How is retinoblastoma treated?

Most cancers are treated by (i) removing the affected part so that it does not spread to other part of the body and cause death. (ii) using radiation treatment. (iii) giving intravenous medicines (chemotherapy) (iv) by using laser or cryo treatment. Retinoblastoma is also treated based on these broad principles.

As an initial step, your ophthalmologist may advice “examination under general anaesthesia”, where the child is examined in detail after giving a short anaesthesia. This is essential to examine the child’s eyes completely and plan treatment. This examination under general anaesthesia may have to be repeated at every visit of the child to assess the treatment response.

Your doctor might have already briefed you about the tentative plan of treatment for your child. He may have advised “Enucleation” that is removal of the eye if the tumour is very advanced. Enucleation is usually advised when the tumour is very large and the eye does not have any vision. Removing this sightless eye will decrease the chances of the tumour spreading to other parts of the body and causing death. Most children adapt to this procedure quite well and grow up normally with one eye. They can attend regular school and be as normal as any other child.

To make the child appear normal, your doctor will fit a “cosmetic shell” in place of the removed eye, 6 weeks later. Some movement of this cosmetic eye can be expected though it cannot match the normal eye.

Subjecting a child to enucleation is a traumatic experience. However, it is in the child’s own interest. Your child’s life may be in danger if the eye is not removed. Eye saving treatment may be tried if the eye with the tumour has vision. If the tumour is small, your doctor may advice “Laser treatment, Cryo treatment or Transpupillary Thermotherapy”, which are treatments that can be performed during examination of the Child under anaesthesia.

If the tumour is large in an eye with vision or if it is the only remaining eye of the child, your doctor may advice “Radiation or Chemotherapy”. You will be referred to a cancer hospital for these treatments as these treatments are available at specialized cancer hospitals only.

Though the treatment is done at the cancer hospital, it is your ophthalmologist who can assess the response to treatment and hence you should come back to your ophthalmologist for follow-up. If chemotherapy is done, it has to be followed-up by Laser or Cryo treatment which will be done by your ophthalmologist.