Nepal detects around 50 cases of eye cancer annually
One-year-old Sabin Mahat (name changed) was taken to a local eye hospital when his mother noticed a white glow in his right eye which was more prominent in the evening time. He was immediately referred to Tilganga Institute of Ophthalmology where he was diagnosed with Retinoblastoma, a type of eye cancer that starts in the retina.
Retinoblastoma represents three percent of all childhood cancers in the world, and is the most common intraocular malignancy in children below five years of age. It is 99 percent fatal if left untreated. Early detection and prompt treatment can save life and eye. Worldwide prevalence is 1:15000 to 1:20000 live births. Exact prevalence in Nepal is not known but a recent survey done in multiple hospital records suggests that around 50 new cases are detected in Nepal each year. Among them, the Ocular oncology department of Tilganga Institute of Ophthalmology (TIO) sees 35 to 45 new cases per year with around 15 of them having bilateral diseases.
Treatment for Retinoblastoma is long (takes about two years to five years depending on the laterality and severity of disease), expensive and psychologically challenging to the parents and children. Stage one and two diseases require at least six months of systemic chemotherapy along with four weekly evaluations under general anesthesia along with needful treatment like laser in eye (transpupillary thermotherapy), cryotherapy and local chemo in the eye until the tumor resolves completely. If the eye is not salvageable, enucleation with implant surgery (removal of eyeball and placement of artificial eye) is done. Even after completion of treatment, the child needs to be followed up under anesthesia for five years. For stage three and four disease, treatment is prolonged (12 cycles of high dose chemotherapy followed by radiation therapy) and even with treatment, life prognosis is not good.
As for Sabin, after a detailed evaluation, he was diagnosed as having Stage zero disease with non salvageable Group E disease in the right eye and Group C in the left eye. He was referred to Kanti Children Hospital for six cycles of chemotherapy. Since Sabin’s family was from a low income background, he was helped by Open Eyes Nepal, a non-government organization focused on creating awareness and providing financial support to Retinoblastoma patients, for treatment at Tilganga Hospital. After completing 6 cycles of chemotherapy, his right eye was surgically removed (enucleation with implant surgery) and provided a custom fit prosthetic eye which was also provided free of cost by Open Eyes Nepal. As for the left eye, it was saved after 8 cycles of laser therapy. After being disease free for two years, Sabin still comes to Tilganga Hospital every six months for follow-up.
However, sometimes this favorable case scenario is not present. When patients come to hospital very late into the disease of Retinoblastoma, the tumor comes out of the eye and presents with a fungating mass. Hence, it is important to identify the disease in the early stage by parents as well as health care personnel, so that with appropriate management, eye and life can be saved with Retinoblastoma.
