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{{Template:Retinoblastoma (patient information)}}
'''For the WikiDoc page for this topic, click [[Retinoblastoma|here]]'''
'''For the WikiDoc page for this topic, click [[Retinoblastoma|here]]'''
 
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jinhui Wu, M.D,{{JC}}, {{Sahar}}
{{DiseaseDisorder infobox |
==Overview==
  Name          = {{PAGENAME}} |
Retinoblastoma is [[eye cancer]]. It originates from the [[Retina|inner layer of the eye]], [[retina]] and usually occurs in children under 3 years.
  ICD10          = {{ICD10|C|69|2|c|69}} |
==What are the symptoms of Retinoblastoma?==
  ICD9          = {{ICD9|190.5}} |
Retinoblastomas are usually found in infants or children.  
  ICDO          = {{ICDO|9510|3}} |
:*The center circle of the eye ([[pupil]]) often appears white or pink when you shine a light in a child's eye.
  Image          = Retinoblastoma.jpg |
  Caption        = Leukocoria of right eye indicating presence of tumor |
  OMIM          = 180200 |
  MedlinePlus    = 001030 |
  eMedicineSubj = oph |
  eMedicineTopic = 346 |
  DiseasesDB    = 11434 |
  MeshID        = D012175 |
}}
{{SI}}
 
'''Editor-in-Chief:''' Jinhui Wu, MD
 
{{EJ}}
 
==What is retinoblastoma?==
Retinoblastoma is cancerous tumor in eyes. It usually occurs in children under 3 years. Epidemilogical data suggest that the development of retinoblastoma is related to heredity. Usual symptoms include [[strabismus]],  white or pink pupil when shining, [[vision problems]], eye pain, etc. Ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) may help diagnosis. Treatments invlove [[surgery]], [[radiation therapy]], [[chemotherapy]], laser therapy, cryotherapy, thermotherapy, or high dose chemotherapy and stem cell transplant.
 
==How do I know if I have retinoblastoma and what are the symptoms of retinoblastoma?==
Retinoblastomas are usually found because a parent or pediatrician notices a child's eye looks unusual.  
:*The pupil often appears white or pink when you shine a light in a child's eye.
:*Lazy eye ([[strabismus]]): Both eyes do not appear to look in the same direction.
:*Lazy eye ([[strabismus]]): Both eyes do not appear to look in the same direction.
:*Vision problems
:*[[Vision problems]]
:*Eye pain
:*[[Eye pain]]
:*Redness of the white part of the eye
:*[[Red eye (patient information)|Redness of the white part of the eye]]
:*A pupil that does not get smaller when exposed to bright light  
:*[[Pupillary reflex|A pupil that does not get smaller when exposed to bright light]]
Other health problems may also cause these symptoms. Only a pediatrician can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.
:*[[Eye swelling]]
 
Other health problems may also cause these [[symptoms]]. Only a [[pediatrician]] can tell for sure. A person with any of these [[symptoms]] should tell the doctor so that the problems can be [[Diagnosis|diagnosed]] and treated as early as possible.
==Who is at risk for retinoblastoma?==
==What causes Retinoblastoma?==
Heredity and age are the risk factors of retinoblastoma.
*Retinoblastoma is caused by a [[mutation]] in a gene controlling [[cell]] division of [[retinal]] cells, causing these [[cells]] to grow out of control and become a pile of [[cells]] ([[tumor]]).
:*Heredity: Studies show that about 1/3 cases of retinoblastoma are caused by the Rb1 gene mutation. The rest 2/3 cases occur as a result of a random gene mutation.
*It is not clear what causes the [[mutation]], but in some cases, children can inherit the [[mutation]] from their parents ([[Familial]] form).
:*Age: Most children diagnosed with retinoblastoma are younger than 3 years old.
*In a little over half of the cases, this [[mutation]] develops in a child whose family has never had [[eye cancer]].
 
