Cancer of the lacrimal gland

Cancer of the lacrimal gland is a rare high-malignant tumor with poor prognosis. The frequency of occurrence is divided into the following histological types: adenocystic, pleomorphic adenocarcinoma, mucoepidermoid, squamous.

Lacrimal cancer is 2 times more likely to develop in women of any age, is characterized by invasive growth already at the earliest stages of development. The tumor is characterized by considerable cellular variability, it grows rapidly. Anamnesis of the disease usually does not exceed 2 years, more often patients note an accelerated increase in all symptoms for several (up to 6) months. Often the first symptoms of developing cancer are pain, discomfort, lachrymation in the affected orbit. Early uneven descent of the upper eyelid (initially ptosis develops in its outer third). The upper transition fold becomes smaller. Develops exophthalmos with the shift of the eyeball down and down, sometimes only downwards. As a result of mechanical deformation of the eye, the tumor develops myopic astigmatism. The palpable tumor is tuberous, practically not displaced in relation to the underlying tissues. Movement of the eye toward the location of the tumor is limited, reposition is greatly hampered.

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Symptoms of lacrimal cancers

Cancer of the lacrimal gland is manifested in 4 -6 decades of life. The anamnesis of the disease is shorter than in a benign tumor.

Pain is a sign of malignancy, but can also be in inflammatory processes. Pleomorphic adenocarcinoma (malignant mixed-cell tumor) is represented by three main clinical options:

• After incomplete removal of benign pleomorphic adenoma, subsequent one or more relapses within a few years and malignant transformation in the end.
• Long-existing exophthalmos (or enlargement of the upper eyelid), which suddenly begins to increase.
• Without a prior anamnesis of pleomorphic adenoma, the fast-growing formation of the lacrimal gland (usually for several months).

Signs of lacrimal cancers

• Neoplasm in the region of the lacrimal gland that displaces the eyeball.
• Spreading posteriorly with the involvement of the upper orbital fissure can lead to stagnant phenomena in conjunctiva and episcler and ophthalmoplegia.
• Limitation of eye movements upward and outward (frequent sign).
• Hypoesthesia of the innervation zone of the lacrimal nerve.
• Edema of the optic disc and folds of the choroid.

Methods of investigation of lacrimal cancers

Diagnosis is established only after histological examination. A presumptive diagnosis can be established based on an analysis of clinical symptoms and the results of instrumental research. At a roentgenography against a background of the increased orbit in a size bones of a bone destruction, more often in the upper, upper and outer walls of an orbit are revealed. Computer tomography allows you to determine the extent of the shadow of the tumor, the unevenness of its edges, the spread to the adjacent extraocular muscles and uneven contours of the orbital bone wall or its complete destruction, and ultrasound examination - only the presence of a tumor shadow and its density. The radio scintigram of the orbit in adenocarcinoma is characterized by an increase in the asymmetry coefficient characteristic of malignant tumors. Remote thermography is informative, especially with sugar loading. Pre-operative fine-needle aspiration biopsy helps to clarify the diagnosis.

• CT scan reveals erosion of the adjacent bone or ingrowth in bone, calcification is often seen;
• a biopsy is necessary to establish a histological diagnosis. The subsequent treatment depends on the prevalence of tumor invasion in adjacent structures, which is detected by CT;
• neurological examination is necessary, since adenocystic carcinoma, which spreads perineurally, can sprout into a cavernous sinus

Treatment of lacrimal cancers

Treatment of lacrimal cancers is a difficult task. Along with the radical point of view, advocates of which require obligatory exenteration of the orbit, there is an opinion that it is possible to perform an organ-preserving treatment that combines local excision of the tumor with a block of adjacent healthy tissues and postoperative external irradiation of the orbit. The choice of this or that method of treatment depends on the size of the tumor and its prevalence. With pre-operative detection of a breach of the integrity of the bones of the orbit, surgical treatment, including exenteration, is contraindicated.

1. Radical removal can be performed in the form of an orbit or mid-sectional resection. Unfortunately, it is rarely possible to completely remove the tumor tissue, which determines a poor prognosis.
2. Radiotherapy in combination with local removal can prolong life and reduce pain.

The prognosis for life and vision is poor, since the tumor is not only prone to recurrence with germination into the cranial cavity, but also to metastasis into the lungs, spine or regional lymph nodes. The timing of the occurrence of metastases varies from 1-2 to 20 years.