Retinoblastoma eye in children

What is a retinoblastoma?

Retinoblastoma is a rare type of eye cancer. Most often amazes children under the age of 5 years. One or both eyes can be amazed.

• "Retino" means from retina
• "Blast" means cells in early development
• OMA means a group of cells or a tumor

In case of illness, one eye can be amazed, the disease will be called a one-sided retinoblast. Bilateral retinoblastoma - when both eyes are affected.

Who develops a retinoblastoma?

Retinoblastoma is most often striking children under 5 years old. Every year in the world in 1 of 20,000 newborn children diagnose the retinoblast. Although the disease can be very dangerous and frightening for a child and his parents, more than 9 out of 10 children (90%) are cured.

In children, the disease with the defeat of both eyes is usually diagnosed in the first year of life. Those who are struck by one eye, as a rule, the diagnosis is made a little later, often aged 2 to 3 years.

Causes and examination

Some children are born with change (mutation) in the Retinoblastoma gene (known as rB1 gene), which they inherit from one of their parents. Gene changes can occur on the most early stages Their development in the womb.

About 4 out of 10 children with a diagnosis (40%) have this hereditary type.which often amazes both eyes. In children who do not have this hereditary type of retinoblastoma develops only in one eye.

Doctors do not know what causes the remaining 60% of the retinoblast. But these not inherited types almost always affect only one eye.

Children who have a parent, brother or sister who had earlier retinoblastoma should be examined for the presence of retinoblastoma. The child usually needs to be screened after birth to 3 years. Surveys include regular inspections under general anesthesia. How often and how long the child passes the examination depends on the level of risk.

Some children can also take blood for the analysis of the RB1 gene. This is possible only if a member of the family, who had a retinoblastoma to be tested first.

Talk to your attending physician if you have a family story of retinoblastoma. They can send your child to one of the specialized centers of Retinoblastoma. Your child is unlikely to be a survey, if a long-range relative, such as a cousin, is a retinoblastoma. However, in the center of the Retinoblastoma can explain who from the family needs to be examined.

Small anatomy of his eyes

To understand how the retinoblastoma develops, you need to learn a little about the eyes and how they work. On the eye 3 main parts:

• eyeball
• orbit
• auxiliary structures (or apparent structures), including lacrimal glands and eyelids.

The eyeball is filled with a jelly-like substance called the vitreous body. He has a front line. The lens is covered with a colored part of the eye, called a rainbow shell.

Lens and rainbow shell focus the incoming light on the back of the eye, called the retina. The retina looks like a film in the camera. When the light hits the retina, it transmits a message to the brain through speed \u200b\u200bnerve. This allows us to see.

How does the retinoblastoma develop?

Retinoblastoma is a retinal cancer. When a child grows in the mother's womb, the eyes are one of the first organs that need to develop. In the earliest stages of the eyes have cells called retinoblasts, which grow very quickly. Later they cease to grow and transform into mature retinal cells that light can detect.

Very rarely immature retinoblasts continue to grow rapidly and are not transformed into mature retinal cells. Instead, they come out from under control and turn into a cancer tumor called the retinoblastoma.

If the tumor is not treated, the cells continue to grow, and the cancer fills most eyeball. It can also spread to other parts of the eye and start blocking the fluid flow inside the eye. This leads to an increase in pressure and can lead to loss of vision.

Most of the retinoblast are found in the early stages and are successfully treated before it is distributed beyond the limits of the eyeball. If the retinoblastomes are distributed (metastasized), the tumor can get to any point of the body, including the brain, bones and lymph nodes. When distributed, they are difficult to treat.

Symptoms of retinoblastoma

Most children with retinoblast seem healthy. But two common features that parents first notice from their child:

• the pupil looks strange;
• strabismus.

Pupil may look white, like a feline eye reflecting the light. Sometimes it is noticed in the photos when the flash is used, and the pupil looks white, and not typical red. The child may not see or the eye can be red and inflamed. Children usually do not complain about pain.

In very rare cases, a child who does not gain weight or normally does not develop, can be sent to the children's doctor-specialist (pediatrician). During the examination of the child in the blood test, an abnormal gene of retinoblastoma (RB1) is found.

Urgent direction to a specialist

The doctor must direct your child to the eyepiece if the pupil eye looks white, and not black. You and your child need to contact this specialist within 2 weeks after the direction.

Stages of retinoblastoma

The stage of cancer will indicate how large it is and spread. As the retinoblastoma is treated, it depends on the stage of the tumor.

Retinoblastoma has 2 main stages:

1. Intraocular retinoblastoma: The tumor is completely in the eye and did not spread. Your child's specialist more accurately places a tumor into one of several more accurate subgroups (from A to E), depending on the size and position of the tumor in the eye. Most children are diagnosed with this localized disease. More than 9 out of 10 of these children (90%) are cured.
2. Embossed Retinoblastoma: The tumor spread beyond the limits of the eye and to the cloth surrounding it. It may have spread to another part of the body.

Treatment

There are many different methods of treatment of retinoblastoma.

Small tumors will need local therapy. That is, treatment only for the very eye itself. Large tumors can be treated with chemotherapy, radiation therapy or surgical intervention.

Treatment of small tumors

Small tumors need local treatment. This means treatment only for the very eye itself.

Your child can assign:

• laser therapy;
• cryotherapy (freezing);
• termotherapy (heat treatment).

These procedures are directed to the destruction of the tumor.

Children are treated during sleep under general anesthesia. Some children can undergo chemotherapy after local treatment.

Treatment of large tumors

Large tumors can be treated with:

• radiotherapy;
• surgery;
• chemotherapy.

Your child can have a combination of these procedures.

Radiotherapy

Some tumors are treated with the type of inner radiation therapy, called brachytherapy. Small radioactive plates (plaques) are stitched directly over the tumor. Radiation destroys the tumor. Plates remain in place for several days, and then removed.

For a big tumor, which reacts poorly to another treatment, your child's specialist can offer radiation therapy of the whole eye.

Surgery

For a very large tumor and when the eye does not work anymore, an eye removal operation is used. The child put an artificial eye to replace the lost.

Chemotherapy

Chemotherapy is therapy using drugs for the destruction of cancer cells. The child can be appointed chemotherapy to try to reduce the tumor.

Also, your child's doctor can offer chemotherapy if there is a risk of cancer.

Chemotherapeutic preparations that usually use doctors include:

• Wincristine;
• Carboplatina;
• Etoposide.

In some cases, your child can undergo chemotherapy by introducing a chemotherapy in blood vessel (arteries) for the affected eye. This is called intraarterial chemotherapy. Doctors most often use Melfalan. It is usually applied for a retinoblastoma that continues to grow after treatment, or for the retinoblastoma that returned.

