• Patients with cancers of the eye and surrounding tissues are treated through Vancouver General Hospitals’ Eye Care Centre:
• Cancer of the eye are treated at the Ocular Oncology Unit.
• Orbital and eyelid cancers are treated at the Oculoplastic and Lacrimal and Orbit unit.
• Eyes are the organs of vision. They are a complex organ with many parts.
• Layers of the eyeball:
• Sclera – the white outer part of the eye.
• Middle layer – which contains the iris, the choroid and the ciliary body.
• Retina – the inner part of the eye.
• Around the eye are other parts, which include the muscles, eyebrows, eyelids, conjunctiva, lacrimal gland, lacrimal sac and drainage system, nerves, fat, vessels and the optic nerve. These are called the adnexal parts of the eye and when cancer is involved, it is referred to as adnexal cancer.
• Cancer of this area can be divided into three categories, based where the cancer starts:
• The eyeball, and it is called ocular or intraocular cancer.
• The orbit - the eye socket, which is the place in the face where the eye sits. Orbital tumours include the bone surrounding the eyeball, plus the muscles and soft tissues that connect between the eyeball and the eyesocket.
• The eyelids and conjunctiva, which is the clear thin membrane that coats the outside of the eyeball and the inside of the eyelid.  Tumours of the eyelid include all types of skin cancers.

• Eye cancers can occur at any age.
• Some eye cancers can be hereditary.
• People with light complexions and light coloured eyes are more at risk for some kinds of eye cancers. Exposure to the sun is a factor, so sunscreen and dark glasses are even more important for people with light eyes and pale complexions.
• Statistics
• BC
• Canada 

• Protect your skin and your eyes from sun damage.

• There are currently no screening programs for eye cancers.

• Development of a squint (crossed eyes) especially in a child.
• A change in vision:
• Seeing sparks or flashes or black spots or ‘floaters’, especially if this symptom develops suddenly.
• A decline in vision, slow or sudden.
• Distorted vision.
• Double vision.
• Physical changes in the eye:
• The eye seems to begin bulging out (proptosis) or become displaced (downward, upward or outward)
• The appearance of a white area in the centre of the pupil. This is the part of the eye that normally looks black or has a red reflex (especially in some photographs).
• Changes in the eyelid, such as drooping, swelling or thickening, or the appearance of the lid such as a dark spot, a lump or elevation.
• A sore or infection on the eyelid that does not heal.
• A rare symptom can be inflamed eyes or glaucoma (high pressure behind the eye).
• Eye cancers may be found during a routine eye examination.

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer. 

• A clinical examination using routine and special ophthalmic instruments that allow a full field, three dimensional view of the back of the eye.
• Examination of the front portion of the eyeball is done using a biomicroscope, which can be used with special lenses to examine the back part of the eyeball.
• CT scans are particularly useful for the study of orbital tumors.
• Ultrasound examinations.
• Fluorescein angiography is a diagnostic test in which a dye is injected into the blood stream. It can be used to visualize the blood vessels of the eye or of the tumour. This can help to visualize and characterize an ocular tumour.
• Ocular fundus colour photography allows visualization and documentation of tumours.
• Ophthalmic A and B ultrasound may be used to characterize the size, tissue features and extent of an ocular melanoma or some orbital tumours.
• Magnetic resonance imaging (MRI) may also rarely help to identify an ocular tumour and define its size and shape but are mostly used for orbital and adnexal tumors.
• A surgical biopsy to take out tissue for examination by pathologists.
• A needle biopsy using a small, hollow needle. This is called Fine Needle Aspiration Biopsy (FNAB).
• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section.

Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T  describes the site and size of the main tumour (primary)
• N  describes involvement of lymph nodes
• M  relates to whether the cancer has spread (presence or absence of distant metastases)

• There are many different types of cancer that can arise in the eye. They may be called ocular tumours, retinoblastoma, ocular melanoma, metastatic tumours of the eyeball, intraocular tumours, choroidal tumours.
• Orbital and adnexal tumors include optic nerve tumours, meningioma, glioma, sphenoid wing meningiomas, lymphoma, secondary tumours, soft tissue tumours, rhabdomyosarcoma, fibrous histiocytoma, vascular tumours, capillary hemangiomas, cavernous hemangiomas, metastatic tumours, lacrimal tumours, lymphomas, epithelial tumours, carcinoma or malignant tumours.
• Cancer of the eyelids and tumours of the conjunctiva include squamous cell carcinoma, basal cell carcinoma, sebaceous carcinoma or malignant melanoma.

Treatment
Cancer therapies can be highly individualized, especially for cancers of the eye and surrounding tissues – your treatment may differ from what is described below.

• Specialization in treating eye cancers is critical, with ophthalmologists, ocular oncologists, oculoplastic surgeons, pediatricians (pediatric oncologists for childhood tumours) and possibly other surgeons who are skilled in cancer treatment.
• Surgery can be a treatment option.
• Local excision (cutting out the tumour)
• Laser treatment
• Enucleation (removal of the eyeball)
• Chemotherapy may be used. It may be given locally or systemically.
• Radiation therapy
• External beam radiotherapy may be used.
• Plaques of iodine 125 or radioactive gold can be sewn on the outside of the eye (to the sclera) so that the required amount of radiation therapy can be delivered to the tumour. These are removed one or two weeks later.
• Proton therapy, given at TRIUMF on the UBC campus utilizes a narrow proton beam of radiation to destroy the tumour.
• Cryotherapy (freezing) may be used.
• Sometimes, small tumours are simply monitored to see how fast they are growing.

Follow-up after Treatment

• You will be returned to the care of your family doctor or your specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances. 
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc. Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Eye cancer
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help.

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information has been reviewed and approved by a member of the Ocular & Orbital Tumour Group.