Chemotherapy for eye cancer
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
There are different types of eye cancer. Chemotherapy does not usually work well for melanoma of the eyeball (uveal melanoma). Your specialist is only likely to suggest it if the melanoma comes back after treatment with surgery or radiotherapy.
You might have chemotherapy eye drops to treat melanoma or squamous cell cancer on the surface of the eye (conjunctiva).
You are more likely to have chemotherapy to treat lymphoma of the eye.
Types of chemotherapy
There are a number of chemotherapy drugs that doctors use to treat eye cancer. The types of drugs you have depend on different factors, including your type of eye cancer and where in the eye the cancer is.
For melanoma and squamous cell cancer of the surface of the eye (conjunctiva) you might have:
- mitomycin C
- fluorouracil (5FU)
The chemotherapy drugs that doctors use to treat eye lymphoma include:
- cytarabine (Ara-C)
If uveal melanoma has spread to other parts of the body from the eye you might have chemotherapy such as:
Targeted and immunotherapy drugs
You might have a targeted or immunotherapy drug. For example, you may have rituximab with chemotherapy for your lymphoma. Or an immunotherapy drug called ipilimumab for uveal melanoma that has spread.
How you have chemotherapy
Chemotherapy eye drops (topical chemotherapy)
Doctors may treat some cancers on the surface of the eye (conjunctiva), such as melanoma and squamous cell cancer, with chemotherapy eye drops. This is called topical chemotherapy. Side effects include redness, a watery eye and inflammation.
You may have it on its own or with other treatments such as surgery or cryotherapy (freezing treatment).
Chemotherapy into your bloodstream
If you have eye lymphoma, you are likely to have chemotherapy. Treatment for eye lymphoma depends on the type and stage of lymphoma. You usually have this into your bloodstream.
You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long line: a central line, a PICC line or a portacath.
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
In some cases, you may have high doses of chemotherapy followed by a stem cell transplant.
Chemotherapy into the fluid around your spinal cord
If you have eye lymphoma you may also have chemotherapy into the fluid around your spinal cord. This is called intrathecal chemotherapy.
Your doctor injects the drug into the fluid around your spinal cord during a lumbar puncture.
You might have methotrexate as a tablet for eye lymphoma.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.
Chemotherapy into the eye (intravitreal chemotherapy)
If you only have lymphoma in your eye, doctors may give the chemotherapy directly into the eye. You are more likely to have this for lymphoma that has come back in the eye (local recurrence). The drug doctors use most often is methotrexate. You usually have regular injections of this over a year.
Having an injection into your eye may sound daunting, but it is a relatively simple and quick procedure. You have local anaesthetic eye drops beforehand to numb the area. You may feel a little pain when the needle first goes in. Possible side effects from the injection include red eye, infection, inflammation inside the eye and a cataract, which is when the lens becomes misty and you can't see clearly.
Doctors are looking into giving a targeted drug such as rituximab into the eye for lymphoma.
Chemotherapy into the liver
Uveal melanoma can spread to the liver in some people. This spread is called liver secondaries or metastasis.
Some treatments deliver chemotherapy directly into the liver. Your doctor puts a small tube (catheter) into the main artery leading to your liver. Chemotherapy is injected in to the tube, allowing a high concentration of chemotherapy to get to the secondaries in the liver.
Examples of these treatments include:
- hepatic artery infusion
- transarterial chemoembolisation
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
When you go home
Chemotherapy for eye cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.