*After the development of the [[tumor]] within the [[Eyeball|eye globe]], it also may invade the nearby structures or even spread to further sites of the body.
==How to know you have retinoblastoma?==
==Who is at highest risk?==
:*Ultrasound: This is an painless test which uses sound waves to create a picture of the eye balls. Because tumors generate different echoes of sound waves than normal tissue, the doctor can locate a mass inside the body. Ultrasound is one of the most commonly used imaging tests to confirm retinoblastoma is present.  
*Those who have a [[mutation]] in the [[RB1]] [[gene]] are at risk of [[tumor]] development.
:*Computed tomography (CT) scan: CT scans are often used to diagnose retinoblastoma. It can confirm the location of the cancer and show the tissues near the tumor.  
*A person with a family history of members of retinoblastoma in a parent, sibling, or first/second-degree relative is also at risk.
:*Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.  
==Diagnosis==
:*Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.
The following methods are used to [[Diagnosis|diagnose]] the [[tumor]]:
 
*[[Eye exam]]: The doctor will do an [[eye exam]] to determine what's causing your child's [[signs]] and [[symptoms]]. The doctor may also recommend using [[anesthetics]] to keep the child still.
*[[Imaging studies]]: These methods help the [[physician]] to assess the [[tumor]] growth and [[invasion]] to the nearby structures. [[Imaging studies]] are such as:
**[[Ultrasound]]: a painless [[test]] which uses sound waves to create a picture of the [[Eyeball|eyeballs]] and locate the approve the [[tumor]] presence.
**[[CT scan|Computed tomography (CT) scan]]: It can confirm the location of [[cancer]] and show the [[tissues]] near the [[tumor]].  
**[[MRI|Magnetic resonance imaging (MRI)]]: An [[MRI]] produces detailed images of the body. Like [[CT|computed tomography (CT)]], a [[contrast]] agent may be [[injected]] into a patient’s [[vein]] to create a better picture.  
**Whole Bone Scan: The goal of a whole body bone scan is to show if cancer has spread and involve the bones.
==When to seek urgent medical care?==
==When to seek urgent medical care?==
Call your health care provider if symptoms of retinoblastoma develop.
*Call your [[health care provider]] if you notice any change in your child'eye that concerns you.
 
*If you have a family history of retinoblastoma ask your [[primary care provider]] when to start eye exam in your child.
==Treatment options==
==Treatment options==
Patients with retinoblastoma have many treatment options. The selection depends on the stage of the tumor. The options are [[surgery]], [[radiation therapy]], [[chemotherapy]], laser therapy, cryotherapy, thermotherapy, or high dose chemotherapy and stem cell transplant. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. [[Side effect]] may not be the same for each person, and they may change from one treatment session to the next.
Treatment differs depending on the following factors:
:*Surgery: The surgery is called enucleation. During the surgery, an orbital implant is also put in to take the place of the eyeball.
*Size of the [[tumor]]
:*Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.
*Location of the [[tumor]]
:*Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.
*Spread of the [[tumor]] to the structures other than the [[eye]]
:*Laser therapy: This treatment uses laser beams to destroy the tumors and the blood vessels that supply them. It is effective only for smaller tumors.   
*Overall health status of the affected child
:*Cryotherapy: Cryotherapy uses a very cool, small probe to kill the retinoblastoma cells by freezing them. It is only effective for relatively single small tumor.
*The parents' preferences
:*Thermotherapy: Thermotherapy uses infrared waves to treat retinoblastoma.
Available treatment options are:<br>
:*High dose chemotherapy and stem cell transplant: This treatment is used to treat children with retinoblastoma that has spread.
'''[[Chemotherapy]]''' which kills the [[cancerous]] [[cells]] using chemical drugs.
 
*It can be prescribed in [[Pill (pharmacology)|pill]] form or through the [[blood vessels]].
==Diseases with similar symptoms==
*This method causes the [[tumor]] to shrink, so other treatment forms treat the remaining [[tumor]] (if any).
:*[[Coats disease]]
*This treatment can decrease the need for the eye [[surgery]].
:*[[Retrolental fibroplasia]]
*It may also be used in case of spread of [[tumor]] outside the eye globe and other sites of the body.
:*[[Persisent hyperplastic primary virtreus]]
*intra-arterial [[chemotherapy]], a new type of [[chemotherapy]], transfer the chemical drug directly to the tumor via a tiny tube (catheter) in the eye artery.
:*[[Metastatic endophthalmitis]]
*[[Intravitreal]] [[chemotherapy]] is also used for retinoblastoma that has spread within the eye via direct injection of the chemical drug into the eye.
 