Side effects of therapy

Your child's doctor will tell you about possible side effects. Side effects that may occur in a child depend on the type of treatment that was used.

Vision

Most parents worry about whether their child will lose sight. If possible, the doctor will try to preserve the eyesight of the eyes. If one eye is amazed and it is necessary to remove it, the vision of another eye will not suffer. Children learn to adapt very quickly and lead a normal life by visiting the usual school.

If both eyes are amazed, then the child will most likely lose sight. Consequently, they may need support in connection with violation of vision, both in secondary school and in a specialized school.

Cataract

After radiation therapy for all eyes in children can develop. It depends on the type of radiation therapy, which they used. Cataract is the cloud of lens of the eye, which leads to slow loss of vision. Recently, a new method of radiation therapy was developed, which gently lens.

Dry eyes

Dry eye - another possible side effect of radiation therapy. Arises as a result of damage to radiation therapy of tear ducts. If a child has this side effect of therapy, he needs to use eye drops or artificial tears to keep eye humidity and reduce the likelihood of infection.

Long side effects

Long problems are rare. Radiation therapy may cause a change in face shape. This is due to the fact that the bones in the zone of radiation therapy after can grow at the same speed as before.

But it is important to remember that most children without treatment can suffer much more.

Returns of retinoblastoma

Very rarely cancer can come back again. Or another tumor can develop in the center of the brain. This is called a trilateral retinoblast and occurs very rarely. Symptoms include headaches, feeling and nausea. Contact your doctor if you are worried about the symptoms manifested in the child. Your child will be under close observation.

Children with hereditary retinoblast can also get sick for cancer at a later age. But it is rare. The doctor will talk to you about it if there are risks.

Retinoblastoma in children - malignant neoplasm in the field of retina. The disease is often congenital in nature, but it is quite difficult to identify it in a timely manner. Mainly retinal tumor is found in 2 years, since it is precisely for this age that the most peak of pathology.

Retinoblastoma in children are distributed worldwide. Often the disease is striking both eyes at once.

Feature disease

The eye has a complex structure. The composition of a small eyeball provides protection against external negative factors, an optical system for a clear perception of objects, a structure that perceives light waves. This is a hereditary disease in children, which is formed from the retinal cells of the eye. Tumor grows out pigless epithelium retina and provokes:

• loss of vision;
• distribution of secondary foci in the brain and other organs;
• increase intraocular pressure.

Retinoblastoma is mainly manifested in the first 2 years of the child's life. Currently, the incidence of this disease is 1 case by 10-13 thousand newborn children.

Types and forms

According to the degree of prevalence of Retinoblastoma in children, this disease is divided into such species as endophytic and exofic. The endophyotic type of pathology refers to intraocular. During the growth of malignant cells, the eyeball is completely affected. At the same time, intraocular pressure increases, the retina is peeled and glaucoma is formed.

Exofed type of disease is characterized by the spread of malignant cells beyond the limits of the eyeball. At the same time, they cover the mucous membranes, the scler and vessels. Moving through the visual cells, malignant neoplasms metastasis in nervous system and lymph nodes.

By clinical flow Diseases allocate several stages. The rest stage is characterized by the lack of pronounced clinical symptoms. Parents can only notice the resulting small white spot. As progressing, binocular vision is lost, the child begins to mow eyes.

The glaucoma stage is characterized by a brighter symptom. The child begins to be afraid of light, and his eyes are watched. At this stage, the rainbow shell is exposed. The outflow of intraocular fluid is disturbed, pressure rises, and very strong pains are felt. Begins to develop glaucoma.

The stage of germination is considered the most dangerous, since the patient has a protrusion of the eyeball. Cancer cells begin to metastasize in soft fabricswhich are located in the eye area. The final stage is characterized by the spread of malignant neoplasms to other organs. Cancer cells are spread with blood brain shell, lymph nodes and optic nerves. The patient is experiencing strong weakness, and he has other signs of pathology.

Causes of occurrence

Retinoblastoma in children can be hereditary and acquired. The hereditary form of the disease is genetic. Basically, parents who have had a retinoblast in childhood, children are born with the same disease. This form develops rapidly and is accompanied by other violations and pathologies.

Malignant tumor The retina eye can occur as a result of the negative impact of environmental factors and the consumption of gennometric products. With this form of illness, only one eye is amazed. Such a tumor appears at an older age, but it is much easier to treat. This pathology can become one of the reasons for red eyes in a child. It is on this basis that the presence of a disease can be determined.

Basic symptoms

Among the main symptoms of retinoblastoma, children need to be distinguished as:

• white stain on pupil;
• reduction of vision;
• photophobia;
• tear;
• change mucosa.

Also, pain in the field of organ of vision can also be observed, intraocular pressure increases as a result of fluid outflow. This leads to the formation of secondary glaucoma. With the development of pathology, the kid has one pupil more than another, which must perhaps the parents.

The stage of germination is accompanied by a displacement of the eyeball a little ahead. This is due to the germination of the tumor in putinous sicklesderived between the brain shells. If a child has red eyes, the reasons for this can be associated with the development of the retinoblastoma. In this case, it is necessary to seem to the ophthalmologist, since at the initial stages much easier to get rid of the existing disease.

The stage of metastasis is characterized by the fact that metastases apply to other organs, in particular the liver, brain, bone. At the same time, the patient's well-being significantly worsens. TO general signs Symptoms of intoxication, severe weakness and headache are joined.

If the baby has one pupil more than the other, squint or there is a decrease in vision, then this may be a sign of retinoblastoma. In this case, it is necessary to contact an ophthalmologist for conducting a survey. An eye-to-forming can be examined for diagnostics, since with ophthalmoscopy, it is easy to consider the neoplasm.

Children, whose parents suffered the same disease, must necessarily be on dispensary accounting, as there is a high risk of hereditary transmission of pathology. To clarify the diagnosis and determine the degree of disease, it is necessary to carry out a number of diagnostic studies, in particular, such as:

• tomography of the affected area;
• brain biopsy;
• ultrasound diagnostics abdominal cavity to identify metastases;
• x-rays of light;
• blood and urine test.

Due to the fact that children with retinobline often have pathology and violations in the work of internal organs and systems, it may be necessary to further consult the Laura and the neurologist.

Features of treatment

Treatment of retinoblastoma depends primarily from the stage of the disease. Often, for therapy applies:

• chemotherapy;
• radiation therapy;
• surgical intervention;
• cryotherapy;
• laser coagulation;
• thermotherapy.

