Awareness on Eye Cancer on International Childhood Cancer Day

February 4th was World Cancer Day and we all did our bit to create awareness on the outcomes of Cancer, its precautions, treatments and effects and how dreadful a disease it is if not diagnosed. February 15 every year is celebrated as International Childhood Cancer Day. International Childhood Cancer Day (ICCD) is an opportunity for the world to come together to raise awareness about childhood cancer and the terrible toll it continues to take on children and families around the world. It is an opportunity to show support for childhood cancer warriors and survivors around the world and their families.

Dr. K. Bhujangashetty with parents of Cancer Survivor & Dr. Roshmi who operated on them - V1

Many of us still think that cancer is an adult disease andnever associate it with children or young adults. However, that does not makethe problem disappear. Childhood cancers are very much a reality and on theverge of becoming a public health concern in a number of developing countrieslike INDIA. According to a 2014 study, Paediatric cancers should be treated asa global child health priority. Dr Christopher Wild, Director of InternationalAgency for Research on Cancer, identifies childhood cancers as a public healthproblem in the developing world. In a statement last year, the organizationmentions that approximately 215,000 new cancer cases are diagnosed every yearin children younger than 15 years of age. Childhood cancers represent onlyabout 1% of total cancer cases in developed countries. However, in low-resourcecountries where children make up almost half of the population, the incidencerate is almost five times higher.

On Account of International Childhood Cancer Day, We atNarayana Nethralaya have taken up the task of creating an awareness on EyeCancer & Retinoblastoma and offer the latest & advances surgicaltechniques to treat Retinoblastoma at concessional rates for the Economicallybackward and totally free of cost  tothose patients who cannot afford the treatment cost at all.

“Retinoblastoma is the most common primary intraocularmalignancy of childhood. About four percent of all childhood cancer isretinoblastoma. Since cancer in children is rarer than in adults,retinoblastoma diagnoses make up only about one percent of all cancerdiagnoses. Approximately one in 15,000 children is diagnosed with pediatricretinoblastoma per year. When the disease is diagnosed in its early intraocularstages, as is usually the case, the probability of disease-free survival hasbeen greater than 80–90%. Till a century ago Retinoblastoma was uniformly afatal disease. Thanks to advances in surgical techniques  focal therapy with laser and cryotherapy, andchemotherapy, the survival rate and preservation of vision have greatlyimproved”, said Dr. Roshmi Gupta, Head, Ocular Oncology, Orbital Disease andOculoplasty.

“Until recently, retinoblastoma outcomes remained uniformlypoor unless diagnosed at an early stage. But with the advent of chemo reductionand external beam radiotherapy, in addition to focal treatments like directphotocoagulation, cryotherapy and trans pupillary thermo therapy, the survivalrates have improved considerably even at advanced stages. However, I would liketo emphasize that screening of children for white reflex should be taken upalong the lines of a public campaign, and dilated fundus screening for childrenshould become a standard clinical practice. The impact of a child going blindis enormous as it corresponds to the loss of number of man years ofproductivity” said Dr. Roshmi

“Early detection of abnormalities could offer prompt management and a reduction in visual morbidity. Mortality rate, that is cancer-related deaths, is also quite high because of lack of healthcare facilities. The problem is not that the disease is untreatable; in fact many of the cancer types that are common in children have a high survival rate, including lack of specialized healthcare institutions, lack of awareness, and financial restraints,” she said.

Treatment of Retinoblastoma is one of the major medical success stories of our era, in that almost 95 % of the children can be saved. This needs commitment. Both from the parents’ side and from the doctor’s side. We usually treat retinoblastoma with a combination of Chemotherapy, lasers, Cryo, i.e. freezing therapy and we keep watching the child every few weeks for several months to make sure that the tumor doesn’t come back”.

Narayana Nethralaya saw around 25 cases in the year 2016. The trend is increasing and more patients are “getting to know about the facilities being provided. On an average, there are 2 cases of Retinoblastoma every month which is being treated successfully. The need of the hour is to spread awareness about Retinoblastoma, enabling early detection and early initiation of treatment to prevent permanent damages” she concluded

Speaking on the occasion, Dr. K. Bhujang Shetty, Chairman and Managing Director of Narayana Nethralaya said, we have treated 129 patients till date for Retinoblastoma and our success rates have been > 90%. We are proud to say that 86 among the 129 patients have been treated free of cost. All thanks to the advanced technology and state of art facilities in Eye Care and Experts from our Hospital. We have been able to deal with these issues very efficiently. And we are glad that more than 90 % of these are from the rural areas.

With the state of art facilities and trained and certified experts, we have come a long way since 2009, when it started to treat eye cancer either through removal of the eye ball and its replacement with a prosthetic eye or recommending a patient for chemotherapy to the latest technique of treating eye cancer, i.e. the Intra Arterial chemotherapy, which only one or two centers in India offer.

We also would like to bring to the notice of people on this occasion of International Childhood Cancer Day that, we have a dedicated retinoblastoma helpline at our Hospital, a helpline which not only creates awareness on Retinoblastoma but also counsels and guides the families of those children suffering from the dreadful disease. As we all know, in any cancer, Time is life. Time is extremely precious. It is not the cancer that kills but, it is the delay in treating the cancer that kills the patient, so also in case of the eye.

