Lacrimal Tumour

What is lacrimal gland tumour?

A lacrimal gland tumour is a tumour in one of the glands that produce tears. The lacrimal gland is located under the outer part of each eyebrow. Lacrimal gland tumours can be harmless (benign) or cancerous (malignant). About half of lacrimal gland tumours are benign.

What are the symptoms of lacrimal gland tumour?

People with a lacrimal gland tumour may experience the following symptoms or signs. Sometimes people with a lacrimal gland tumour do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a tumour.

• Vision problems, such as blurry vision
• Pain in or around the eye
• A fullness of the eyelid, or a mass that can be felt on the eyelid
• Swelling around the eye
• Double vision

What are the risk factors?

The following factors may raise a person’s risk of developing a lacrimal gland tumour:

• A lacrimal gland tumour occurs more frequently in people in their 30s.
• A history of lymphoma: People who have a history of lymphoma are at higher risk for developing a periocular (around the eye) lymphoma.
• Incomplete removal of a previous benign tumour: In some instances, if a noncancerous lacrimal gland tumour was not completely removed, there is a higher risk of a malignant lacrimal gland tumour occurring. Therefore, a careful evaluation after surgery is recommended for people having this type of surgery.

How is a lacrimal gland tumour diagnosed?

Doctors use many tests to diagnose a tumour and find out if it is cancerous, and if so, if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of tumours, a biopsy is the only way to make a definitive diagnosis of cancer.

If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• Type of tumour suspected
• Signs and symptoms
• Previous test results

In addition to a physical examination, the following tests may be used to diagnose a lacrimal gland tumour. Not all tests listed will be used for every person.

• Biopsy. 
• Computed tomography (CT or CAT) scan.
• Magnetic resonance imaging (MRI). 
• Positron emission tomography (PET) scan.
• Bone scan.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is a cancerous lacrimal gland tumour, these results also help the doctor describe the cancer; this is called staging.

What are the treatment options for lacrimal gland tumour?

Descriptions of the most common treatment options for lacrimal gland tumour are listed below. Goals of treatment include complete removal of the tumour, as well as maintaining the health and vision of the patient’s eye(s).

Treatment options and recommendations depend on several factors, including:

• The type and stage of tumour
• Possible side effects
• Whether one or both eyes are involved
• Whether the tumour is cancerous
• The patient’s preferences
• The patient’s overall health

Lacrimal gland Tumour Surgery?

Surgery is the removal of the tumour and some surrounding healthy tissue during an operation. Surgery to the eye is common in the treatment of a lacrimal gland tumour. During surgery, the ophthalmologist will remove parts of the affected eye. Or, if necessary, the entire eye will be removed, depending on the size and spread of the tumour.

Possible side effects of eye surgery are similar to that of any surgery. They include a risk of infection, problems with anaesthesia (medication used during surgery to block awareness of pain), and pain.

 

Having an eye removed

Sometimes it is medically necessary to remove the eye. Because of this visual loss, a person with one eye may have trouble with depth perception. Most people adjust to these differences, which support from the health care team.

Many people worry about what they will look like when they have an eye removed. The cosmetic surgery available today usually yields good cosmetic results. To fill the area left by the missing eye, the person is fitted for a prosthesis, which is an artificial eye. The prosthesis will look and behave almost the same as a natural eye. For example, the artificial eye will move along with the person’s remaining eye, just not as much as a natural eye moves. Family members may be able to tell that the eye is not real, but it is unlikely that strangers will know.

If enucleation is required, talk with your doctor about a prosthesis. It may take many weeks for you to receive one. Also, ask about support services that may be available to you to help adjust to the loss of an eye.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. It is most often used for lacrimal gland lymphoma. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a specific time.

There are different types of radiation therapy, including:

• External-beam radiation therapy. The most common type of radiation, external-beam radiation therapy is given from a machine outside the body.
• Proton therapy.Also called proton-beam therapy, this is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.
• Intensity modulated radiation therapy (IMRT).IMRT is another way to deliver external-beam radiation therapy. The intensity is varied to more precisely target the tumour. As a result, IMRT damages less surrounding healthy tissue than is possible with traditional radiation treatment. IMRT may also reduce the damage to nearby important organs.

The dosage of radiation used and the site and type of the tumour significantly affect the risks of side effects.

 Common side effect of radiation therapy to the eye area include:

• A cataract is when the lens of the eye becomes cloudy. People with cataracts may have cloudy or foggy vision, have trouble seeing at night, and/or have problems with glare from the sun or bright lights. If the cataract is causing major problems with a person's eyesight, the cataract can be surgically removed.
• Loss of eyelashes and/or a dry eye. These side effects can occur with external-beam radiation therapy and proton-beam radiation therapy.

The following side effects are less common and can cause a loss of vision:

• Radiation retinopathy: The development of abnormal blood vessels in the retina
• Radiation optic neuropathy:Optic nerve damage
• Neovascular glaucoma: A painful condition where new blood vessels develop and block the outflow of fluid from the eye

If there is significant damage to the eye from radiation therapy, the eye may need to be removed. Other side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, or loose bowel movements. Most of these side effects go away soon after treatment is finished. Talk with your doctor about the risks and benefits of the different types of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumour cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating a tumour with medication.

Systemic chemotherapy gets into the bloodstream to reach tumour cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed. For a lacrimal gland tumour, chemotherapy may also be delivered through the blood vessel (intra-arterial) feeding the eye and the tumour by inserting a catheter in the groin area. The doctor guides the catheter into position with the help of imaging technology to reach the blood vessel in the head.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, or diarrhea. These side effects usually go away once treatment is finished.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the tumour. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Rituximab (Rituxan) is the most common immunotherapy used in the treatment of a lacrimal gland tumour. It is also used for the treatment of non-Hodgkin lymphoma.

Treatment by type of lacrimal gland tumour?

Below is an outline of the common treatments used depending on the type and stage of the lacrimal gland tumour. In addition to standard treatments, patients are encouraged to talk with their doctors about clinical trials that are open to them, no matter the type or stage of the tumour.

• Benign mixed epithelial tumour.The most common type of treatment for a benign mixed epithelial tumour is an excisional biopsy, where the tumour is removed surgically. The prognosis is more favorable if the tumour is completely removed.
• Malignant mixed epithelial tumour. The most common treatment for a malignant mixed epithelial lacrimal gland tumour is the complete surgical removal of the tumour.
• Lymphoma may be treated with external-beam radiation therapy, chemotherapy, immunotherapy, or a combination of these treatments. The chance of recovering from lymphoma of the lacrimal gland is higher if only one eye is affected. The specific treatment for ocular lymphoma depends on whether other parts of the body are affected, so it is important to know the stage of the lymphoma.
• AdCC of the lacrimal gland: AdCC is an aggressive form of cancer, and the most common type of treatment for AdCC is a procedure called exenteration. In this procedure, the surgeon removes the lacrimal gland, eyeball, muscles, and all orbital contents and adjacent bone. A combination of chemotherapy and radiation therapy may also be used as part of the treatment plan. Treatment is most successful when cancer has not spread.

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