Retinoblastoma

From the 'American Cancer Society'

 

Retinoblastoma

Retinoblastoma is a cancer of the eye. It accounts for about 3% of childhood cancers. It usually occurs in children around the age of 2, and is seldom found in children older than 6. Retinoblastomas are usually found because a parent or doctor notices a child’s eye looks unusual. Normally when you shine a light in a child’s eye, the pupil (the dark spot in the center of the eye) looks red because of the blood in vessels in the back of the eye. In an eye with retinoblastoma, the pupil often looks white or pink. This white glare of the eye may be noticed after a flash picture is taken.

What is retinoblastoma?

Most cancers are named for the part of the body where the cancer starts. 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. Rarely, children can have other kinds of eye cancer, such as medulloepithelioma, which is described briefly below. But the information in this document focuses on retinoblastoma and not other kinds of eye cancer.

To understand retinoblastoma, it helps to know something about the normal structures of the eye and how they work.

About the eye

The main part of the eye is the eyeball (also known as the globe), which is filled with a jelly-like material called vitreous. The front of the eyeball has a lens with an iris (the colored part of the eye that acts like a camera shutter), which allows light to enter the eye and focuses it on the retina.

The retina is the inner layer of cells in the back of the eye. It is made up of specialized nerve cells that are sensitive to light. These light-sensing cells are connected to the brain by the optic nerve, which runs out the back of the eyeball. The pattern of light (image) that reaches the retina is sent through the optic nerve to an area of the brain called the visual cortex, allowing us to see.

Illustration showing parts of the eye and the location of the retina.

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 retinoblasts that divide into new cells and fill the retina. At a certain point, the cells stop dividing and develop into mature retinal cells.

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

The chain of events that lead to retinoblastoma is complex, but it starts with an abnormality (mutation or change) in a gene called the retinoblastoma (Rb or RB1) gene. The normal RB1 gene helps keep cells from growing out of control. Depending on when and where the change in the RB1 gene occurs, 2 different types of retinoblastoma can result.

Congenital (hereditary) retinoblastoma

In about 1 out of 3 retinoblastomas, the abnormality in the RB1 gene is congenital (present at birth) and is in all the cells of the body (known as a germline mutation). This includes all of the cells of both retinas.

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

Children born with a mutation in the RB1 gene usually develop retinoblastoma in both eyes (bilateral retinoblastoma). Within the eyes there are often several tumors (multifocal retinoblastoma).

Because all of the cells in the body have the changed RB1 gene, these children also have a higher risk of developing cancers elsewhere in the body.

  • A small number of children with this form of retinoblastoma will develop another tumor in the brain, usually in the pineal gland at the base of the brain (a pineoblastoma). This is also known as trilateral retinoblastoma.
  • For survivors of hereditary retinoblastoma, the risk of developing other cancers later in life is also higher than average. (For more information, see the section, “What happens after treatment for retinoblastoma?”)

Sporadic (non-hereditary) retinoblastoma

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

How does retinoblastoma grow and spread?

If retinoblastoma tumors are not treated, they can continue to grow and may fill much of the eyeball. Cells may break away from the main tumor on the retina and float through the vitreous to reach other parts of the eye, where they can form more tumors. If these tumors block the channels that let fluid circulate within the eye, the pressure inside the eye can rise. This can cause glaucoma, a possible serious complication of retinoblastoma, which can lead to pain and loss of vision in the affected eye.

Most retinoblastomas are found and treated before they have spread outside the eyeball. But retinoblastoma cells can occasionally spread to other parts of the body. The cells sometimes grow along the optic nerve and reach the brain. Retinoblastoma cells can also grow through the covering layers of the eyeball and into the eye socket, eyelids, and nearby tissues. Once tissues outside the eyeball are affected, the cancer may then spread to lymph nodes (small bean-shaped collections of immune system cells) and to other organs such as the liver, bones, and bone marrow (the soft, inner part of many bones).

Medulloepithelioma

Medulloepithelioma is another type of eye tumor. It is not a type of retinoblastoma, but it is mentioned here because it also usually occurs in young children. These tumors are very rare.

Most medulloepitheliomas are malignant (cancerous), but they rarely spread outside the eye. They usually cause eye pain and loss of vision.

The diagnosis is made when a doctor finds a tumor mass in the eye by using an ophthalmoscope (an instrument that helps doctors to look inside the eye). Like retinoblastoma, the diagnosis is usually made based on the appearance and location of the tumor inside the eye. A biopsy (removing cells from the tumor to be looked at under a microscope) to confirm the diagnosis is almost never done because it might harm the eye or risk spreading the cancer outside of the eye.

Treatment for medulloepithelioma is almost always surgery to remove the eye.

The rest of this document refers only to retinoblastoma.

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