treatment you might have.

The main treatments

The treatments doctors use for eye cancer are surgery, radiotherapy and chemotherapy. The treatment you have will depend on:

  • the type of eye cancer you have and where it is in the eye
  • the size of your tumour and how far it has grown or spread (the stage)
  • your general health and level of fitness

As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it. When planning your treatment, your doctors will try their hardest to save as much of your sight as they can.

Treatment for melanoma of the eyeball

Treatment for eye melanoma is surgery or radiotherapy, or both.

Whether you have surgery or radiotherapy depends on:

  • where the tumour is
  • the size of the tumour and
  • how much it is affecting your sight

If the tumour is large or already stopping you from seeing out of the eye, you will probably have surgery to remove the eye. This operation is called an enucleation. Otherwise, your doctor may decide to:

  • remove just the tumour or
  • give you radiotherapy

Ask your doctor as many questions as you need to. Together you can decide which treatment is best for you.

It can come as quite a shock if you need to have surgery to remove your eye. You will need time to come to terms with this change.

As long as you have sight in one eye, it may not make much difference to what you can and can’t do. You may still be able to drive, for instance.

It may help to know that many people who have had this surgery rate their quality of life as highly as people who have kept their eye.

Treatment for iris melanoma

This type of can be so slow growing that you don’t need treatment, especially if you don’t have symptoms. Your doctor will give you regular check ups to make sure the cancer is not getting bigger. If the tumour is growing, or if it is causing symptoms, you will normally have one of the following operations:

  • removal of the iris (an iridectomy)
  • removal of the iris and the tissues around the clear layer covering the front of the eye (the cornea) – this operation is called an iridotrabeculectomy
  • removal of the iris and the ciliary body (the muscle that focuses the eye) – this operation is called an iridocyclectomy
  • removal of the whole eye (an enucleation)

For some iris melanomas your doctor may suggest radiotherapy.

Treatment for choroid or ciliary body melanoma

If melanoma of the choroid or ciliary body is not getting bigger you may not need treatment straight away. You will have regular check ups to make sure the tumour has not started to grow.

If you do need treatment, for small melanomas you may have one of the following:

  • radiotherapy
  • surgery to remove just the tumour
  • surgery to remove the whole eye (enucleation)

For medium sized melanomas, you may have one of the above treatments or radiotherapy followed by surgery to remove the eye.

Surgery or radiotherapy are the treatments for large melanomas. If you need surgery, this will usually mean removing the eye.

Treatment for melanomas that have spread outside the eye

If your tumour has spread outside the eye, to the optic nerve or the eye socket, it is called an extraocular melanoma. Your doctor may call this extraocular extension. You will probably need surgery to remove your eye and some of the surrounding tissue to make sure all the cancer is gone. You might have radiotherapy as well.

Sometimes ocular melanoma can spread to another part of the body such as the liver. Because ocular melanoma is rare it is hard to do trials to find the best treatment. You may have chemotherapy or biological therapies, or a combination of treatments.

Treatment for recurrent eye melanoma

If the cancer has come back in your eyeball (intraocular) you will most likely have surgery to remove your eye (enucleation). You may also have radiotherapy after surgery to kill off any cancer cells left behind.

If the cancer has come back in the tissues around the eyeball (extraocular melanoma) or has spread to another part of the body such as the liver, you may have chemotherapy or biological therapy, or both.

Clinical trials are looking at how helpful biological therapy may be in treating melanoma of the eye.

Which treatment for lymphoma of the eye

Doctors call lymphoma of the eye intraocular lymphoma. They treat it in a similar way as other types of non Hodgkin lymphoma. You may have radiotherapy, chemotherapy or both.

For some types of non Hodgkin lymphoma, doctors may use a type of biological therapy. You are not likely to have surgery to treat intraocular lymphoma.

Radiotherapy to treat intraocular lymphoma

To treat lymphoma of the eye your doctor may suggest external radiotherapy to your eye and brain. This can get rid of the cancer in the eye and also help stop it coming back in the brain or spinal cord.

Chemotherapy to treat intraocular lymphoma

Most people with lymphoma of the eye will have chemotherapy. This is usually through a drip into your vein (systemic chemotherapy).

You may also have chemotherapy injected into the fluid around your spinal cord (intrathecal chemotherapy). This might be along with radiotherapy. You may have chemotherapy put into your eye (intravitreal chemotherapy). This is more likely for lymphoma that has only come back in your eye.

Choosing your treatment

Most people with eye cancers are referred to a specialist centre for their treatment. These centres provide a range of treatments. The eye surgeon and the specialist nurse will explain your treatment choices in detail. They will talk through the potential benefits and complications of each.

Occasionally, it may help to get a second opinion from another eye cancer specialist. Not all treatments are available at every specialist centre, so you may need to travel to another hospital for your treatment.

Information and help

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