Ocular Oncology PDF

Preface

Ocular tumors are unique among the diseases of the eye, threatening both sight and life. Prior texts in oncology and ophthalmology have focused primarily on providing physicians with information about the treatment of eye tumors. Ocular Oncology differs in that it is our objective to present a comprehensive account of the most current basic and clinical science related to eye tumors, and to offer new ideas about innovative treatments derived from recent genetic, biochemical, and immunological studies. In addition, this book discusses the current status of clinical trials in ocular oncology, as well as provides an up-to-date review of risk and prognostic factors associated with eye tumors. Finally, current findings are presented from studies of animal models and their use to assess the efficacy of novel treatment modalities with potential for human treatment.

Ocular Oncology focuses on uveal melanoma and retinoblastoma, the principal tumors originating in the eyes of adults and children, respectively. Although considered uncommon diseases, we need to acknowledge that rare and uncommon diseases often provide insights into fundamental biological processes and advance the development of innovative treatments of more prevalent diseases. There is perhaps no better example in science than retinoblastoma, a rare childhood ocular tumor with an incidence of only 300 to 400 cases per year in the United States. Studies of retinoblastoma, however, funded by the National Eye Institute, led to the identification of the first tumor suppressor gene. Prior to these studies, cancer was considered solely a ‘‘gain of function'' phenomenon; studies of retinoblastoma instigated a fundamental change in thinking and scientific approach. In addition, studies of retinoblastoma led to the identification of further genes and pathways involved in one of the most fundamental processes in biology, namely the molecular control of cellular growth. Likewise, while much attention has been focused recently on anti-angiogenic strategies for the treatment of solid tumors, new studies of uveal melanoma have revealed a form of non-endothelial-based tumor microcirculation, owing to the dedifferentiation of tumor cells, that may compromise anti-angiogenic treatments. The relevance of such an alternative circulatory pathway during the growth and progression of other types of cancer is now an active area of investigation, instigated by studies of a rare eye tumor.

What is evident from recent technological advances, encompassed in new cytogenetic methods and the use of DNA chip arrays, is that ocular tumors, like eye diseases such as retinitis pigmentosa, are really a composite of different sentinel mutations that lead to the alteration of very different cellular pathways. Ultimately, the phenotype is unrestricted growth, a fairly limited description that likely undervalues the variety of causes leading to an eye tumor. This diversity and the ensuing complexity at a molecular level eventually will require methods of diagnosis and treatment that are tailored on a more individual level.

We would like to thank all of the contributors who thoughtfully considered the complexities of their particular scientific subdiscipline of ocular oncology, who fairly presented the controversies and candidly acknowledged the limitations of our knowledge, and who speculated boldly on what we need to accomplish before we can hope to successfully treat or prevent eye tumors and their metastases.