Ocular melanoma is a rare cancer originating in the eye’s pigment-producing cells, called melanocytes. While it is the most common primary eye cancer in adults, it affects only about 5 to 6 out of every million adults annually. Despite its ocular origin, this cancer often spreads to distant parts of the body. The liver is the most frequent site for this spread, known as metastasis, occurring in 90% to 95% of cases where the disease metastasizes.
How Ocular Melanoma Affects the Liver
When ocular melanoma cells travel through the bloodstream and establish new tumors in the liver, they are called liver metastases. These metastatic tumors disrupt the liver’s normal functions, which include filtering toxins, producing essential proteins, and aiding digestion.
The disruption of liver function can lead to a range of physical symptoms. Fatigue is common, often from the liver’s reduced ability to process waste products and maintain energy. Abdominal pain or discomfort, typically in the upper right side, can occur as growing tumors cause the liver to enlarge, a condition known as hepatomegaly.
Nausea and unexplained weight loss are also frequently observed. Nausea may arise from impaired detoxification or pressure on adjacent digestive organs. Weight loss often results from reduced appetite, impaired nutrient metabolism, and the increased energy demands of growing tumors.
In some cases, liver dysfunction can manifest as jaundice, a yellowing of the skin and eyes. This occurs when bilirubin, a yellow pigment normally processed and excreted by the liver, builds up in the bloodstream due to the liver’s inability to clear it. The severity and combination of these symptoms vary depending on the size, number, and location of the metastatic tumors.
Identifying Liver Metastasis
Regular surveillance is a key aspect of follow-up care for individuals diagnosed with ocular melanoma. This monitoring aims to detect any spread of the cancer early, often before symptoms appear, which can influence treatment options and outcomes.
Diagnostic methods for identifying liver metastasis involve blood tests and imaging scans. Blood tests include liver function tests (LFTs), which measure enzymes and proteins indicating liver health, and lactate dehydrogenase (LDH) levels, which can suggest active cancer. While these markers can indicate potential issues, they are not definitive for metastasis.
Imaging scans provide visual evidence of tumors. Ultrasound is often an initial screening tool. More detailed imaging includes computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. CT and MRI provide detailed anatomical images, while PET scans detect metabolically active cancer cells.
In some situations, a liver biopsy may be performed to confirm the diagnosis. This procedure involves taking a small tissue sample from a suspicious area, which is then examined under a microscope. A biopsy provides definitive confirmation of melanoma cells.
Treatment Approaches for Liver Metastasis
Treating ocular melanoma that has spread to the liver focuses on controlling disease progression, alleviating symptoms, and enhancing quality of life, as a cure is often not achievable at this advanced stage. Treatment strategies are multidisciplinary, combining various approaches tailored to the individual patient.
Systemic therapies target cancer cells throughout the body. Targeted therapies, such as tebentafusp, attack cancer cells with specific genetic characteristics. Immunotherapy, including checkpoint inhibitors, uses the body’s immune system to fight cancer.
Local or regional therapies focus directly on the liver. Hepatic artery chemoembolization (HACE) delivers chemotherapy drugs directly into the artery supplying liver tumors, often followed by blocking blood flow. Radioembolization, using Yttrium-90 (Y90), delivers radioactive microspheres directly to the tumors. Stereotactic body radiation therapy (SBRT) uses focused radiation beams to deliver high doses to tumors while sparing healthy liver tissue.
Surgical options, such as metastasectomy (removing tumors from the liver), are considered in limited circumstances. Surgery is reserved for patients with a small number of resectable tumors and good overall health. The decision depends on factors like liver involvement and the patient’s general condition.
Prognosis and Support
The outlook for individuals with ocular melanoma that has spread to the liver can be challenging due to the advanced nature of the disease. Prognosis varies based on the extent of liver involvement, the patient’s overall health, and treatment response. Early detection of liver metastasis, often before symptoms appear, is associated with a more favorable prognosis.
Supportive care services and palliative care help manage symptoms and improve quality of life. These services address physical symptoms, emotional well-being, and practical needs. Palliative care provides relief from the symptoms and stress of a serious illness.
Engagement with a multidisciplinary care team, including oncologists, interventional radiologists, surgeons, and supportive care specialists, optimizes treatment and symptom management. Patient support groups offer a community for individuals and their families to share experiences and find emotional support. These resources help patients navigate their diagnosis and treatment.