If timely start taking treatment and choose the most effective therapy, then we can preserve the normal vision and health of the child. With double-sided lesion, the techniques are selected separately for each eye.

At the Institute of Eye Diseases is carried out comprehensive therapywhich implies the use of several different techniques. Typically, the treatment of the tumor begins with radiation therapy, since the cancer cells of the retinoblastoma are characterized by very high degree Sensitivity to the effects of radiol. This technique is quite effective, however side manifestations It is possible to note the formation of cataracts and secondary bone tumors. With localized radiation therapy, the risk of side manifestations is significantly reduced.

In prefer to apply conservative therapy techniques. If the tumor has a size of less than 7 mm and is in the front area of \u200b\u200bthe eye, then cryotherapy is assigned. If the tumor is located in the rear sections and is less than 4 mm, then photocoagulation is shown. When conducting thermotherapy, infrared radiation and ultrasonic rays are directed to the affected area.

In the event of a significant increase in tumor tissue, the addition of secondary glaucoma, as well as the impossibility of preservation of the view, an operation to remove the eye is carried out with the subsequent use of special artificial prostheses. In the formation of metastases in the field of optic nerves, the only method of therapy is chemotherapy in combination with the use of cytostatics.

Retinoblastoma is necessarily subject to surgery. However, to preserve normal vision of the affected eye is not always possible. In the clinic "Microsurgery of the eye" named after Fedorov, treatment is treated with the use of modern techniques that allow you to quickly eliminate the existing problem and improve vision.

With a small tumor size, thermotherapy is used. Such technique implies a targeted impact high temperatures. Cryotherapy gives a very good result when carrying out a small tumor therapy, which is formed on the front of the retina of the eye. The procedure implies the freezing of tissues of the neoplasm with the help of a special probe that is applied to the outer surface of the sclera.

In addition, if there is a small tumor, photocoagulation is assigned. The operation is based on the destruction of vessels that feed the cancer cells of the vessels. This uses a laser beam.

In the "Microsurgery" clinic named after Fedorov, laser treatment is also conducted, which helps quickly and efficiently eliminate the existing problem with a minimally invasive way.

With a significant distribution of the retinoblastoma from the retina on other departments of the eye, a complete removal of the eyeball is performed, followed by an implantation of an artificial lens. One of the most important points of the operation is the excision of the optic nerve so deep as possible.

If the tumor went beyond the limits of the eye, the neoplasia is removed along with the bone walls of the socket. After removal, prosthetics is carried out.

Chemotherapy

In a complex with an operation, chemotherapeutic treatment can be carried out, which guarantees 80-90% of cure. Chemotherapy is required at:

• significant intraocular lesion;
• invasia of the optic nerve;
• lesions of orbit;
• regional metastasis.

Retinoblastoma is very sensitive to chemotherapy. To carry out treatment, several cytostatics can be used. The most good result can be obtained by combining such drugs as "Carboplatin", "Wepzid", "Wincristine".

Chemotherapy allows you to reduce the neoplasm in size, which is why such a technique is recommended before carrying out an operation. In addition, such a technique is intended for system therapy in running cases.

Other techniques

The treatment of malignant neoplasms is carried out under the control of ophthalmologist, oncologist and ophthalmosurge. The tumor is sensitive to X-ray radiation. Treatment is carried out in several sessions, and the dosage is selected by the Dr. Radiologist purely individually.

The exposure of the neoplasm is carried out remotely when the X-ray source is at some distance from the pathological focus. The contact method implies the use of appliques of radioactive substances that are applied directly on the eyeball. However, in this case, the risk of complications increases, in particular, such as inflammation of the cornea, ulcer, turbidity of the lens.

The introduction of antitumor drugs to the body allows preventing the spread of malignant neoplasms and reduce its size. Medication drugs Entered directly to the tumor region or are used as intravenous injections. During treatment, anesthesia and a special table for fixing the patient are applied.

Eye Prostheses

If the eye apple was removed during the operation, then the child teach to the wearing of an artificial prosthesis. Its constant presence is required in order to prevent the deformation of the face in the process of child growth. In addition, the absence of a prosthesis can lead to wrapping of eyelashes inside the orbit, which leads to irritation of the mucous membrane.

The temporary prosthesis is inserted 6 days after the operation to remove the eyeball. After the edema of the eye bag passes, the child is put on a permanent prosthesis. Prosthetics has 3 destinations at once, namely:

• cosmetic;
• functional;
• psychological.

Modern materials and technologies make it possible to produce prostheses that are practically not distinguished from the present eye. Models of prostheses skillfully imitate the movements of their own eyeball.

In order for the similarity with a healthy eye is even more pronounced, a lens is placed on the surface of the prosthesis, which is exactly the form, dimensions and colors of a healthy iris. Thanks to this, the child will not feel a disabled person.

Possible complications

Complications are observed if the disease becomes very aggressive, it is not diagnosed in a timely manner or treatment was not carried out correctly. With strong germination of the retinoblastoma in the orphanage, the risk of metastasis is significantly increased. The main complication of malignant neoplasm is the recurrence after the treatment.

The tumor growing inside the eye can be distributed beyond the limits of the organs of vision. Cancer often passes through the optical nerve inside the brain. Such a complication can lead to a child's death. In some cases, cancer passes through the walls of the eye and applies to other internal organs throughout the body. If there is complications, there is a high risk of fatal outcome, which is why diagnosis and treatment must be carried out in a timely manner.

Prediction and prevention

Timely diagnosis of retinoblastoma at the initial stage makes it possible to complete with the help of photocoagulation, cryotherapy or radiation therapy. All these techniques belong to organ-grumbling and less traumatic. Surgical removal The eye also guarantees complete cure, but it gives discomfort and leaves a cosmetic defect. The forecast is unfavorable in the presence of such complications as:

• extrasleral proliferation of the neoplasm;
• germination of the tumor deep into the visual nerve;
• involvement in the pathological process of choroidal shells.

Prevention is very important, as this will prevent the subsequent long-term treatment and the occurrence of dangerous complications. Families who have a history of hereditary retinoblast should consult the genetics. It is important to undergo surveys from an ophthalmologist, as this will determine the disease at the initial stages of the child's development and to preserve vision.

Retinoblastoma - very dangerous oncological disease. The sooner the diagnosis is raised, the more favorable outcome of treatment and preservation of vision.

but) Genetic counseling in retinoblastoma. The most reliable way to determine someone in the family will develop a retinoblastoma, is a survey to clarify the RB1 mutant allele discovered from the proband. With ignorance of accurate mutant RB1 alleles in a tumor or blood, an approximate empirical risk of developing a disease in relatives of patients with a retinoblast can be calculated.

