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Retinoblastoma, Definition, Causes, Symptoms, Diagnosis, Treatment, Complications, Prevention

Retinoblastoma is cancer that starts in the retina or the lining of the eye. Retinoblastoma attacks the retina located on the back of the eyeball wall. The retina consists of neural networks that function to send patterns of light captured to the brain through the optic nerve, so the eyes can see. When retinoblastoma occurs, eye cells called retinoblasts do not turn into mature cells but continue to divide to form cancer in the retina.

Retinoblastoma can attack one or both eyes. This condition is usually experienced by toddlers. Retinoblastoma is generally found before it spreads out from the white part of the eye, so it can still be cured with several treatment options. For example through radiotherapy, surgery, or chemotherapy.

Retinoblastoma, Pengertian, Penyebab, Gejala, Diagnosis, Pengobatan, Komplikasi, Pencegahan

Causes of Retinoblastoma

Retinoblastoma can occur since the fetus is in the womb. During the early stages of its growth, retinoblast cells divide themselves into new cells. Furthermore, the cell will develop into mature retinal cells. In the case of retinoblastoma, gene changes or mutations occur so that the cell grows continuously uncontrollably.

Until now, the cause of gene mutations has not been confirmed. Approximately 25% of cases of retinoblastoma are inherited with an autosomal dominant pattern, that although only one parent inherits the gene in a child, can increase the risk of retinoblastoma. Reduced retinoblastoma usually attacks both eyes. Whereas retinoblastoma, which is not inherited from parents, generally only affects one eye.

Symptoms of Retinoblastoma

Signs that arise from retinoblastoma are in the form of leukocoria, which is the presence of white in the pupils of the eye when illuminated by light. Blood vessels that are behind the eyes should emit red when exposed to light. In addition, the signs that can accompany retinoblastoma are:

  • Red and swollen eyes.
  • Right, and left eye movements are different, or not in line.
  • Pupils are always wide open.

Diagnosis of Retinoblastoma

A series of tests need to be done before an eye specialist can provide a diagnosis of retinoblastoma to the patient. The doctor will use a device called an ophthalmoscope to see the conditions inside the eye, including checking the possibility of a tumor in the patient's eyes.

In addition, scanning can also be done to determine the severity of retinoblastoma. Scanning can be done with eye ultrasound, CT scan, or MRI. The severity of retinoblastoma is distinguished based on the extent of spread and location of cancer, which will then determine the steps to be taken.

In the early stages, namely intraocular retinoblastoma, cancer cells have not spread to the tissues outside the eyes. While at a later stage, or extraocular retinoblastoma, cancer cells have spread to the outside of the eye or other parts of the body. While recurrent retinoblastoma is retinoblastoma that reappears in the eye or other body parts.

Retinoblastoma treatment

The treatment step is determined based on the severity of retinoblastoma. There are several therapeutic options that can be done to kill cancer cells in retinoblastoma, including:

  • Laser photocoagulation. Laser beam therapy can be used to destroy blood vessels that supply nutrients to the tumor so that they can kill cancer cells.
  • Cryotherapy. This therapy uses liquid nitrogen to freeze cancer cells before they are removed. The process of freezing and lifting can be done several times until the cancer cells disappear completely.
  • Thermotherapy. In this therapy, heat waves are directed at cancer cells by laser, microwave, or ultrasound.
  • Radiotherapy. Radiotherapy is done with the help of X-rays. There are two types of radiotherapy or radiation therapy, namely internal and external radiation. In internal radiation, radioactive material is placed near the tumor for several days to slowly effect radiation on the tumor. As for external radiation, radiation is emitted from a machine to provide greater exposure. Compared to internal therapy, external therapy is more at risk of damaging healthy tissue around the eyes. External radiation is usually given to patients with advanced retinoblastoma where other treatments are not effective.

Another method of treatment is through chemotherapy. Chemotherapy is done by using drugs to kill or inhibit the growth of cancer cells. Chemotherapy can be given in the oral form, injections into blood vessels, or injections into fluids around the brain and spine (intrathecal chemotherapy).

If the tumor is very large and difficult to handle with other methods, then the doctor can recommend surgical removal of the eyeball. This procedure is carried out in several stages beginning with enucleation or removal of the cancerous eye. After that, an artificial eyeball (implant) or artificial eye will be installed and connected to the eye muscles. Eye muscle tissue will adapt to artificial eyeballs as the healing process so that later the artificial eyeball can move like a real eye, even though it cannot see.

Complications of Retinoblastoma

Complications can occur in retinoblastoma and usually occur in advanced retinoblastoma. Some of them are:

  • Retinal detachment.
  • Bleeding in the eyeball.
  • Glaucoma.
  • Inflammation of the eyeball tissue and its surroundings (orbital cellulitis).
  • The eyeball is wrinkled and does not function normally (phthisis bulbi).

Prevention of Retinoblastoma

Regular eye examinations need to be done, especially in children who have family members with a history of retinoblastoma. The discovery of retinoblastoma in the early stages will determine the success of treatment. The examination can be done every month until the age of one year. While routine eye examinations in adults can be done at least once a year.
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