Monday, June 23, 2008

Sizing Up Eye Cancer

The ocular oncology community is divided over when to treat small choroidal lesions: when they present with the risk of growth based on the TFSOM clinical standard or when they actually grow.

The above graphic, (click on image for a larger size), uses everyday images to illustrate the size differences between a choroidal nevus (less than 5 mm) and small, medium and large-sized choroidal melanomas (5-18 mm).

A choroidal nevus is a lesion that is roughly the size of the end of a small birthday candle or less than 5 mm in diameter.
Small choroidal melanomas range in diameter from 5 – 10 mm, or from the eraser top of a pencil to the bottom of a AAA battery.
Medium choroidal melanomas range in diameter from 10 - 15 mm, or from a size slightly smaller than a watch battery to the bottom end of a tube of lip balm.
Large choroidal melanomas are more than 15 mm in diameter, or at least dime and penny-sized eye cancers.

Eye cancers larger than 18 mm in diameter are usually enucleated (removed). First, the globe cannot tolerate the radiation doses required to successfully treat such a large cancer. Secondly, to prevent recurrences, treatment usually extends 2-3 mm beyond the tumor's edge. Since the COMS plaques range in size from 12 - 20 mm, a safety margin around a 19 mm tumor is not possible raising the risk of recurrence.

A 12 mm (watch battery-sized) tumor will be treated with at least a 14 mm (AA battery-sized) plaque. In contrast, small melanomas of 7 mm (pencil eraser-sized) in diameter will still be treated with the 12 mm plaque - the smallest currently available plaque size. Proton beam (pg. 19) is also a treatment option for choroidal melanomas.

If you have been diagnosed with a small suspicious or a medium to large-sized choroidal melanoma, this graphic can put the size of your lesion/eye cancer into context using everyday examples which are easily found in a utility drawer or change purse.

It's your sight.

It’s your life.

Together, we can see a cure.™

Thursday, June 19, 2008

A Closer Look - TFSOM

Cancer is a life-threatening disease in which early detection and treatment is the standard of care.

Yet, the eye cancer community continues to debate the merits of early detection and treatment of small but suspicious choroidal nevi. Some ocular oncologists are diagnosing and treating extremely small lesions. Others advocate a wait-and-see approach in which growth indicates malignancy and therefore treatment.

This conversation is taking place while 50% of the patient population dies at 10 to 15 years, a mortality rate that is unchanged despite treatment advances. Since the incidence rates in both the U.S. and Europe are also unchanged, it raises the question as to whether we are catching and treating this rare cancer in time to save the life of the patient.

Under either the COMS or American Joint Committee on Cancer (AJCC) tumor classifications, small choroidal melanomas - when the threat to life is the lowest - are lesions that are less than 3 mm thick and at least 7 mm in diameter.

The TFSOM clinical standard (click on above graphic to view larger image) found that the risk of malignant growth is 50% when 2 or more factors are present. Therefore, waiting for growth when malignant conditions already exist, is begging the question.

Why does size matter? Genetic research is showing that uveal melanomas may acquire more chromosomal defects as they grow, leading to a higher risk of metastatic death. Currently, there is no treatment for metastatic uveal melanoma with the average time of diagnosis to death being 7 to 12 months in unresectable tumors.

Without clear agreement and direction from the ocular oncology community, downstream providers, such as family practitioners, general ophthalmologists and optometrists, will fail to recognize these lesions as early cancers and refer out these patients for specialized sight and life-saving care.

Since a ‘growth’ management philosophy may be potentially devastating on a patient’s outcome, See A Cure urges individuals presenting with small but suspicious choroidal lesions to be informed about the TFSOM standard and the diagnosing controversy so that they can either partner with their doctor - or obtain a second opinion - on their sight and life decision.

It's your sight.

It’s your life.

Together, we can see a cure.™

Wednesday, June 18, 2008

Biology of a Cure?

Why do some small and unremarkable primary uveal melanomas metastasize while larger, more invasive eye tumors do not?

What factors cause an existing choroidal nevus to transform into a choroidal melanoma? And how are those factors different from or similar to the ones that cause uveal melanomas to arise de novo (new)?

How on earth is it possible that the rates of incidence (the number of people diagnosed) and mortality (number of people dying) for uveal melanoma remain eerily unchanged for decades despite diagnosing and treatment advances?

Just what is uveal melanoma (also called choroidal melanoma, eye melanoma, ocular melanoma, intraocular melanoma, eye cancer and ciliary body melanoma)? More importantly, how do we successfully treat this rare and puzzling cancer?

Uveal Melanoma: A Model for Exploring Fundamental Cancer Biology does not answer any of these questions. So far, much of the research on uveal melanoma chromosomes, molecules and proteins has only confirmed long-standing clinical observations that tumor pigmentation, diameter, blood vessel morphology, cell type, race, eye color influences its prevalence, progression and prognosis.

In other words, all this cellular research has merely affirmed on a genetic level what was already known on a clinical level. Real progress will only be achieved when this genetic research is translated into improved patient outcomes - a process which appears decades away from reality.

If, as one of the authors argues, that uveal melanoma is "an excellent model for the study of cancer biology in general," than a more multi-disciplinary and-faceted approach is warranted.

That kind of support is not only going to come from the lab but also from the larger community of medical professionals and their patients. This was a fascinating book which ironically proves that research alone will not lead us to see a cure.

It’s your sight.

It’s your life.

Together, we can see a cure.™