At the offspring of patients with family history of retinoblastoma Or a double-sided tumor there is a 50% risk of inheritance of a mutant allele and 45% risk of retinoblastoma due to incomplete penetration. If practically healthy parents It is sick two children, then one of the parents should be a carrier of a mutant, but non-expressed allele. Consequently, subsequent children also have a 45% risk of developing retinoblastoma.

The risk of relatives There is an inherited mutant allele depends on the number of intermediate "practically healthy" individuals, each of which has a 10% probability of being a mutant, but non-expressed allele. The risk falls on the coefficient of 0.1 with each intermediate disabouted generation. Since 15% of patients with a unilateral retinoblastoma have a germ mutation, the offspring of persons with a one-sided retinoblast is 7.5% of the risk of carriage of the pathological gene.

The likelihood that the rest of the relatives will develop retinoblastoma, falls on the coefficient of 0.1 with each intermediate contradictory generation.

Infants born with the risk of developing retinoblastoma should be examined immediately after birth and then with permanent intervals for early detection of tumors that can be affected with the achievement of the best visual results. Babies, tested for the family mutation of the RB1 alleles, can be hospitalized for several weeks earlier to carry out minimally invasive therapy and increase the likelihood of preserving good vision. The retinal inspections begin with birth and continue with frequent intervals depending on the degree of risk in the child.

Until three months of age, the inspection is much facilitated by the Retcam camera in video recording mode, which can be carried out without general anesthesia. After three months, general anesthesia is needed to carefully inspect the retina to identify the smallest retinal tumors within the gear line.

The timely and sensitive molecular diagnosis of mutations of the RB1 gene has a pronounced influence on the quality of the outcomes: early treatment Retinoblastoma reduces risks and improves outcomes, allowing families to make decisions on fertility planning, and requires smaller costs than in conventional observation. When avoiding repeated examinations of children from a risk group, savings significantly exceeds the one-time value of molecular testing. In addition, savings in the health system continues on subsequent generations due to avoiding unnecessary examination and often lack of need for a molecular study, since their parents are not carriers of a family allele mutation.

RB1 gene mutations typically lead to an unstable protein or its absence. Such mutations have a high penetrant (\u003e 95% among all affected) and expressiveness (on average, seven tumors for each child). Rare Mutations of the RB1 gene lead to less penetration and expressiveness: deletions inside the reading frame or insertion of nucleotides cause the formation of a defective but stable PrB protein; Promotor mutations leading to a decrease in the number of normal proteins; and splice mutations that can additionally change due to unrelated "modifier genes".

(A-c) one-sided leukeokoria.
(D) bilateral leukeokoria.
(D, E) Right-sided leukeokoria, better visible when viewed to the right due to the localization of the tumor of the Kepende from the temporal side.

b) Symptoms and clinic Retinoblastoma. Most children have no family history and pay attention due to the presence of leukeokoria.

Parents reveal a strange eye of their child's eyes. Very often primary examination Doctors do not suspect the importance of what parents say, and the diagnosis is delayed. During the examination, you should pay attention to the descriptions of the reflex "Cat Eye" reflex for the direction of the child on full examination eye.

Foundation to support families with Retinoblastoma has begun an information company for wide enlightenment of the importance of the symptom of the "White Pupil". On digital pictures in children with a retinoblast is often visible pupil white color, "PHOTOCOCKORY", in contrast with red reflex on healthy eyes in photographs with flash. While the retinoblastoma is the most important and dangerous state causing leucocor, there are various states that in photographs with an outbreak are manifested in an unusual way such as congenital cataracts, myeline nerve fibers, Koloboma optic nerve, high myopia, astigmatism and, with normal visual nerves, when the camera's tilt direction is directed directly to the optic nerve.

The second most frequent manifestation of the retinoblastoma is the squint (Ezotropia or Exotropy). A red reflex test should be used by each child with strabismus or suspicion of squint, when identifying deviations from the norm, the child is promptly sent to an ophthalmologist. Other Symptoms and Symptoms include a habitant eye (due to glaucoma), cellulite orbit due to pronounced necrosis of intraocular tumor, one-sided mydriasis, heterochromium, hyphate, hypocion, uveitis and "search" nystagm (due to blindness during the damage to the macular area from two parties).

In countries with limited medical help Due to late access to health care, many children have a pronounced one-sided or bilateral exophthalm with an increased orbit and / or with metastases.

A screening survey on the retinoblast in infants and children with relatives with a hereditary retinoblast should be particularly closely accustomed, unless the genetic study eliminates the presence of mutant allele. Most families can be revealed to the exact mutation of the RB1 gene in the sample, to establish relatives with this mutation, to determine the carriers of a mutant allele, to diagnose and start early treatment when the tumor of small sizes and it can often be cured by only laser treatment or short chemotherapy courses with the best visual results.

Available symptoms and signs of retinoblastoma:
- White reflex 56%
- squint 20%
- glaucoma 7%
- Low vision 5%
- with a routine inspection of 3%
- Cellulite orbit 3%
- single-trap mydriasis 2%
- heterochromia iris 1%
- Gifema 1%
- Other 2%

(A) One-sided retinoblastoma presented in the form of cellulite orbits (group E according to the Classification of IIRC, which involves the presence of extraocular tumor).
(B) Pronounced intraocular necrosis with a displacement of an optic nerve due to tumor.
(B) Despite the treatment after four months the brain was struck by the meningital retinoblast and the child died.

in) Diagnosis of retinoblastoma in a child. With a primary inspection of a child with a possible retinoblast, you should spend differential diagnosis With a short circle of diseases, including the disease of the Cate, the primary persistent vitreous body, toxocamism, medullo-absorbers and others. If you suspect a retinoblast, a child should be urgently (within one week) aims for a survey.

Ultrasound examination is an easily accessible tool for confirming the diagnosis with the detection of calcined masses in front of the leucokoria, as well as to test the second eye to the possible presence of a tumor. To eliminate the trilateral retinoblastoma and the evaluation of the optic nerve, the standard is the implementation of MRI in several dimensions, in contrast to the CT, which causes significant irradiation to be avoided in children with mutant RB1 alleles. If chemotherapy is shown, it is necessary to establish a central venous catheter. The entire multidisciplinary team should be aware of the patient, since each of them plays a role throughout the course of treatment.

d) Examination for anesthesia. To fully evaluate the eye with a retinoblast, including the inspection of the front segment and the full inspection of the eye dna, the examination must be carried out under general anesthesia. After the maximum expansion of pupils with a sclerocompressor inspect the retina to the toothed line. Retinoblastoma looks like a white cream color forming in a vitreous body with a large irregular shape with vessels, walking along its surface and penetrating the tumor. Hemorrhage can be on the surface of the tumor. Grouped tumor cells in the vitreous body ("dissemination") are pathognomonic for retinoblastoma.

