What is retinoblastoma?
Retinoblastoma is a rare cancer of the retina, the thin membrane on the inside back of the eye that is stimulated by light. Retinoblastoma is usually diagnosed before a child reaches the age of 3.
Retinoblastoma can be hereditary (passed down in families) or non-hereditary.
- Forty percent of retinoblastoma patients have a genetic defect that leads to multiple tumors in one eye or both eyes. This is known as hereditary or germline retinoblastoma. These patients are typically diagnosed before 1 year of age.
- Patients with hereditary retinoblastoma may pass this disease to their children.
- Throughout their lives, patients with hereditary retinoblastoma are more likely to develop other cancers inside and outside of their eyes.
- Sixty percent of patients have the nonhereditary form of retinoblastoma. Each of these patients develops a tumor in only one eye. Nonhereditary patients are diagnosed on average around 2 years of age.
Untreated, retinoblastoma can spread widely:
- Throughout the retina
- Throughout the fluid inside the eye (also called the vitreous). Large tumors may detach from the retina and break into smaller tumors, called vitreous seeds. Floating in the vitreous, these seeds are very difficult to treat.
- Into the tissue under the retina
- Into the eye socket, optic nerve and brain
- To the bones and the bone marrow
How common is retinoblastoma?
- Retinoblastoma accounts for about 3 percent of all childhood cancers.
- About 250 to 300 children in the United States are found to have retinoblastoma each year.
What are the symptoms of retinoblastoma?
Symptoms of retinoblastoma may include:
- “Cat’s eye”: a white-yellow mass or glow seen through the pupil—often first noticed in a photo of a child’s face when the flash is used without “red eye reduction.” Normally, the center of the eye appears red in response to the camera flash, but in retinoblastoma, the center of the eye may have a white glow.
- Complaints of poor vision
- One or both eyes turning inward or outward
- Pain from increased pressure in the eye as the tumor grows
How is retinoblastoma treated?
Treatment of retinoblastoma depends on whether:
- The tumor affects one eye or both eyes
- The center of vision is affected by the tumor
- The tumor has spread to other parts of the body
Treatment can include surgery, chemotherapy, focal therapy and radiation therapy.
- Surgery — is used to remove the eye, if needed.
- Eye(s) may be removed in children with advanced retinoblastoma.
- In patients with only one affected eye: When that one eye is removed, more than 90 percent of those patients do not need any more treatment.
- In patients with both eyes affected: If one eye is removed, treatment will focus on saving the remaining eye.
When the tumor has spread into the tissues surrounding the eye or the eye socket, the patient is treated with chemotherapy after surgery.
- Chemotherapy (“chemo”) — uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells:
- Chemo may be injected into the blood stream, so that it can travel throughout the body.
- Chemo may also be injected around the eye (periocular) for local treatment.
- Combination therapy uses more than one type of chemo at a time.
Chemotherapy alone cannot cure retinoblastoma, so patients often receive “focal therapy.”
- Focal therapy — is treatment with laser therapy or freezing treatments (cryotherapy) while under anesthesia (medicine to help the child sleep). These focal therapies may continue even after chemotherapy is complete. Sometimes, the tumors in the eye are small enough to be treated with only focal therapy.
Very rarely the tumor invades the brain or spreads to the bones or bone marrow. These patients require more intensive chemo, usually including a stem cell transplant.
- Stem cell transplant — includes replacing blood-forming cells in the bone marrow that have been killed by chemo and/or radiation therapy:
- A stem cell transplant gives the patient new immature blood cells from a donor’s blood or bone marrow. These cells grow into healthy blood cells to replace the ones the patient lost.
- Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
Sometimes only radiation therapy, the strongest treatment for fighting retinoblastoma, helps maintain vision and prevent the spread of the cancer.
- Radiation therapy — uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. Radiation is reserved for patients who have not responded to other therapies.
- External radiation uses machines outside the body to deliver the X-ray dose.
- Internal radiation uses needles, seeds, wires or catheters (tubes) to deliver the radiation directly into or close to the cancer.
A very young child with multiple tumors or retinoblastoma in both eyes is likely to keep developing retinoblastoma tumors until 3 years of age. So, treatment might be less aggressive until age 3:
- Chemotherapy — to shrink the tumors
- Focal therapy — laser therapy and certain freezing methods done under anesthesia
What are the survival rates for retinoblastoma?
- If the tumor is contained within the eye (one or both eyes), more than 95 percent of treated patients can be cured.
- For children with retinoblastoma in both eyes, about 70 to 80 percent of the eyes can be saved.
Why choose St. Jude for your child’s retinoblastoma treatment?
- St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
- St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
- The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
- Your child will have access to a large clinical team of pediatric oncologists, ocular oncologists, pediatric ophthalmologists, surgeons, radiation treatment specialists, rehabilitation specialists and genetic counselors at St. Jude. This team forms one of the largest groups anywhere in the world dedicated to the treatment of children with retinoblastoma.
- Complete retinoblastoma treatment includes on-site services to enhance your child’s quality of life, including physical therapy, speech therapy, and a low-vision rehabilitation clinic for children whose sight has been impaired. These specialists work together so that each patient can make the best of the vision that remains.
- Clinical efforts to improve ocular salvage (saving the eye) and vision preservation occur alongside research efforts that find new strategies to treat rare diseases such as retinoblastoma.
- St. Jude scientists have found possible targeted therapies that kill retinoblastoma cells better than compounds used in the past. These drugs may dramatically impact the treatment of children with this type of cancer.
- Cancer survivors, especially those cured at a young age (such as retinoblastoma patients) face medical and psychosocial challenges as they age. The After Completion of Therapy (ACT) Clinic provides close monitoring and resources for managing late effects related to disease and therapy. They offer these services for St. Jude patients until they are 18 years of age or until 10 years after diagnosis.
Associated Clinical Trials
Intravitreal Carboplatin for the Treatment of Participants with Recurrent or Refractory Intraocular Reintoblastoma
- Age 17 or younger
- Diagnosis of retinoblastoma that did not go away with treatment or came back after treatment
SJRET6: Combination Chemotherapy in Treating Patients with Newly Diagnosed, Previously Untreated Intraocular Retinoblastoma
Protocol for the Study and Treatment of Participants with Intraocular Retinoblastoma
- Newly diagnosed retinoblastoma that has not spread beyond the eye
- Has not received previous treatment with chemotherapy or radiation therapy
- Patients who have been diagnosed with retinoblastoma in one eye who did not receive chemotherapy, but then developed retinoblastoma in the opposite eye
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