**This method is usually used when the [[tumor]] is resistant to other types of treatment.
==Where to find medical care for retinoblastoma?==
'''[[Radiation therapy]]''' which kills [[Cancer|cancerous]] cells using high energy beams such as [[X-ray]] and protons.<br>
 
Radiotherapy categorized into two categories:
*[[Brachytherapy|Internal radiation]] ([[brachytherapy]]) which the device is within or in the close distance of the [[tumor]] temporarily.
**This method uses a small disk which is stitched in place and left for a few days while it radiates the beam to the retinoblastoma tumor.
**This method reduces the risk that treatment will affect healthy eye tissue due to the placement of the device near the affected eye.
*[[External beam radiotherapy|External beam radiation]] which uses high-powered beams to radiate the tumor from a large machine outside of the body.
**This method can cause [[side effects]] due to simultaneous [[radiation]] of other parts of the body such as the [[brain]] so, [[External beam radiotherapy|external beam radiation]] is typically reserved for children with advanced retinoblastoma and those for whom were resistant to other forms of treatment.<br>
'''[[Laser therapy]] ([[laser photocoagulation]])''' which uses a [[laser]] to destroy [[blood vessels]] supplying the [[tumor]] with [[oxygen]] and nutrients.
   
'''[[Cryotherapy|Cold treatments]] ([[cryotherapy]])''' which uses extreme cold to kill [[cancerous]] [[cells]].
'''[[Surgery]]''' removes the [[tumor]] which is too large to be treated by other methods.  
*It decreases the risk of spread of the [[tumor]] to the nearby structures.
*[[Surgical]] methods for retinoblastoma include:
**[[Surgery]] to remove the affected eye ([[enucleation]]) as well as a portion of the [[optic nerve]], which extends from the back of the eye into the [[brain]]
**[[Surgery]] to place an eye implant which replaces the empty space of the [[eyeball]] by a special ball — made of plastic or other materials — in the eye socket and connects the [[muscles]] that control eye movement to the implant.
**Fitting an artificial eye which involves the placement of a custom-made artificial eye that can be made to match your child's healthy eye.
*[[Surgery]] may be complicated by [[side effects]] such as [[infection]] and [[bleeding]].
==Where to find medical care for Retinoblastoma?==
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|retinoblastoma}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating retinoblastoma]
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|retinoblastoma}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating retinoblastoma]
 
==Prevention of Retinoblastoma==
==Prevention of retinoblastoma==
*Because retinoblastoma is caused by a [[genetic]] [[mutation]], it remains unpreventable. But it is very important to detect [[cancer]] early and get the most effective treatment.
Because retinoblastoma is related to heredity, a parent or child can do nothing to prevent this cancer. But it is very important to detect cancer early and get the most effective treatment.
*In the inheritable form of the [[disease]], however, other children of the family should be [[Screening|screened]] using [[genetic analysis]] for the presence of the [[mutation]], so eye exam can start at an early age and [[diagnose]] the [[tumor]] when it is [[Surgery|surgically]] removable.
 
==What to expect (Outlook/Prognosis)?==
==What to expect (Outook/Prognosis)?==
The [[prognosis]] of retinoblastoma depends on the following:
The prognosis of retinoblastoma depends on the following:
:*Whether or not the [[tumor]] can be removed by [[surgery]].
:*Whether or not the tumor can be removed by surgery.
:*The stage of [[cancer]]: the size of the [[tumor]], whether [[cancer]] has spread  
:*The stage of the cancer: the size of the tumor, whether the cancer has spread  
:*The child’s general health
:*The child’s general health
 
==Possible complications==
==Copyleft Sources==
*Invasion of the [[tumor]] to the nearby structure
http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=37
*Development of other [[tumors]] in inheritable form of the [[tumor]]
 
*Return of the [[tumor]] in the treated eye
http://www.nlm.nih.gov/medlineplus/eyecancer.html
*[[Side effects]] of [[radiotherapy]]
 
{{WH}}
{{WS}}
[[Category:Patient Information]]

Latest revision as of 20:40, 2 May 2019

Retinoblastoma

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

Diagnosis

When to seek urgent medical care?

Treatment options

Where to find medical care for Retinoblastoma?

Prevention

What to expect (Outlook/Prognosis)?

Possible complications

Retinoblastoma On the Web

Ongoing Trials at Clinical Trials.gov

Images of Retinoblastoma

Videos on Retinoblastoma

FDA on Retinoblastoma

CDC on Retinoblastoma

Retinoblastoma in the news

Blogs on Retinoblastoma

Directions to Hospitals Treating Retinoblastoma

Risk calculators and risk factors for Retinoblastoma

For the WikiDoc page for this topic, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jinhui Wu, M.D,Jyostna Chouturi, M.B.B.S [2], Sahar Memar Montazerin, M.D.[3]

Overview

Retinoblastoma is eye cancer. It originates from the inner layer of the eye, retina and usually occurs in children under 3 years.