Some tumors are surrounded by halo from proliferating PES, which is supposed to grow slowly and can be a component of the retinoma. Calcification inside a tumor resembling "cottagel mass". Such tumors leave no doubt about the diagnosis of retinoblastoma.

Less characteristic of the retinoblastoma in the form of avascular white mass on the periphery of the retina. The tumor can be hidden with a muddy vitreous body or a pronounced retinal detachment. Detection of calcinates in ultrasound examination, and even earlier on CT and MRI, may be crucial in the diagnosis. The presence of a tumor in the second eye confirms the diagnosis of hereditary bilateral retinoblastoma. If the tumor inspection is not detected, it is necessary to examine the second eye of general anesthesia.

Unusual manifestations, such as heterochromia, hyponeon, uveit or cellulite orbits can delay and mask the diagnosis of retinoblastoma. It is important to consider the retinoblast early as differential diagnosisSince the delay can lead to the death of a child. Diffuse infiltrative retinoblastoma is not typical and can remind you.

In the absence of a dense, calcined tumor formation or retinal detachment, the diagnosis is difficult.

When the inner border membrane, the retina "seeds" (tumor cells) is floating in a vitreal cavity, where they are in hypoxic state and relatively resistant to therapy, therefore, treatment with laser -ugoagulation or cryotherapy cannot be carried out. When the cells are settled on the retinal surface, they can attach to it and grow, laser and cryotherapy and cryotherapy are successfully applied with early detection.

Crosth and lumba puncture to identify metastases are shown only if extraocular distribution is suspected and can be performed after identifying pathological changes in an enucleated eye.

The states simulating the retinoblast are presented in below. In North America, the disease of the Cate, Toksokazoz and the primary persistent glassy body are the main three states with which the retinoblast is confused.

e) Methods of visualization in the treatment of retinoblastoma. The Retcam wide-angle chamber provides a wide-angle picture of the retina and an angle of the front chamber. A piece of small retinoblast, poorly visible due to vessels of choroids and tumor cells in a vitreous body, are better visible on the images of the Retcam chamber than with indirect ophthalmoscopy. Phased shooting are useful for determining the growth or regression of the tumor. The Retcam® camera is also clearly visible to the anterior segment of the eye and an angle of the front chamber. With the help of fluorescene angiography using the RetCam chamber, it is possible to estimate the blood circulation, residual tumor activity and tumor relapses inside the laser -ugoaguits.

Sometimes local laser and adaging and cryotherapy conducted to relieve the tumor cause plots of ischemia, which can be clearly defined using fluorescene angiography and spend preventive treatment Ischemic angiogenesis (neovascularization) by pyretinal photocoagulation.

The tumor located the Kelli from the toothed line in the ciliary body, behind the iris and adjacent to the lens, can be revealed only with ultrasonic biomicroscopy. These areas of the eye are not available indirect ophthalmoscopy, Retcam chamber or traditional ultrasonography. It is very important to identify a tumor in the front segment of the eye (group E according to the IIRC classification), which requires immediate enucleation, since there is no accurate local therapy for the front segment of the eye.

Optical coherent tomography (Oct) is also useful when examining under general anesthesia. Small tumors in the inner nuclear retinal nuclear layer are very light (transparent), so infants from the risk group (that is, the carriers of the mutant allest RB1) with suspicious stains on the retina using an OCT can confirm or refute the presence of a tumor. Octa is also useful in assessing the results of laser treatment, identifying regional recurrences, accurate localization of sensitive structures for treatment planning, as well as to identify secondary pathology, such as cystic macular swelling, in which a visual forecast can deteriorate.

With intraocular retinoblast, patients survival is good (96% of cases), but at the exit of the retinoblastoma outside the eyeball, treatment becomes very complex, the biopsy of the retinoblastoma is strictly contraindicated due to the risk of tumor distribution beyond the eyeball. In rare cases, when despite all the studies, the diagnosis remains unclear, after careful weighing of all "for" and "against" with the discussion within the interprofessional team of experts and with parents, it is possible to carefully aspirate the liquid through the cornea paracentesis for a cytological study followed by Cryotherapy in the field of the inlet.

The retinal detachment is shown with not so white as with a retinoblast leukecochloride with yellow inclusions (xantokoria)
and characteristic aneurysmatic vascular malformation on the periphery.
Isolated toxocroqual granuloma with cilucleotinal arteriole in a macular region,
imitating retinoblast.
Medulloepitheloma (Dikhae), looking like a foil-shaped structure,
arriving in a ciliary body and exciting iris.
Retinoblastoma with endophyte growth.
(A) The tumor spread to the vitreous body and tumor cells can be visible behind the lens (group E according to the classification of the IIRC).
(B) An enucleated eye segment with a tumor filling the eye (at the same patient).
(A) Extraocular retinoblastoma with the introduction of glaucoma in the iris, the development of glaucoma, the spread of the conjunctiva and orbit.
(B) on CT shows the involvement of the optic nerve.
(C) with CT, the propagation of the tumor from the optic nerve into the supracellory space and in the brain is revealed.
Retinoblastoma looks like cellulite orbits (group E according to the IIRC classification).
(A) When examining the child is sick, but there is no temperature. It is impossible to inspect the eyeball because of the edema, which passed two days after the systemic reception of steroids.
At CT, a small non-elocked left eye tumor and a calcined tumor of the right eye (b) were revealed.

