Narayana Nethralaya 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.
Many of us still think that cancer is an adult disease and never associate it with children or young adults. However, that does not make the problem disappear. Childhood cancers are very much a reality and on the verge of becoming a public health concern in a number of developing countries like INDIA. According to a 2014 study, Paediatric cancers should be treated as a global child health priority. Dr Christopher Wild, Director of International Agency for Research on Cancer, identifies childhood cancers as a public health problem in the developing world. In a statement last year, the organization mentions that approximately 215,000 new cancer cases are diagnosed every year in children younger than 15 years of age. Childhood cancers represent only about 1% of total cancer cases in developed countries. However, in low-resource countries where children make up almost half of the population, the incidence rate is almost five times higher.
On Account of International Childhood Cancer Day, We at Narayana Nethralaya have taken up the task of creating an awareness on Eye Cancer & Retinoblastoma and offer the latest & advances surgical techniques to treat Retinoblastoma at concessional rates for the Economically backward and totally free of cost to those patients who cannot afford the treatment cost at all.
“Retinoblastoma is the most common primary intraocular malignancy of childhood. About four percent of all childhood cancer is retinoblastoma. Since cancer in children is rarer than in adults, retinoblastoma diagnoses make up only about one percent of all cancer diagnoses. Approximately one in 15,000 children is diagnosed with pediatric retinoblastoma per year. When the disease is diagnosed in its early intraocular stages, as is usually the case, the probability of disease-free survival has been greater than 80–90%. Till a century ago Retinoblastoma was uniformly a fatal disease. Thanks to advances in surgical techniques focal therapy with laser and cryotherapy, and chemotherapy, the survival rate and preservation of vision have greatly improved”, said Dr. Roshmi Gupta, Head, Ocular Oncology, Orbital Disease and Oculoplasty.
“Until recently, retinoblastoma outcomes remained uniformly poor unless diagnosed at an early stage. But with the advent of chemo reduction and external beam radiotherapy, in addition to focal treatments like direct photocoagulation, cryotherapy and trans pupillary thermo therapy, the survival rates have improved considerably even at advanced stages. However, I would like to emphasize that screening of children for white reflex should be taken up along the lines of a public campaign, and dilated fundus screening for children should become a standard clinical practice. The impact of a child going blind is enormous as it corresponds to the loss of number of man years of productivity” 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.
Mr. Thanmaya BP, Founder Trustee of Iksha Foundation, Dr. Roshmi, Dr. K. Bhujang Shetty with Eye Cancer Survivors who were operated succe
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 retinoblasts that divide into new cells and fill the retina. At a certain point, these cells stop dividing and develop into mature retinal cells.
Rarely, something goes wrong with this process. Instead of maturing into special cells that detect light, some retinoblasts continue to divide and grow out of control, forming a cancer known as retinoblastoma.
The chain of events inside cells that leads to retinoblastoma is complex, but it almost always starts with a change (mutation) in a gene called the retinoblastoma (RB1) gene. The normal RB1 gene helps keep cells from growing out of control, but the change in the gene stops it from working like it should. 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 children with retinoblastoma, the abnormality in the RB1 gene is congenital (present at birth) and is in all the cells of the body, including all of the cells of both retinas. This is known as a germline mutation.
In most of these children, there is no family history of this cancer. Only about 25% of the children born with this gene change inherit it from a parent. In about 75% of children 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 (known as bilateral retinoblastoma), and there are often several tumors within the eye (known as 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 in other areas as well.
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 children with 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.
Children with this type of retinoblastoma do not have the same increased risk of other cancers as children with congenital retinoblastoma.
How does retinoblastoma grow and spread?
If retinoblastoma tumors are not treated, they can grow and fill much of the eyeball. Cells might 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, 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 the cancer reaches tissues outside the eyeball, it can 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).
Treatment for Retinoblastoma & Preventions
Chemoreduction followed by adjuvant consolidative treatment has replaced external beam radiotherapy as the primary modality of treatment for intraocular retinoblastoma. Further, histopathological high-risk factors have been identified in enucleated eyes, allowing use of prophylactic chemotherapy to take care of possible micrometastasis.
The ophthalmologists stated that late diagnosis and misconceptions about the symptoms were the major reasons that the eye cancer even extended to the brain and then to the entire body, ultimately leaving no option of treatment for the patients.
"Treatments like surgery, laser therapy, chemotherapy are the only way to cure the disease. The situation is such that currently it is not possible to save the eyesight of the patient after the surgery, however research 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 screening of neonates is currently not standard of care. Early detection of abnormalities could offer prompt management and a reduction in visual morbidity. Since retinoblastoma can develop at any point in the first few years of life, prompt attention must be given to any abnormality noticed by the child’s parents.