Little did Mark Hood know how life would change the day his reading glasses broke.
“I was at the office, juggling a million things,” says the busy software executive from Austin, Texas, “when my prescription glasses snapped in two.”
He drove to local store to order a new pair. While there, the optometrist performed a cursory checkup.
“I’d been putting off my annual eye exams for several years because my vision wasn’t changing,” says Hood, 54.
The optometrist completed his exam, then shared some somber news.
“You have a small area of abnormal tissue in your left eye, and it may be cancerous. You need to see a retinal specialist tomorrow.”
The next day, a stunned Hood sat in the office of an Austin retinal surgeon, who held his hand and delivered the diagnosis: “I know this is difficult to hear, but you have cancer.”
She sent Hood to MD Anderson’s Chief of Ophthalmology, Dan S. Gombos, M.D., for a second opinion. With that visit, all doubt was removed.
“Yep, this is melanoma of the eye,” Gombos concurred, “and we’re going to take care of it.”
Eye melanoma vs. skin cancer: different diseases with different treatments
Most people think of melanoma as an aggressive type of skin cancer, but 5% of melanomas originate in the eyes. The cancer forms in melanocytes – the cells that make the pigment known as melanin that gives color to skin, eyes and hair. Eye melanomas behave much differently than skin melanomas and can be much more challenging to treat.
“Even though people want to lump eye and skin melanomas together, they’re very different diseases. A lot of the treatments for skin melanoma don’t work for eye melanoma. The genes involved in the two cancers are significantly different,” explains Gombos, who is president of the American Association of Ophthalmic Oncology and Pathology and vice president of the International Society of Ocular Oncology.
When uveal melanoma spreads beyond the eye, treatment options are limited
Most eye melanomas, like Hood’s, develop in the uvea (you-vee-uh) – a layer of tissue beneath the white of the eye. Though exceeding rare, the rest occur on the conjunctiva – the outermost tissue layer, or on the skin that surrounds the eyeball.
When melanoma doesn’t spread beyond the eye, the five-year survival rate is 80%. But half of uveal melanoma patients develop metastatic disease that spreads mainly to the liver, and sometimes to the lungs or bones. When this happens, the five-year survival rate drops to just 15%.
“For patients whose cancer has spread, treatment options are limited,” Gombos says. “That’s why a significant amount of uveal melanoma research focuses on understanding and preventing metastasis.”
Uveal melanoma symptoms
Uveal melanoma is classified as an “orphan” disease – a rare condition that affects only a small number of people. A mere 2,500 individuals are diagnosed with the disease each year in the United States. Many, like Hood, have no forewarning symptoms.
“Most cases appear out of the blue, and are uncovered during a routine eye exam,” Gombos explains. “Patients are caught off-guard.”
Hood remembers that experience: “In the span of five short days, I went from ‘I’m healthy, happy and life is great’ to ‘I have cancer – will I lose my vision, will I lose my life?’”
Those who do have symptoms report blurry vision or loss of peripheral vision in one eye; a growing dark spot in the colored part of the eye, called the iris; a pupil that has changed shape; or flashes of light or “floaters” in their field of vision.
“These often are the first signs of trouble,” Gombos says. “Get checked promptly by an ophthalmologist, because an earlier diagnosis means a better chance for recovery and more treatment options.”
Plaque brachytherapy provides effective eye cancer treatment
Hood was lucky. His broken eyeglasses led him to a doctor before his tumor had time to grow.
“My cancer was caught early,” he says, “but without those damaged glasses … I shudder to think. Divine intervention was definitely happening that day.”
On a scale of small, medium and large, pathologists classified Hood’s tumor as small. It was only two millimeters wide, the width of two pencil leads. And it hadn’t spread to other organs.
This made Hood a perfect candidate for a treatment known as plaque brachytherapy, a procedure where a plaque, or disc – think tiny bottle cap – is stitched to the back of the eye, directly over the tumor. The plaque is embedded with radioactive seeds that continuously deliver concentrated doses of cancer-killing radiation directly to the tumor, while sparing nearby healthy tissue and maintaining the patient’s vision. Four to seven days later, the procedure is complete and the plaque is removed.
“Plaque brachytherapy offers a greater than 90% likelihood of controlling the disease in the eye,” says Gombos.
A devoted ruthenium fan after effective treatment
Radioactive iodine has long been the most common source of radiation used in plaque brachytherapy. But MD Anderson is among a handful of hospitals in the United States that have access to a radioactive form of platinum called ruthenium, widely used in Europe.
“Ruthenium gives a very high radiation dose to a very small area — even more so than iodine — so the toxicity to normal tissues tends to be less,” Gombos says.
But because of its shallow depth of penetration, ruthenium is typically reserved for very small tumors, those less than 5 millimeters. Gombos says that describes a large percentage of the uveal melanoma tumors seen at MD Anderson.
“Iodine is still a very good treatment,” he says, “but for patients with very small tumors, ruthenium seems to be even better.”
Hood, for one, is a devoted ruthenium fan. The personalized license plates on his car read “RU44TY” – “RU” for ruthenium, “44” for ruthenium’s atomic number on the periodic table of elements, and “TY” for thank you.
He’s also an ardent admirer of Gombos and his entire MD Anderson treatment team.
“I had all these experts assembled in one place – doctors, imaging technicians, nurses, appointment schedulers, and more, who helped me focus on staying positive and assured me I was never alone.”
Shifting priorities after eye cancer treatment
It’s been three years since Hood’s diagnosis, and he’s still cancer-free.
He returns regularly to MD Anderson to be checked for signs of recurrence. Gombos handles the ophthalmology duties, while Hood says oncologist Sapna Patel, M.D., “monitors the rest of me to make sure cancer doesn’t pop up somewhere else.”
Each visit, Hood says, serves as a reminder that “life is a timed event, so we should focus on what really matters.”
“I’ve been forever changed by the events of the last three years, and my priorities have shifted,” he explains. “I was a ‘Type A’ company executive – always busy and on the go – but now I’ve learned to relax and enjoy the little things. My story began with me seeking clearer vision, and I’ve found it, in more ways than one.”