Because the diagnosis depends on the doctor’s expertise, patients with suspected cases of eye cancer should work with an ophthalmologist (an M.D. specializing on the eye) who has been specialty trained in diagnosing cancers of the eyeball.
They may use the following tests and exams to diagnose cancer or monitor its progress during treatment.
Your ophthalmologist may perform a dilated retinal exam and ultrasound imaging to help diagnose tumors of the eyeball. For orbital, eyelid and conjunctival tumors you may undergo a careful inspection of the outside of the eye and eye movements.
Imaging exams can help doctors identify the location, size and shape of suspected cancer tissue. Imaging tests used to diagnose eye cancer include:
- CT or CAT (computed axial tomography) scans: A CT scan uses an X-ray machine to take several pictures from different angles, providing a highly detailed image.
- PET scan: During a positron emission tomography scan, or PET scan, a small dose of radioactive sugar is injected into a patient. A scanner shows where the body distributes the sugar, allowing for the creation of an image. This image can help radiologists find cancer cells in the body.
- MRI (magnetic resonance imaging) scans: Magnetic resonance imaging, or MRI, uses magnetic fields and radio waves to generate pictures of the body’s soft tissue and organs.
- Optical coherence tomography (OCT): An imaging exam used to look at the tumor in greater detail.
- Ultrasound: Ultrasound operates with high-energy sound waves that bounce off internal tissues and organs and produce echo patterns. The echo patterns create a picture referred to as a sonogram, which can be seen on an ultrasound machine.
During a biopsy, a small tissue sample is removed and examined under a microscope for the presence of cancer cells. Depending on tumor location, some biopsies can be done on an outpatient basis with only local anesthesia. Other times patients must undergo a surgical procedure under general anesthesia to retrieve cancer cells. Biopsies are used in limited circumstances to diagnose eye cancer.
Patients undergo blood testing to monitor how the body is responding to treatment.
Molecular diagnosis to look for specific mutation of tumor cells that help doctors understand the risk of metastasis or plan treatment.
DNA and/or genetic testing
These can be used to tell if the patient has an inherited form of eye cancer.
If you are diagnosed with eye cancer, your doctor will determine the stage of the disease. Staging is a way of classifying how much disease is in the body and where it has spread when it is diagnosed. This information helps your doctor plan the best type of treatment for you.
Once a cancer's stage classification is determined, it stays the same even if treatment is successful or the cancer spreads.
The most common staging system used for ocular cancers is the one set up and approved by the American Joint Committee on Cancer (AJCC). The TNM system of the AJCC is based on three key pieces of information:
- T describes the size of the primary tumor and/or whether it has invaded nearby structures
- N describes whether the cancer has spread to nearby (regional) lymph nodes
- M indicates whether the cancer has metastasized (spread) to other parts of the body. The most common site of eye melanoma spread is the liver.
Numbers or letters appear after T, N and M to provide more details about each of these factors:
- The numbers 0 through 4 indicate increasing severity
- The letter X means "cannot be assessed" because the information is not available
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