Types of Childhood Cancer

Retinoblastoma

• Types
• Symptoms
• Typical Treatments
• Stages

Retinoblastoma is a cancer of the eye. It is rare, accounting for just under 3% of childhood cancers. It usually occurs in children under the age of 4, and is seldom found in children older than 6. Retinoblastomas are usually found because a parent or doctor notices a child’s eye looks unsual. Normally when you shine a light in a child’s eye, the pupil (the dark spot in the center of the eye) looks red because of the blood vessels in the back of the eye. In an eye with retinoblastoma, the pupil often looks white or pink. The white glare of the eye may be noticed after a flash picture is taken.
About 3 out of 4 children with retinoblastoma have a tumor in only one eye. In about 1 case in 4, both eyes are affected.
Retinoblastoma occurs about equally in boys and girls and in different races and ethnicities. It also occurs equally in the right or left eye.
Overall, more than 90% of children with retinoblastoma can be cured, but the outlook is not nearly as good if the cancer has spread to other parts of the body.

Types

Unilateral retinoblastoma affects one eye and accounts for about 75% of cases. It can either be hereditary or sporadic. The latter usually occurs in children over age one and is about 75% to 80% of unilateral cases.

Bilateral retinoblastoma affects both eyes, and usually indicates a genetic influence. In one-fourth of cases, there is a positive family history. A new mutation occurs in about 75% of cases. The disease can slso be the result of inheritance from a parent who carries but does not have symptoms of retinoblastoma. About 10% of carriers do not develop the disease. Patients with bilateral retinoblastoma are usually diagnosed at a younger age (under one year old) than those with unilateral disease.

In trilateral retinoblastoma, children with inherited retinoblastoma develop an associated intracranial neuroblastic (originating in primitive nerve cells) tumor. These tumors are rare, occurring in about 5% of patients with bilateral retinoblastoma.

Symptoms

• Opaque white area in the pupil (leukocoria), caused by the tumor reflecting light
• Problems with eye movement (eyes may cross) (strabismus)
• Decreased vision in one eye
• Eye pain
• Pinkeye (erythmatous conjunctivae)

Typical Treatments

Standard Retinoblastoma Treatment (additional new types of treatments are being tested in clinical trials and can be found on the NCI Web site): The treatments listed below are to be used as a suggestion of what you may expect. Please speak with your doctor about specific treatment plans he or she may have for your child.

• Laser treatment, or photocoagulation, is a very successful treatment for small tumors that are confined to the retina but do not involve the optic disc or the area near it called the macula.
• Cryotherapy, or freezing treatment, is performed in multiple sessions to treat small, peripheral tumors.
• Chemotherapy 
• Radiation therapy 
• Enucleation surgery, or removal of the eye, may be performed when the tumor fills more than half the eye, when other structures in the eye are involved or when the retina is detached. Because tumors are detected earlier now than in the past, and more conservative treatments can be used, there has been a significant decrease in enucleation.

In addition, new types of treatments are often being tested in clinical trials and can be found on the National Cancer Institute Website.

Remember, you’re not alone.
Use our Forums to ask other parents what they’ve experienced.

Stages

The following stages are used for retinoblastoma:

• Intraocular retinoblastoma

In intraocular retinoblastoma, cancer is found in the eye and may be only in the retina or may also be in other parts of the eye such as the choroid, ciliary body, or part of the optic nerve. Cancer has not spread to tissues around the outside of the eye or to other parts of the body.

• Extraocular retinoblastoma

In extraocular (metastatic) retinoblastoma, cancer has spread beyond the eye. It may be found in tissues around the eye or it may have spread to the central nervous system (brain and spinal cord) or to other parts of the body such as the bone marrow or lymph nodes.

References:

MD Anderson Childhood Cancer Types. Houston, TX: MD Anderson. Retrieved August 15, 2011 from http://www.mdanderson.org/patient-and-cancer-information/
cancer-information/cancer-types

National Institute of Health. Types of Cancers 2011. Retrieved September 13, 2011 from http://www.cancer.gov/cancertopics/pdq/treatment

American Cancer Society. Cancer Facts and Figures 2009. Atlanta, GA: American Cancer Society. Retrieved September 1, 2011, from http://www.cancer.org/downloads/STT/CAFF2009PWSecured.pdf.