Life & Work

Look out for eye cancer in a child

child

Retinoblastoma can affect developing foetuses in the womb, as well as new born babies, infants and children up to the age of 5 years old. PHOTO | FILE

September is childhood cancer month. In Kenya, eight out of 10 children diagnosed with cancer die from it. This is in stark comparison to developed nations where on average only one out of 10 children succumb to their cancer. The main challenge we have here is that we diagnose cancers at an advanced stage when they have spread and very little can be done to treat them.

Retinoblastoma is a cancer of the eye and is found almost exclusively in children under the age of 5 years. It starts in the retina (a layer of nerve tissue in the back of the eye that senses light and sends signals to the brain. These signals are interpreted by the brain and we perceive this as images). Retinoblastoma is the most common type of eye cancer in children.

How does retinoblastoma develop?

The eyes develop very early as babies grow in the womb. Ideally, the cells of the eye should develop and mature in an organised way. However, sometimes, the cells lining the retina divide and grow out of control, forming a cancer known as retinoblastoma. Retinoblastoma can affect developing foetuses in the womb, as well as new born babies, infants and children up to the age of 5 years old.

It can affect one or both eyes. In some cases, it spreads out of the eye to other organs. The most common site is the brain and spinal cord.

What should you do?

A vast majority of parents make their first mistake here. It is not unusual to have parents go to an optician to have their child’s eyes checked. Most opticians are highly skilled and professional but they do not manage cancers of the eye.

You need to take your child to an ophthalmologist. This is a doctor who has the ability to operate on the eye. If you have any doubt, speak to your child’s paediatrician and they should be able to guide you to the right person.

The ophthalmologist will examine your child’s eye. S/he might also order imaging tests, like an ultrasound of the eye, a CT scan or an MRI. If there are features in keeping with cancer, your ophthalmologist will enrol the help of an oncologist (this is a cancer specialist). Further tests may be conducted. These may include blood tests, a spinal tap and a bone marrow biopsy.

Treatment options

As with any cancer, the main goal of treatment is to get rid of the cancer and save the child’s life. If possible, it is important to save the eye and preserve the child’s vision. Unfortunately, most children in Kenya are brought to hospital at a stage where their eye cannot be preserved. They usually end up with surgery to remove the affected eye. In countries with more accessible health care services, most children have their vision preserved.

Chemotherapy: These are drugs that kill cancer cells. They can be given directly into the eye, via a blood vessel in body or orally.

Radiation therapy: This uses high-energy x-rays (and other types of radiation) to kill cancer cells and prevent new ones from growing. This radiation can be administered using a machine outside the child’s body or by using implants with radiation close to or into the eye.

Cryotherapy: In this treatment, the cancer cells are frozen and subsequently destroyed.

Thermotherapy: This uses laser energy to heat up and destroy cancer cells.

Photocoagulation: Laser energy is delivered to blood vessels surrounding the cancer causing blood clots and depriving the cancer cells of nutrients.

Surgery/Enucleation: If there is little or no chance that vision can be saved and when the tumour is large or did not respond to treatment, or comes back after treatment, the entire eyeball is removed to prevent the spread of cancerous cells to other areas of the body. The child is then fitted with an artificial eye.

Follow up: Children treated for retinoblastoma have a risk of cancer returning in and around the treated eye. In addition, it could develop in the other eye. For this reason, your child’s ophthalmologist will schedule regular follow-up exams. In addition, these children have increased risk of developing other cancers so you need to take your child for regular physical check-ups even after they are past the age at which retinoblastoma occurs (discuss this with your child’s oncologist).

Can retinoblastoma be prevented?

Retinoblastoma, like all cancers that occur in babies and children fill most parents with feelings of guilt. Often, most want to know if they played a role in the development of the cancer. If your child develops retinoblastoma, it is important to realise that neither you nor your child did anything to cause it.

In some cases, there may be a family history of retinoblastoma. Usually, there a mutations (gene changes) that run in the family. These mutations can be seen by doing genetic tests (lab tests). If you are very concerned about passing on genes that may have mutations, you can opt to have in vitro fertilisation and implant only embryos that don’t have the gene mutation.

This is very expensive but can be arranged locally if needed. Most importantly, however, if you have a family history of retinoblastoma, start screening for the disease in your baby as soon as possible.

Ideally, an ophthalmologist should review your baby in the first few days of life. After that, the ophthalmologist will arrange for regular check-ups. The aim here is to catch the cancer as early as possible. This is because cancers caught early tend to have very successful treatment outcomes.

Do all children with retinoblastoma go blind?

No. Some children with successful treatment go on to have perfect vision (these tend to be the children in whom the cancer was found in its early stages).

Some children do, however, develop poor vision and in sometimes, lose sight in the affected eye (a common scenario in Kenya). The good news is that, with major advances in treatment over the past few decades, most children treated for retinoblastoma have normal lifespans.