One-sided retinoblastoma with endophyte growth of the group E according to the IIRC classification.
On the image, Retcam® cameras are visible (AI) massive swells of tumors in the vitreous body (left), and (AII) (right). Distribution of the tumor for 180 ° below,
kell-line switches (arrows) with location on a flat part of the cylinder body (Pars Plana) (Retcam ® cameras from Carmelina Trimboli.)
(B) Ultrasonic tumor biomicroscopy in Pars Plana and Pars Plana Pars Parcata.
(C) on the ciliary body sections, a tumor is visible, located Kelli from the gear line (arrow); The site corresponds to the area shown on (b).
Collage from the images of the entire retina using the Retcam® camera. With the help of sclerokompression, the gear line is visible for 360 °.
(A) the left eye of the child with a diagnosis of double-sided multiple retinoblastoma with an exofite growth of the group D according to the IIRC classification,
family history is absent, revealed zero mutation RB1 (heterozygous deletion from 18 to 23 exons) in the blood.
(B) Good regression after 3 of the 7 cycles of CEV chemotherapy with cyclosporin A, the arrow indicates a residual tumor after the laser -ugoagulation or cryotherapy.
On an appearance, an eye looks from a residual tumor with a swollen mesh next to the Maculat treatment to improve visual functions, it was not revealed after a year.
This child has a great response to the treatment at both eyes with the PS Group Tumor
Relief Retinoblastoma after remote radiation therapy.
(A) The appearance of calcinates in the form of "cotton mass".
(B) Mixed, suspicious regression, but after four years of recurrence observation did not occur.
(A) At the time of the diagnosis, one-sided retinoblastoma was revealed.
(B) Subretinal tumor cells (arrow) at the bottom of 6 hours of this eye with a tumor of a group D according to the classification of the IIRC (subprinople with more than 3 mm from the tumor).
(C) Reaction to chemotherapy (4 cycles of CEV with high doses of cyclosporine), laser -ugoagulation and cryotherapy.
(D) On fluorescent angiography in the RubE, the active tumors vessels are visible, which were successfully coagulated by a laser 532 nm and 810 nm.
Retinoblastoma group E according to the classification of the IIRC before enucleation.
It is observed (a) a large retinoblastoma, total retinal detachment, large sections in subretinal space, non-disconnecting glaucoma and (b) tumor cells in the front chamber,
visible in the photograph of the front segment of the eye and angle of the anterior chamber, made using the Retcam® camera through the gel.

With retinal cancer, small children are commonly faced, which are less than five years old. In adults, this pathology is practically not detected. This disease is called a retinoblastoma - a malignant education that is formed in children on the reticular shell of the eye, as well as the striking fabric and orbit. With the advent of the cancerous tumor, any person may face, regardless of age and gender, while cancer is able to affect the most different human bodies, even eyes.

Retinoblastoma is equally found in children of different sexes. The peak of the disease is a period of 2 to 3 years. Of all cases of diagnosing cancer tumors in children, about 5% are on the retinoblast. If you cannot recognize pathology in a timely manner, it can not only cause loss of vision, but also to progress to start spreading metastases.

Causes of development

The exact causes of the occurrence of retinal cancer in children have not yet been proven, but in the predominant number of cases, the disease has a hereditary nature.

Retinoblastoma in children can arise due to such factors:

• harmful environmental situation, which is observed in large industrial cities;
• poor-quality food containing many carcinogens;
• professional activities of parents associated with chemical or other harmful substances;
• the age of parents - the risk of the appearance of retinoblastoma increases in children, if at the time of the birth of the child parents for more than 40 years.

More often, the retinoblast is considered hereditary, but it has a clear connection with the environmental impact on a woman during pregnancy, which is reflected in the fruit. As the retinoblastoma increases, it grows beyond the robes of the retina, strikes the eye and optic nerve.

The treatment of retinoblastoma in children should be carried out without slowdown, otherwise gradually the tumor will involve the fabric of the orbit, remote metastases will begin to struggle vitally important organs. Parents who have already come across this pathology are obliged to carefully follow the development of their children, and regularly visit the ophthalmologist with them.

Classification of pathology

First of all, the retinoblastoma is divided into hereditary and acquired. The hereditary form of the disease begins to manifest itself aged 2-3 years after birth, with her characteristic feature is the defeat of both eyes. The acquired cases of the disease are characterized by the defeat of only one eye.

When classifying the retinoblastoma, the direction of growth is of great importance:

• Endophytic growth - the retinoblastoma grows from the cells, which are located on the inner surface of the mesh shell. The tumor is developing inside, hitting all the patterns of the retina and destroying the vitreous body.
• Exofite - Retinoblastoma is striking the retina, behind which the exudate begins to accumulate, and also involves the visual nerve and elements of the orfall.

Tumor cells are both differentiated and undifferentiated, from which the course of the disease depends. Undifferentiated tumors are characterized by more aggressive development with intensive clinical manifestations. In the tissues of education, calcium salts deposition can accumulate, as well as develop necrosis.

Stages

When the children appears in the children, the following stages of the development of the disease are distinguished by the TNM system:

• T1 - the size of the tumor does not exceed more than 25% of the fundus;
• T2 - the neoplasm growth grows on the retina, but does not occupy more than 50% of its surface;
• T3 - Retinoblastoma is striking the greater half of the retina and can even go beyond its limits;
• T4 - neoplasm cells are distributed beyond the borders of the orbit;
• N1 - arises a single metastasis in regional lymph nodes;
• Mi - tumor metastasizes to remote organs.

In the acute course of illness and the risk of metastasis, there is a threat to the life of a sick child. The most dangerous period is when the retinoblastoma reaches the soft shell of the brain, after which it begins to grow on its surface

Symptoms

Symptoms of retinoblastoma largely determines its current stage of development. Often it is very difficult to clarify all the symptoms, since small children are not yet able to fully speak and describe what they feel. At the first stage of pronounced manifestations, it does not occur, but a change in the diameter of the pupil can be observed. The loss of binocular and central vision is an early symptom of this pathology, because of what children are often observed by squint.

The second stage of growth of the retinoblastoma is characterized by the appearance of lights, hyperemia, the development of iridocyclitis and uveitis. Due to the tumor invasion, children appear in pain. The pressure of an intraocular apple enhances, the emergence of secondary glaucoma increases. In the presence of tumor stratification, the retinal is made of the neoplasm.

At the third stage, children often develop the displacement of the eyeball. The intensity of such a displacement may vary. Orbit's fabrics and its walls may also be damaged. The neoplasm sprouts into the apparent sinuses and the subarachnoid space becomes.

At the fourth stage of the retinoblastoma destroys the visual nerve and involves the soft shell of the brain. The neoplasm extends metastases throughout the body, initially hitting the brain, and then the liver and other important organs. The propagation of malignant cells occurs through blood flow and lymph. The patient is in critical condition, it has strong weakness, nausea with gusts of vomiting, headaches and intoxication develops.

Diagnostics

When the child arises symptoms indicating retinal cancer, urgent consultation of the ophthalmologist is necessary. Oncologists and neuropathologists take part in the diagnosis of retinoblastoma. First of all, the doctor conducts an external examination and checks vision. The presence of retinoblastoma may indicate squint, a weak reaction to light and expansion, as well as leukeokoria.

In the presence of these signs of the disease in a child, additional studies are prescribed for the formulation of an accurate diagnosis:

• ophthalmoscopy;
• fluorescent angiography;
• radiography;
• computer tomography (CT);
• magnetic resonance tomography (MRI);
• ultrasound examination (ultrasound);
• biopsy.

