ORBITAL TUMOR
An orbital tumor refers to any tumor
located in the “orbit,” which is the bony socket in the front of the skull that
contains the eye. The socket is a complicated structure that includes the eye
itself along with muscles, nerves, and connective tissue.
OVERVIEW
The orbit is the cone-shaped bony
socket that contains the eyeball; the orbital contents include the extraocular
muscles that move the eye, the optic nerve, the nerves and blood vessels
supplying these structures and the fat inbetween. Tumors that develop in any of
the tissues that surround the eyeball are referred to as orbital tumors
COMMON TYPES OF
ORBITAL TUMOUR
Orbital tumors may affect both
adults and children. Fortunately, in both age groups most orbital tumors are
benign.
The most common orbital tumors in
children are
Rhabdomyosarcoma
is the most common cancer that starts in the orbit in children.
Retinoblastoma is the most common tumor inside the eyeball in children.
Neuroblastoma is the most common cancer to spread to the orbit in children.
Dermoids and
vascular lesions such as
capillary hemangiomas, lymphangiomas and cavernous hemangiomas
Adult orbital
tumors are usually malignant and can include:
Lymphoma: This is the most common type of orbit tumor that starts in adults. Lymphoma is
a cancer of the blood in which specific white blood cells (called lymphocytes)
become cancerous. Even though lymphoma is a blood cancer, it usually presents
as a solid tumor in the body.
Lacrimal gland
cancers: These are very similar to salivary
gland cancers, and they can be of the same type, including:
1.
Adenoid
cystic carcinoma
2.
malignant
mixed tumor (carcinosarcoma)
3.
Adenocarcinoma
Lacrimal sac
cancers: These can include squamous cell
carcinoma, adenocarcinoma, transitional cell carcinoma, salivary gland
carcinoma and poorly differentiated carcinoma.
Cancers of the
skin of the eyelid: These can
include squamous cell carcinoma, basal cell carcinoma and even rare tumors such
as sebaceous cell carcinoma and Merkel cell carcinoma.
Sarcomas: These can also arise in the orbit and include rhabdomyosarcoma,
osteosarcoma, chondrosarcoma, liposarcoma and angiosarcoma.
Other very rare tumors such as
malignant neurogenic tumors or peripheral nerve sheath tumors are possible;
multiple myeloma, or even spread of cancers from another site, are possible as
well.
TNM staging system
One tool that doctors can use to
describe the stage is the TNM system.Factors that go into determining the stage
of the cancer in orbital tumour.
T Characteristics
of the main Tumor mass
N Status of the lymph Nodes in the neck (i.e., evidence
of cancer spread)
M Metastasis Status
of cancer spread to parts of the body outside of the head and neck
CAUSES OF
ORBITAL TUMOUR
The cause of primary orbital tumors
is unknown. In children most orbital tumors result from developmental
abnormalities. When visual loss or deterioration occurs with an orbital tumor,
it may result from either mass effect, compromise of the vasculature to the
optic apparatus as a result of the tumor, or invasion of the optic nerve by the
tumor.
SYMPTOMS OF
ORBITAL TUMOUR CAN INCLUDE:
Many people with tumour don't have
symptoms unless the tumour grows in certain parts of the eye or becomes more
advanced.
1.
Blurred
vision.
2.
Redness
of the eye
3.
Shadows,
flashes of light
4.
A
dark patch in the eye that's getting bigger.
5.
Partial
or total loss of vision.
6.
Bulging
of one eye ,sudden proptosis
7.
A
lump on eyelid or in your eye that's increasing in size.
8.
Pain
in or around eye, although this is rare.
Diagnostic
tests
In addition to a physical
examination, the following tests may be used to diagnose eye cancer:
Eye
examination.
Most cases of melanoma are found
during a regular eye examination. The doctor will examine the eye with a
lighted instrument called an ophthalmoscope and a slit lamp, which is a
microscope with a light attached to it.
Ultrasound. An ultrasound uses sound waves to create a picture of the eye.
Fluorescein
angiography. This
procedure takes a picture of the blood vessels in the eye. Fluorescein
angiography may be used to rule out eye problems other than cancer
Fine needle
biopsy. This procedure removes tumor cells
from the eye with a needle. This allows the doctor to look at the cells under a
microscope.
Cytogenetics
and gene expression profiling. Doctor's may recommend this type of test to
help gather more information about your prognosis (chance of recovery) and
treatment options. Cytogenetics or gene expression profiling tests are done
using a tissue sample removed during either a biopsy or surgery.
Computed
tomography (CT) scan. A
CT scan creates a three-dimensional picture of the inside of the body . it
provides a detailed, cross-sectional view that shows any abnormalities or
tumors. A CT scan can also be used to measure the tumor’s size. A special dye
called a contrast medium is given before the scan to create a clearer picture.
This dye can be injected into a patient’s vein or given as a pill to swallow.
Magnetic
resonance imaging (MRI). An MRI uses
magnetic fields to produce detailed images of the body. MRI can also be used to
measure the tumor’s size. A special dye called a contrast medium is given
before the scan to create a clearer picture. This dye can be injected into a
patient’s vein or given as a pill to swallow.
Positron
emission tomography (PET) scan. The
doctor may also order a positron emission tomography (PET) scan. A PET scan is
a way to create pictures of organs and tissues inside the body. A small amount
of a radioactive sugar substance is injected into a patient’s body. This sugar
substance is taken up by cells that use the most energy. Because cancer tends
to use energy actively, it absorbs more of the radioactive substance. A scanner
then detects this substance to produce images of the inside of the body.
PROGNOSIS
Surgical removal is curative for
many orbital tumors and the cosmetic results can be excellent. The outcome and
prognosis ultimately depends on the pathological diagnosis. Some orbital tumors
may require additional therapy rather than biopsy or removal this may include
conventional "external beam" or Gamma Knife Radiotherapy.
Occasionally chemotherapy may also be necessary.
MEDICAL AND SURGICAL
MANAGEMENT
GOALS
To prevent a
malignancy from progressing to a life-threatening stage
To preserve
vision, and preserve the eye
To alleviate
the symptoms of an orbital tumor and restore the patient to good health
1.
Radiotherapy
2.
Chemotherapy
3.
Gamma
Knife Radiosurgery
4.
Surgical
excision
Surgical removal of the cancer is
often the first line of treatment for head and neck cancers.
Orbitotomy. A surgical incision made into the orbit to allow the removal of a
tumour or foreign body, to treat a lesion, or to drain an abscess.
Evisceration
Evisceration is the removal of the
inside of the eyeball but not the outer layers.
Exenteration
Orbital exenteration is the removal
of the entire eye socket, optic nerve and even bones surrounding the eye.
Enucleation
Enucleation is the removal of the
eye but leaving the eye socket in place.
BIBLIOGRAPHY
1.
Brunner
and Suddarth’s, “Medical Surgical Nursing” Published by Lippincott, 10th
edition.
2.
Lewis,
Heitkemper and Dirksen’s , “Medical surgical nursing”, Published by Mosby, 6th
edition.
3.
Head
and neck cancer guide.com
4.
Nursesoutlook.blogspot.com