What are the symptoms of Retinoblastoma?

Retinoblastomas are usually found in infants or children.

Other health problems may also cause these symptoms. Only a pediatrician can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

What causes Retinoblastoma?

  • Retinoblastoma is caused by a mutation in a gene controlling cell division of retinal cells, causing these cells to grow out of control and become a pile of cells (tumor).
  • It is not clear what causes the mutation, but in some cases, children can inherit the mutation from their parents (Familial form).
  • In a little over half of the cases, this mutation develops in a child whose family has never had eye cancer.
  • After the development of the tumor within the eye globe, it also may invade the nearby structures or even spread to further sites of the body.

Who is at highest risk?

  • Those who have a mutation in the RB1 gene are at risk of tumor development.
  • A person with a family history of members of retinoblastoma in a parent, sibling, or first/second-degree relative is also at risk.

Diagnosis

The following methods are used to diagnose the tumor:

When to seek urgent medical care?

  • Call your health care provider if you notice any change in your child'eye that concerns you.
  • If you have a family history of retinoblastoma ask your primary care provider when to start eye exam in your child.

Treatment options

Treatment differs depending on the following factors:

  • Size of the tumor
  • Location of the tumor
  • Spread of the tumor to the structures other than the eye
  • Overall health status of the affected child
  • The parents' preferences

Available treatment options are:
Chemotherapy which kills the cancerous cells using chemical drugs.

  • It can be prescribed in pill form or through the blood vessels.
  • This method causes the tumor to shrink, so other treatment forms treat the remaining tumor (if any).
  • This treatment can decrease the need for the eye surgery.
  • It may also be used in case of spread of tumor outside the eye globe and other sites of the body.
  • intra-arterial chemotherapy, a new type of chemotherapy, transfer the chemical drug directly to the tumor via a tiny tube (catheter) in the eye artery.
  • Intravitreal chemotherapy is also used for retinoblastoma that has spread within the eye via direct injection of the chemical drug into the eye.
    • This method is usually used when the tumor is resistant to other types of treatment.

Radiation therapy which kills cancerous cells using high energy beams such as X-ray and protons.
Radiotherapy categorized into two categories:

  • Internal radiation (brachytherapy) which the device is within or in the close distance of the tumor temporarily.
    • This method uses a small disk which is stitched in place and left for a few days while it radiates the beam to the retinoblastoma tumor.
    • This method reduces the risk that treatment will affect healthy eye tissue due to the placement of the device near the affected eye.
  • External beam radiation which uses high-powered beams to radiate the tumor from a large machine outside of the body.
    • This method can cause side effects due to simultaneous radiation of other parts of the body such as the brain so, external beam radiation is typically reserved for children with advanced retinoblastoma and those for whom were resistant to other forms of treatment.

Laser therapy (laser photocoagulation) which uses a laser to destroy blood vessels supplying the tumor with oxygen and nutrients.

Cold treatments (cryotherapy) which uses extreme cold to kill cancerous cells.

Surgery removes the tumor which is too large to be treated by other methods.

  • It decreases the risk of spread of the tumor to the nearby structures.
  • Surgical methods for retinoblastoma include:
    • Surgery to remove the affected eye (enucleation) as well as a portion of the optic nerve, which extends from the back of the eye into the brain
    • Surgery to place an eye implant which replaces the empty space of the eyeball by a special ball — made of plastic or other materials — in the eye socket and connects the muscles that control eye movement to the implant.
    • Fitting an artificial eye which involves the placement of a custom-made artificial eye that can be made to match your child's healthy eye.
  • Surgery may be complicated by side effects such as infection and bleeding.

Where to find medical care for Retinoblastoma?

Directions to Hospitals Treating retinoblastoma

Prevention of Retinoblastoma

  • Because retinoblastoma is caused by a genetic mutation, it remains unpreventable. But it is very important to detect cancer early and get the most effective treatment.
  • In the inheritable form of the disease, however, other children of the family should be screened using genetic analysis for the presence of the mutation, so eye exam can start at an early age and diagnose the tumor when it is surgically removable.

What to expect (Outlook/Prognosis)?

The prognosis of retinoblastoma depends on the following:

  • Whether or not the tumor can be removed by surgery.
  • The stage of cancer: the size of the tumor, whether cancer has spread
  • The child’s general health

Possible complications