Tomographic studies are necessary to assess the prevalence of neoplasm. Intraocular biopsy is prescribed to the child only in the urgent need for this study, since this procedure may entail the dissemination of malignant cells in the eye. Only after receiving the results of all studies conducted, the doctor may appoint a further course of therapy.

Differential diagnosis

It is very important to distinguish with a retinoblast from other diseases that can cause retinal resignation in children. Clinical manifestations of retinoblastoma are similar to many other pathologies, among which the dysplasia retina, scar retinopathy, soft-tanned sarcoma.

In addition, it is necessary to distinguish this tumor from the granuloma of the vitreous body and the copper gamart. The latter can still be combined with neurofibromatosis and tuberculosis sclerosis. From how accurately the diagnosis will be raised, the effectiveness of further treatment depends, because in each individual case, the methods for conducting therapy are fundamentally different.

Treatment methods

With timely discovery of the retinoblastoma of the eye, with the condition of adequate treatment, in 90% of cases, predictions for children are favorable. The methods of treatment of retinoblastoma differ, and when choosing the most optimal method, ophthalmologists take into account the following factors:

• preservation of vision, as well as the chances of its recovery after passing therapy;
• the number of affected eyes;
• the size of the retinoblastoma;
• the tumor is located on, or behind the equator;
• involvement of the optic nerve, the distribution of the process on the fabric of the orbit;
• the presence or absence of remote metastasis.

During treatment, not only the possibility of preservation of vision is of particular importance, but also the preservation of the very eye itself. After conducting an operational intervention to remove an intraocular tumor, a significant violation of the growth of the skull in the facial region is possible, which may cause serious cosmetic flaws.

The maximum preservation of eye tissues is possible in drug treatment of retinoblastoma, but the conduct is rational only at the initial development of the disease. With double-sided lesion, for each eye is chosen separate way Therapy.

Cryotherapy and photocouples

These methods are rational to apply in the first stages of development, while they allow you to preserve not only an organ, but also a visual function. After conducting several sessions of cryotherapy, you can eliminate small neoplasms that are on the front periphery. Photocoagulation allows you to remove small tumors forming on the retina. After such treatment, the risk of recurrence of the retinoblastoma remains, but in such a situation you can once again conduct a course of treatment.

Surgery

During surgical manipulations, not only the eyes can be removed, but also the fabric of the soccer. Such an operation is assigned in the case of the following readings:

• abundant damage to the organ, when the use of conservative methods does not give results;
• the development of glaucoma due to the growth of the tumor;
• large tumor sizes;
• loss of vision without the possibility of its renewal.

During surgical manipulations, it is very important that the visual nerve has been cut off as far as possible from the lesion area. It is necessary to prevent the spread of neoplasia. Some time after the operation, a prosthesis is installed.

Radiation therapy

Conducting radiation therapy is remote and using radioactive appliques. Irradiation is rational to apply with small neoplasms in children located outside the visual nerve. If a child suffers from congenital retinoblastoma, he is prescribed remote irradiation, which allows you to influence several foci of pathology at once.

In about 70% of cases, irradiation allows you to achieve a positive result and even save vision. Also, radiation therapy is combined with operational intervention and drug treatment. Dose of irradiation is usually about 4500 gr. In addition to the retina, the vitreous body and 10 mm front of the optic nerve are exposed to irradiation.

Chemotherapy

Indications for the course of chemotherapy are:

• abundant lesion of the fabric of the orbit;
• defeat of the visual nerve;
• metastation of the tumor.

During treatment, patients prescribe special preparations that can be administered intravenously or orally. This method is quite effective for the treatment of children with a diagnosed retinistist, but chemotherapy has a large number. side Effects, among which hair loss, nausea, apathetic state and overall malaise.

Folk remedies

It is impossible to get rid of the retinoblastoma with folk techniques. Consignment of bravery and teas can be attributed to the folk remedies that help relieve tension and weaken clinical manifestations Diseases. Also after chemotherapy course, acupuncture is recommended that allows you to improve general state patient. Before applying any means of alternative medicine, it is necessary to consult with the doctor.

Complications and consequences

When the children occur in the initial stages of its development, a visual function is exposed, which is due to the loss of vision. As the tumor grows, if timely not start the therapy in a timely manner, the tumor begins to spread to the softer tissues, as well as the visual nerve. Destruction processes are accompanied by strong pain. In the launched cases, pathology can cause fatal outcome.

Prediction and prevention

It is very good when children manage to reveal the retinoblast at first of its growth. Then, in addition to the operation, it is possible to conduct other methods of treatment, allowing to preserve the organ of view: cryotherapy, photocoagulation and radiation therapy. When metastases appear, the retinoblastoma is removed by enucleation of the eye, which allows you to fully cure the child. However, due to the loss of eye, a significant cosmetic defect remains. If in the process of growth of the retinoblastoma in the brain, secondary foci of lesion appear, the chances of keeping the life of the child are significantly reduced.

The main cause of development in children of such a disease as a retinoblastoma is gene mutations transmitted inheritance. Therefore, if some of the parents have already been cancer, the family is obliged to undergo medical and genetic consulting. Kids in the risk group must early age Complete full medical examination.

Retinoblastoma in children - malignant neoplasm retina eye. Retinoblastoma is dangerous in that at the started stages leads to the removal of the eye, at worst - to the death of a child. The total frequency of the disease is up to 4.5% of the number of all cancers among children up to 15 years, regardless of gender. The most often retinal cancer is diagnosed in children 2-3 years.

Retinoblastoma is a retinal cancer arising from the hereditary transmission of changed genes or without an explicit reason. The lesion begins with the retina, then the vascular shell is involved, eye orbit, remote organs.

The share of congenital genetic disorders accounts for more than 50% of the retinal cancer in children. Characteristic combination with other congenital anomalies development caused by the presence of mutations in cells.

The remaining percentage of cases refer to sporadic, i.e., "random", which has no clear cause. In this case, education is detected among older age group Children. The predisposing factors causing disorders at the chromosome level, consider:

• age parents;
• the work of parents at the metallurgy plant;
• bad ecology;
• unhealthy food.

Retinoblastoma is prone to rapid growth. Metastases can be detected in bones, bone or brain, liver.

Classification

Rak retinal in children has several classifications.

For reasons of occurrence:

1. Hereditary form - transmitted from parents. Characterized by bilateral eye damage.
2. Sporadic shape - arises without a clear reason. Characterized by one-sided defeat with the formation of one cancer node.

For distribution of cancer education:

1. Unilateral or monolateral form - the retinoblastoma of one eye.
2. Bilateral - bilateral defeat.
3. Trilateral - retinoblastoma, striking also epiphyra (endocrine brain iron).

