Why was I sent to an oncology Centre if my tumour was not malignant?
The techniques used for diagnosing and treating benign tumours of the
eye are similar to those required for treating malignant tumours. The
appropriate facilities are not widely available because ocular tumours
are rare, making it necessary to concentrate resources in only a few
centres around the country.
If I have an
ocular melanoma, what are my chances of survival?
The chances
of survival are usually good. They depend on:
- The size of the
tumour at the time of treatment;
- Whether the melanoma
cells are spindle-shaped or round (ie, 'epithelioid');
- Whether or not
certain chromosomal abnormalities are present in the tumour cells;
- Whether or not
certain changes have occurred in the supporting tissues within the tumour
(ie, 'closed loops').
Will my tumour
grow significantly by the time I come to the oncology clinic in Liverpool?
If the tumour is a melanoma, it is most unlikely to change significantly
within a few weeks, so the delay of two weeks should not alter your
chances of survival or of saving your eye. Nevertheless, we try to see
patients quickly so as to minimize any anxiety as soon as possible.
If an ocular tumour
is a metastasis, arising from a primary tumour elsewhere, then rapid
growth commonly occurs, making treatment more urgent.
Why didn't the
doctors at my local hospital explain to me what was wrong with my eye?
Ocular tumours are rare and their treatment is highly specialized, so
that many doctors prefer to leave all explanations to us.
Is the eye removed
during surgery?
Not unless it is to be removed permanently. This is because it is not
possible to return the eye to its normal position once it has been removed.
Access to the back of the eye for the insertion of markers or a radioactive
plaque or for local resection is gained by temporarily detaching one
or two muscles from the eyeball and gently turning the eye so that it
looks sideways.
How long will
I be in hospital?
The time you spend in hospital will depend on the type of operation
and the need for any intensive postoperative eye care. The discharge
times are normally as follows:
- One day after
marker insertion;
- One day after
radioactive plaque removal;
- Two days after
removal of the eye;
- The same day,
if any procedure is performed under local anaesthesia.
If you have plaque
radiotherapy, the time for which the plaque is left in place depends
on:
- The size and nature
of the tumour, and hence the dose required;
- The age of the
plaque, which influences the amount of radiation emitted per second.
This is usually
between three and seven days.
What drops will
I be given on leaving the hospital and for how long?
You may be given any of the following drops:
- Chloromycetin
or other antibiotic drops, to be taken four times daily for one week,
to prevent infection;
- Betnesol or other
steroid drops, to be taken four or six times daily for between four
and twelve weeks, to reduce inflammation;
- Atropine, Mydrilate
or other pupil-dilating drops, two or three times daily for three to
four weeks, to prevent painful spasm of the eye muscles. These drops
may blur your vision.
What are the
side-effects of radiation?
If you receive plaque radiotherapy or proton beam radiotherapy, any
side-effects will be limited to the region of the eye itself.
Within the eye,
these can include:
- Fluid leakage
from the tumour, this fluid accumulating within or beneath the retina,
causing retinal detachment;
- Closure of the
blood vessels within the optic nerve or retina;
- Cataract;
- The formation
of delicate blood vessels, which have a tendency to bleed into the eye;
- The formation
of blood vessels on the iris, which prevent fluid outflow from the eye,
resulting in elevation of the intraocular pressure and pain.
- Outside the eye,
these can consist of:
- Loss of lashes
in the treated area;
- Redness of the
eye;
- Watering or dryness
of the eye;
Before your treatment,
you will be told of the chances of developing any of these side-effects.
You should not
lose your hair or develop any general side effects as a result of radiation.
There is no radioactivity
remaining after your treatment is completed, that is, once the radioactive
plaque is removed or once the proton beam is switched off.
How much pain
will I experience?
We will give you whatever medications are necessary to control pain.
Our usual measures for dealing with this problem include:
- Paracetamol, ibuprofen
or other oral analgesics, to be taken every six hours;
- Infiltration of
the eye with a long-acting local anaesthetic, administered during your
operation;
- Strong agents,
such as morphine, if pain is severe.
Previously, painkillers
were only offered on request whereas now we prefer to administer these
agents every six hours whether or not there is any pain, so as to prevent
pain from developing in the first place.
If I have a
melanoma, aren't my chances of survival better if my eye is removed
than if it is conserved?
Several studies have shown that as long as long as the tumour is
destroyed, the chances of survival are about the same whether the eye
is removed or whether it is saved.
What is meant
by 'conservative treatment' and is such treatment more 'old-fashioned'
than radical treatment?
Conservative treatment is any kind of treatment that aims to conserve
the eye and vision. Radical treatment refers to removal of the eye.
Nowadays, conservative treatment has largely superseded radical treatment.
Is it possible
to remove or treat the wrong eye?
To prevent the wrong eye from being treated, we always tape the normal
eye shut, then sterilize the skin around the abnormal eye using a yellow
disinfectant, then cover the face with a drape containing a small window,
placing this window over the abnormal eye, and then we examine the eye,
by ophthalmoscopy if necessary, not proceeding with the surgery until
the tumour is seen. This protocol makes it impossible to operate on
the wrong eye.
What should
I bring with me to the hospital?
You should bring:
- All medicines
and drops;
- Dressing gown;
- Slippers;
- Underwear;
- Toiletries;
- Hairbrush or comb;
- Toothpaste and
toothbrush;
- Soap and towels;
- Shaving equipment.
If you use any of
the following:
- Spectacles or
contact lenses;
- Hearing aid;
- Walking stick;
- Special shoes;
- Zimmer frame.
If you wish, you
can bring any of the following items:
- Books/magazines;
- Knitting;
- Writing materials;
- Personal stereo;
- A small amount
of money
- A magnifying lens.
What should I
not bring with me to the hospital?
You should not bring:
- large amounts
of money;
- valuables;
- food requiring
refrigeration;
- alcohol.
The hospital does
not accept liability for loss of or damage to any of your personal possessions.
Where can my
accompanying relatives stay while I am in hospital?
If possible, your relatives will be accommodated in the Hilsborough
suite. If this is full, we will organize on your behalf a room at a
nearby hotel.
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