“The Treatment of Retinoblastoma, although currently well established, is not accessible to the general population, mostly due to the financial constraints. So, we at Narayana Nethralaya have decided that because of the situation in our country, in case the patients cannot afford the treatment cost, they need not waste time running from pillar to post to collect money for their treatment. We are willing to treat them at concessional rates for the economically challenged families and totally free of cost to those who are not able to afford the cost at all, as far as Eye Cancer in Children are concerned. Rashtriya Bal Swasthya Karyakram (RBSK), Iksha Foundation & Narayana Nethralaya Foundation will be supporting us in the cause” he Concluded.

All we need to know about Retinoblastoma, its causes, effects & preventions:

Retinoblastoma and its causes?

Retinoblastoma is a cancer that starts in the retina, the very back part of the eye. It is the most common type of eye cancer in children. It is the most common intraocular malignancy in children. The survival of retinoblastoma patients and visual outcome has improved dramatically in the developed world. This can be attributed to early tumor recognition and advances in the management of retinoblastoma. 

Retinoblastoma basically occurs among children below five years. This can be caused both genetically and non-genetically. The problem with Indian children is that due to lack of awareness the parents bring their children only after observing anything major in the eyes of their children.

Many people in India don't recognize the symptoms of eye cancer due to lack of awareness. Any patient with a white spot in the eye, squint or any type of shine in the eye balls should come and get tested for retinoblastoma.

How does retinoblastoma develop?

The eyes develop very early as babies grow in the womb.During the early stages of development, the eyes have cells called retinoblaststhat divide into new cells and fill the retina. At a certain point, these cellsstop dividing and develop into mature retinal cells.

Rarely, something goes wrong with this process. Instead ofmaturing into special cells that detect light, some retinoblasts continue todivide and grow out of control, forming a cancer known as retinoblastoma.

The chain of events inside cells that leads toretinoblastoma is complex, but it almost always starts with a change (mutation)in a gene called the retinoblastoma (RB1) gene. The normal RB1 gene helps keepcells from growing out of control, but the change in the gene stops it fromworking like it should. Depending on when and where the change in the RB1 geneoccurs, 2 different types of retinoblastoma can result.

Congenital (hereditary) retinoblastoma

In about 1 out of 3 children with retinoblastoma, theabnormality in the RB1 gene is congenital (present at birth) and is in all thecells of the body, including all of the cells of both retinas. This is known asa germline mutation.

In most of these children, there is no family history ofthis cancer. Only about 25% of the children born with this gene change inheritit from a parent. In about 75% of children the gene change first occurs duringearly development in the womb. The reasons for this are not clear.

Children born with a mutation in the RB1 gene usuallydevelop retinoblastoma in both eyes (known as bilateral retinoblastoma), andthere are often several tumors within the eye (known as multifocalretinoblastoma). Because all of the cells in the body have the changed RB1gene, these children also have a higher risk of developing cancers in otherareas as well.

A small number of children with this form of retinoblastomawill develop another tumor in the brain, usually in the pineal gland at thebase of the brain (a pineoblastoma). This is also known as trilateralretinoblastoma.

For survivors of hereditary retinoblastoma, the risk ofdeveloping other cancers later in life is also higher than average. (For moreinformation, see the section What Happens After Treatment for Retinoblastoma?)

Sporadic (non-hereditary) retinoblastoma

In about 2 out of 3 children with retinoblastoma, theabnormality in the RB1 gene develops on its own in only one cell in one eye. Itis not known what causes this change. A child who has sporadic (non-hereditary)retinoblastoma develops only one tumor in one eye. This type of retinoblastomais often found at a later age than the hereditary form.

Children with this type of retinoblastoma do not have thesame increased risk of other cancers as children with congenitalretinoblastoma.

How does retinoblastoma grow and spread?

If retinoblastoma tumors are not treated, they can grow andfill much of the eyeball. Cells might break away from the main tumor on theretina and float through the vitreous to reach other parts of the eye, wherethey can form more tumors. If these tumors block the channels that let fluidcirculate within the eye, the pressure inside the eye can rise. This can causeglaucoma, which can lead to pain and loss of vision in the affected eye.

Most retinoblastomas are found and treated before they havespread outside the eyeball. But retinoblastoma cells can occasionally spread toother parts of the body. The cells sometimes grow along the optic nerve andreach the brain. Retinoblastoma cells can also grow through the covering layersof the eyeball and into the eye socket, eyelids, and nearby tissues. Once thecancer reaches tissues outside the eyeball, it can then spread to lymph nodes(small bean-shaped collections of immune system cells) and to other organs suchas the liver, bones, and bone marrow (the soft, inner part of many bones).

Treatment for Retinoblastoma & Preventions

Chemoreduction followed by adjuvant consolidative treatmenthas replaced external beam radiotherapy as the primary modality of treatmentfor intraocular retinoblastoma. Further, histopathological high-risk factorshave been identified in enucleated eyes, allowing use of prophylacticchemotherapy to take care of possible micrometastasis.

The ophthalmologists stated that late diagnosis andmisconceptions about the symptoms were the major reasons that the eye cancereven extended to the brain and then to the entire body, ultimately leaving nooption of treatment for the patients.

"Treatments like surgery, laser therapy, chemotherapyare the only way to cure the disease. The situation is such that currently itis not possible to save the eyesight of the patient after the surgery, howeverresearch is on to make it possible," 

Children do not even have access to effective medical care,basic cancer treatments, or sometimes even a diagnosis. Universal eye screeningof neonates is currently not standard of care. Early detection of abnormalitiescould offer prompt management and a reduction in visual morbidity. Sinceretinoblastoma can develop at any point in the first few years of life, promptattention must be given to any abnormality noticed by the child’s parents.

For further information, you may please visit NarayanaNethralaya website on http://www.narayananethralaya.org/


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