According to the degree of differentiation of malignant cells:

1. Differentiated cancer (retinocytoma).
2. Untifferentiated cancer (retinoblastoma).

By the nature of growth:

1. Endophyte growth, i.e. in the center of the visual body.
2. Exofite growth, i.e., the defeat of the mesh shell and space next to it.
3. Infiltrative growth is an extensive germination of the retina of the cancer tumor. Characterized by the accumulation of fluid, the formation of battleships, manifestations of the pseudogopopion (accumulation of tumor cells and deposition in the corner area between the cornea and the iris).

By number of nodes:

1. Retinoblastoma with monocentric growth (one node).
2. Retinoblastoma with multicenter growth (several nodes).

The TNM classification is folded from the three components: T - TUMOR (from lat. "Tumor"; area of \u200b\u200blesion), n - nodus (from lat. "Nodes", namely lymph nodes), M - metastasis (from lat. "Metastasis" ; their presence or absence).

• T1 - lesion tumor to 25% of the retina;
• T2 - the tumor takes 25-50% of the retina;
• T3 - cancer takes more than 50%;
• T4 is the defeat of all the structures of the eye, as well as adjacent fabrics.
• N0 - lymph nodes are not affected;
• N1 is the defeat of the malignant lymph nodes.
• M0 - no metastasis;
• M1 - Metasicization to other organs.

Classification of the stages of the disease:

• I - Stage of Peace;
• II - Glaucoma Stage;
• III - germination stage;
• IV - stage of metastasis.

Symptoms of Disease

Clinical manifestations of retinoblastoma in children differ at different stages of the disease. In the early stages there are no subjective sensations, therefore the first stage is called the stage of peace. You can determine the cancer on the white pupil, the so-called "cat eye". This is the first symptom of child cancer in children. It is caused by the fact that the tumor shines through the pupil. Later violations with the formation of a squint.

In the second stage, external signs appear - redness of the eye, tearing, fear of light. It develops, iridocyclite, and also enhances intraocular pressure with the formation of secondary glaucoma.

The third stage is manifested by a blinding eye (). There is a tumor germination in neighboring fabrics.

The last fourth stage is the terminal, the most severe. Metastases appear in other organs. Children at the last stage of the retinoblastoma are experiencing strong weakness, headache, lose weight. Nausea appears, vomiting, pain of affected eyes.

Diagnosis of the disease

On the dispensary accounting of the ophthalmologist are all children, in whose family was a retinoblastoma. To suspect the first signs of retinal cancer in the classical triade of symptoms:

• leucokoria ("white pupil");
• strabismus;
• weakening of the pupil reaction to the light.

When the symptoms of the retinoblastoma in children are thorough diagnosis:

1. Inspection of the eye dna methods of biomicroscopy (with the help of a slit lamp) and ophthalmoscopy (with the help of an ophthalmoscope).
2. Assessment of visual acuity.
3. Measurement of intraocular pressure.
4. Inspection of the front eye chamber.
5. Study of binocular vision.
6. Determination of the severity of the emphasis of the eyeball.
7. Separate angle measurement.
8. Ultrasound Eye Apple.
9. Evaluation of the prevalence of oncology by the methods of radiography of eye orbits, otolonic sinuses, MRI and CT brain, liver scintigraphy, bones.
10. Intraocular biopsy - taking a piece of fabric to determine the cellular composition. Performed only with absolute readings.
11. Metastasis is evaluated by the study of the spinal fluid, the bone marrow point.

Treatment

Retinoblastoma is subject to observation and treatment of the following doctors:

• ophthalmologist;
• ophthalmhibrh;
• oncologist.

The treatment of eye cancer in children includes the operational removal of the focus (several varieties of operations), radiation therapy, chemotherapy.

Operational removal

Retinoblastoma of small sizes is treated by small-acting methods. Apply the following methods:

• cryotherapy - removal by destruction by cold tumor;
• photocoagulation - impact on the hearth light;
• thermotherapy is a high-temperature impact with microwaves, ultrasonic waves, infrared radiation.

Large areas of cancer damage are forced to remove the eye (enucleation). The next child is installed an eye prosthesis. If the cancer goes beyond the visual organ, then the extent of the soccer is carried out, i.e., a complete deletion of its contents.

Raundic treatment

The radiologist individually selects the course and dose of X-ray irradiation. Rauchery treatment of retinoblastoma with X-rays can be carried out contactless (remote) and contact methods. The first option is more secure, the second often leads to complications. X-ray treatment in 70% of children gives very nice results, It allows you to reduce the size of the retinoblastoma, to achieve persistent improvement.

Chemotherapy

Medical antitumor drugs are prescribed in the treatment of large tumors, the presence of metastases, the defeat of the adjacent tissues. Medicines are injected intravenously or directly to the area of \u200b\u200bthe pathological focus. Antitumor preparations have cytostatic and cytotoxic actions:

• The cytostatic action is in violation of the processes of dividing all organism cells, including cancer. The cytostatic group includes: "Winkerstine", "Carboplatin", "Doxorubicin".
• Cytotoxic action is deep cell damage leading to death. This group includes: "Cisplatin", "etoposide".

The best effect of chemotherapy is achieved with a combination of at least 3 different drugs.

Complications and forecast

The main complication of the retinoblastoma is a relapse after treatment. It occurs about 5% of children. The recurrence is especially inclined hereditary form retinal cancer.

A favorable prediction after the treatment of retinoblastoma in children is marked in 95% of cases in the event of the discovery of initial stages of cancer and early treatment. In these cases, it is possible to achieve a long-term remission without relapses, preserve vision and eyes.

The forecast of the disease is deteriorating in the presence of factors:

• a large number of cancer foci;
• the area of \u200b\u200bthe cancer tumor is 50% or more of the total volume of the eye;
• distribution of cancer outside the retina;
• germination into nearby fabrics;
• metastasis;
• hereditary form.

If the cancer went beyond the limits of the organ of vision, metastasis occurred, then high risk of death.

Prevention

Specific prophylaxis of retinoblastoma in children does not exist. Future parents are recommended before conception to survey in genetics. This will allow you to assess the risk of developing a child's education on retina and other congenital diseases.

Before conception you need to lead healthy image Life, avoid toxic effects on the body. This will help reduce the likelihood of a sporadic shape of the tumor.

Parents who had this disease, need to regularly led the child to an ophthalmologist. This will allow you to reveal the retina cancer at an early stage and save the child eyesight, and most importantly - life.

Be careful to your children. If there was a retinal cancer in the family, then regularly inspect the child's eyes. A sign of "cat's eyes" is easy to determine even people without medical education.