Eye symptoms may signal bigger problems for cancer patients

Hakan Demirci, M.D., director of the Kellogg Eye Center's new Orbital and Ocular Oncology Service

Fundus photo of the left eye showing a metastatic tumor (see arrows) from breast cancer in a 55-year-old female.

Eye problems in patients with cancer should send up a red flag, says Hakan Demirci, M.D., director of the Kellogg Eye Center's new Orbital and Ocular Oncology Service. These eye symptoms may reveal the presence of an ocular tumor, which may be an early sign of systemic metastasis.

Demirci is developing a multidisciplinary network of physicians at the Eye Center and throughout the U-M Health System to manage care of patients with ocular cancers. "Our goal is to communicate with colleagues and patients about symptoms that can have profound implications for the patient's health," he says

The most common intraocular tumor is often the result of metastasis from primary cancer of the breast or lung, observes Demirci. He cites studies showing that 47 percent of intraocular metastatic tumors arise from breast cancer, while 20 percent of ocular metastasis can be secondary to lung cancer.

Yet the symptoms are not always obvious. About two-thirds of these patients will complain of blurry vision, while the rest may have no symptoms. Upon clinical examination, metastatic cancers are likely to be yellow in color, plateau shaped, and associated with subretinal fluid; frequently, the tumor is located on the macula or between the macula and equator.

"When eye symptoms arise in a cancer patient, it is critical that an ophthalmologist become involved in that patient's care," says Demirci. Recent studies show that when cancer metastasizes to the eye, the risk of it spreading to the brain or central nervous system increases significantly. Imaging of the brain and central nervous system should be part of systemic evaluation.

If detected early, metastatic lesions can be successfully treated with modalities that include external beam radiotherapy or radioactive plaque brachytherapy, systemic and hormone eye symptoms may signal bigger problems for cancer patients therapies, and, in selected cases, an emerging class of immunotherapies. "There is always concern that ocular tumors go undetected in patients with advanced cancers," says Demirci. "In the face of multiple health problems, these patients may not mention eye complaints."

Other concerns arise when the eye is the primary site of a tumor, as in uveal melanoma, the most common primary eye tumor. While diagnosis may be challenging due to atypical clinical presentation, early detection of uveal melanoma is important.

Demirci believes that advances in ophthalmic genetics and emerging treatments will improve systemic outcomes for patients with ocular tumors. "With new gene profiling tests, we are better able to identify the uveal melanoma patients who carry a higher risk of developing systemic metastasis," he notes.

Kellogg ophthalmologists are also working closely with colleagues in radiation oncology to adopt new techniques to minimize side effects associated with radioactive plaque brachytherapy. And clinical trials are now available at the U-M Comprehensive Cancer Center to evaluate new treatments for patients with systemic metastasis from uveal melanoma.

Demirci's hope is that all physicians become more vigilant in looking for eye disease in cancer patients. "With early diagnosis and treatment, these patients can expect to have improved vision and better quality of life," he says.

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Orbital and Ocular Oncology