Eye cancer

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Staging eye cancer

 

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes the size of the tumour and where the cancer is. Your healthcare team uses the stage to plan treatment and estimate your prognosis.

The most common staging system for eye cancer is the TNM system. Each stage is given a number from 1 to 4. Stages 1 to 4 are usually given as the Roman numerals I, II, III and IV. Generally, the higher the number, the more the cancer has spread.

Eye cancers are staged based on the type and location of the cancer. The staging information below applies only to intraocular melanoma. Intraocular melanoma includes melanomas that develop in the iris, choroid and ciliary body. These structures make up the uvea of the eye.

When describing the stage, doctors may use the words intraocular, extraocular, regional or distant. Intraocular means that the cancer is only inside the eye and has not spread. Extraocular means that the cancer has spread outside of the eye. Regional means close to or around the eye. Distant means in a part of the body farther from the eye.

TNM descriptions

T describes the size of the primary tumour. It also describes if the tumour has grown into other parts of the eye or tissues around the eye. T is usually given as a number from 1 to 4. A higher number means that the tumour is larger. It may also mean that the tumour has grown farther into the eye or nearby tissues.

 

N describes whether or not cancer has spread to lymph nodes near the eye (called the regional lymph nodes). N0 means the cancer hasn’t spread to any nearby lymph nodes. N1 means cancer has spread to lymph nodes.

 

M describes whether or not the cancer has spread (metastasized) to other parts of the body. M0 means that cancer has not spread to other parts of the body. M1 means that it has spread to other parts of the body.

Stages of intraocular melanoma of the iris

When intraocular melanoma of the iris is staged, the doctor compares the iris to a face of a clock. The iris is divided into 12 sections like the hours on a face of a clock.

Stages of intraocular melanoma of the iris

StageTNMDescription

I

T1a

N0

M0

The tumour is only in the iris and is not more than 3 clock hours in size (1/4 the size of the iris).

IIA

T1b, T1c or T2a

N0

M0

The tumour is one of the following:

T1b – only in the iris and more than 3 clock hours in size

T1c – only in the iris and causing glaucoma

T2a – has spread next to or into the ciliary body without causing glaucoma

IIB

T2b

N0

M0

The tumour has spread next to or into the choroid without causing glaucoma.

T3

N0

M0

The tumour has spread next to or into the ciliary body, choroid or both. The tumour has also spread into the sclera.

IIIA

T2c

N0

M0

The tumour has spread next to or into the ciliary body, choroid or both and is causing glaucoma.

T4a

N0

M0

The tumour has spread outside of the sclera and this part of the tumour is 5 mm or less in diameter.

IIIB

T4b

N0

M0

The tumour has spread outside of the sclera and this part of the tumour is more than 5 mm in diameter.

IV

T1, T2, T3 or T4

N1

M0

The tumour is one of the following:

T1 – in the iris

T2 – has spread next to or into the ciliary body, choroid or both

T3 – has spread into the sclera

T4 – has spread outside of the sclera

The cancer has spread to nearby lymph nodes.

T1, T2, T3 or T4

N0 or N1

M1

The tumour is one of the following:

T1 – in the iris

T2 – has spread next to or into the ciliary body, choroid or both

T3 – has spread into the sclera

T4 – has spread outside of the sclera

The cancer may or may not have spread to nearby lymph nodes.

The cancer has spread to other parts of the body, such as the liver or lungs (called distant metastasis).

Stages of intraocular melanoma of the ciliary body and choroid

Stage of intraocular melanoma of the ciliary body and choroid is based on the size of the tumour, where the tumour is in the eye and if it has spread outside of the eye.

Size category

A size category is given from 1 to 4 for melanoma of the ciliary body and choroid. The size category is based on the thickness (height) and largest diameter at the base of the tumour. The size category is used with the TNM classification for melanoma of the ciliary body and choroid. Category 1 tumours are the smallest and category 4 tumours are the largest.

Category 1

The tumour is either:

  • not more than 12 mm wide and not more than 3 mm thick
  • not more than 9 mm wide and 3.1 to 6 mm thick

Category 2

The tumour is one of the following:

  • 12.1 to 18 mm wide and not more than 3 mm thick
  • 9.1 to 15 mm wide and 3.1 to 6 mm thick
  • not more than 12 mm wide and 6.1 to 9 mm thick

Category 3

The tumour is one of the following:

  • 15.1 to 18 mm wide and 3.1 to 6 mm thick
  • 12.1 to 18 mm wide and 6.1 to 9 mm thick
  • 3.1 to 18 mm wide and 9.1 to 12 mm thick
  • 9.1 to 15 mm wide and 12.1 to 15 mm thick

Category 4

The tumour is one of the following:

  • more than 18 mm wide and may be any thickness
  • 15.1 to 18 mm wide and more than 12 mm thick
  • 12.1 to 15 mm wide and more than 15 mm thick

Stages of intraocular melanoma of the ciliary body and choroid

StageTNMDescription

I

T1a

N0

M0

The tumour is size category 1 and only in the choroid.

IIA

T1b, T1c, T1d or T2a

N0

M0

The tumour is size category 1 and is one of the following:

T1b – has spread to the ciliary body

T1c – has spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick

T1d – has spread to the ciliary body and outside of the eyeball. The part of the tumour outside of the eyeball is not more than 5 mm thick

Or

T2a – the tumour is size category 2 and only in the choroid.

IIB

T2b or T3a

N0

M0

T2b – the tumour is size category 2 and has spread to the ciliary body.

Or

T3a – the tumour is size category 3 and only in the choroid.

IIIA

T2c or T2d

N0

M0

T2c – the tumour is size category 2. It has spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

Or

T2d – the tumour is size category 2 and has spread to the ciliary body. The tumour has also spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

T3b or T3c

T3b – the tumour is size category 3 and has spread to the ciliary body.

Or

T3c – the tumour is size category 3. It has spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

T4a

T4a – the tumour is size category 4 and only in the choroid.

IIIB

T3d

N0

M0

T3d – the tumour is size category 3 and has spread to the ciliary body. The tumour has also spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

T4b or T4c

T4b – the tumour is size category 4 and has spread to the ciliary body.

Or

T4c – the tumour is size category 4. It has spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

IIIC

T4d or T4e

N0

M0

T4d – the tumour is size category 4 and has spread to the ciliary body. It has also spread outside of the eyeball, and this part of the tumour is not more than 5 mm thick.

Or

T4e – the tumour is size category 1, 2, 3 or 4. It has also spread outside of the eyeball, and this part of the tumour is more than 5 mm thick.

IV

T1, T2, T3 or T4

N1

M0

The tumour is size category 1, 2, 3 or 4 and may or may not have spread to the ciliary body or outside of the eyeball.

The cancer has spread to nearby lymph nodes.

T1, T2, T3 or T4

N0 or N1

M1

The tumour is size category 1, 2, 3 or 4 and may or may not have spread to the ciliary body or outside of the eyeball.

The cancer may or may not have spread to nearby lymph nodes.

The cancer has spread to other parts of the body, such as the liver or lungs (called distant metastasis).

Staging other types of eye cancer

The following types of eye cancer are grouped and staged with different systems, including TNM staging.

  • lymphoma of the eye
  • squamous cell carcinoma (SCC) of the conjunctiva
  • melanoma of the conjunctiva
  • orbital sarcoma

Recurrent eye cancer

Recurrent eye cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, which is called a distant metastasis, or a distant recurrence.

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