Breast Cancer Metastasis and Eye Exams

October is no longer just an orange and black month in the spirit of Halloween. October is also a pink month—October is Breast Cancer Awareness Month. October is the month when major campaigns to promote early detection of breast cancer with screening mammograms and monthly self-breast exams and fundraising campaigns to fund breast cancer research occur.

Breast cancer affects 1 out of 8 or 12% of women over the course of her lifetime and 99% of breast cancer cases are in women. Approximately 85% of breast cancers occur in women who have no family history of breast cancer. The most significant risk factors for breast cancer are gender (female) and aging. It has been estimated that 316,120 new cases of breast cancer will be diagnosed in the United States in 2017.

Breast cancer is often categorized in Stages from 0 – 4, with Stage 0 being non-invasive (in situ) and Stages 1 – 4 being invasive. Approximately 80% of the new cases are invasive breast cancer (Stages 1 – 4). Stage 4 breast cancer is also known as metastatic breast cancer which is breast cancer that has spread to other parts of the body. About 6 percent of new breast cancer diagnosis in women is metastatic. Most cases of metastatic breast cancer are recurrences of previously treated early stage breast cancer. Metastatic breast cancer will usually spread to bones, lungs, liver or brain and in some instances, to the eye.

Metastatic tumors seen in the eye are usually spread from the primary cancer site through the bloodstream to the vascular layer of the eye called the uvea and specifically the choroid (the largest part of the uvea) and the iris; approximately 89% of the eye tumors are located in the choroid. Some of the symptoms for metastatic eye tumor are blurry vision, double vision, distortion of vision, floaters, droopy eyelid and headache.

Metastatic eye tumors are rare but they may be the first indication of metastatic cancer or may even lead to the first diagnosis of cancer. A dilated eye exam at least once a year is recommended for all cancer survivors, who may have been treated with medications that could potentially have long-term toxicity to the eye. Additionally, patients who were treated with radiation may be at risk for cataract and dry eye. A dilated eye exam may be “inconvenient” or a nuisance, but it can be the difference between detecting a metastatic eye lesion or not.

References

1. Freedman MI, Folk JC: Metastatic tumors to the eye and orbit. Patient survival and clinical characteristics. Arch Opththalmol. 1987 Sep; 105(9):1215-9.
2. Konstantinos IP, Sinha A, Ioannidis AS, Davidson NG: Ocular metastases from HER2 positive breast carcinoma and the response to combination therapy with Paclitaxel and Trastuzumab: a case report. Cases Journal 2009 2:9143.
3. Eckardt AM, Rana M, Essig H, Gellrich N: Orbital metastases as first sign of metastatic spread in breast cancer: Case report and review of the literature. Head Neck Oncol. 2011; 3:37.
4. Finger, P: Choroidal Metastasis, https://eyecancer.com/eye-cancer/conditions/choroidal-tumors/choroidal-metastasis/
5. Arepalli S, Kaliki S, Shields CL: Choroidal metastases: Origin features, and therapy. Indian J Ophthalmol 2015 Feb; 63(2): 122-127.
6. Seddik Y, Brahmi SA, Al-Jarroundi O, Chacha R, Barabino AD, Ruck S, Afquir S: Choroidal Metastasis as a First Sign of Recurrence in a Patient with Breast Cancer: A Case Report. https://www.omicsonline.org/open-access/choroidal-metastasis-as-a-first-sign-of-recurrence-in-a-patient-with-breast-cancer-a-case-report-.php?aid=80620.
7. Susan G. Komen: Treatments for Metastatic Breast Cancer. http://ww5.komen.org/BreastCancer/RecommendedTreatmentsforMetastaticBreastCancer.html.
8. Park C, Sinha N, Shields CL: Breast Cancer Metastasis to the Eye: Facts and Figures, Retina Today, March 2010.
9. Gombos D, Garvin L: Metastatic Eye Cancer, https://www.mdanderson.org/transcripts/cancer-newsline/2010/transcript-8-02-10---metastatic-eye-cancer.html
10. Metastatic Breast Cancer. http://www.nationalbreastcancer.org