The document discusses orbital tumors, which are tumors located in the bony socket of the skull that contains the eye, outlining their causes, symptoms, diagnostic tests, and treatment options. It highlights common types of orbital tumors in children and adults, details the TNM staging system for cancer, and reviews various surgical and medical management options available. The prognosis varies depending on the tumor type and may require therapies like surgery, radiotherapy, and chemotherapy.

1. Prepared by Bobby Abraham
Submitted to Sis.Jennitta SDU

2. An orbital tumor refers to any tumor located in
the “orbit,” which is the bony socket in the front
of the skull that contains the eye. The socket is a
complicated structure that includes the eye
itself along with muscles, nerves, and
connective tissue.

3. OVERVIEW
The orbit is the cone-shaped bony socket that contains the
eyeball.The orbital contents include the extra ocular
muscles that move the eye, the optic nerve, the nerves and
blood vessels supplying these structures and the fat
inbetween. Tumors that develop in any of the tissues that
surround the eyeball are referred to as orbital tumors

4. TNM staging system
TNM staging system
One tool that doctors can use to describe the stage is the
TNM system.Factors that go into determining the stage of
the cancer in orbital tumour.
T Characteristics of the main Tumor mass
N Status of the lymph Nodes in the neck (i.e., evidence
of cancer spread)
M Metastasis Status of cancer spread to parts of the
body outside of the head and neck

5. COMMON TYPES OF
ORBITAL TUMOUR
Rhabdomyosarcoma is the most common cancer of the
orbit in children.

6. RetinoblastomaRetinoblastoma is the most common tumor
inside the eyeball in children.

7. Neuroblastoma
Neuroblastoma is the most common cancer
to spread to the orbit in
children

8. Dermoids and
vascular lesions

9. Adult orbital tumors
Lymphoma: This is the most common type of orbit
tumor that starts in adults. Lymphoma is a cancer of the
blood in which specific white blood cells (called
lymphocytes) become cancerous. Even though lymphoma
is a blood cancer, it usually presents as a solid tumor in the
body.

10. Lacrimal gland cancers:
Lacrimal gland cancers: These are very similar to salivary
gland cancers, and they can be of the same type, including:
1. Adenoid cystic carcinoma
2. malignant mixed tumor (carcinosarcoma)
3. Adenocarcinoma
4. Mucoepidermoid carcinoma

11. Lacrimal sac cancers
Lacrimal sac cancers: These can include squamous cell
carcinoma, adenocarcinoma, transitional cell carcinoma,
salivary gland carcinoma and poorly differentiated
carcinoma

12. Cancers of the skin of the
eyelid
Cancers of the skin of the eyelid: These can include
squamous cell carcinoma, basal cell carcinoma and even
rare tumors such as sebaceous cell carcinoma and Merkel
cell carcinoma

13. Sarcomas
• Sarcomas: These can also arise in the orbit and include
rhabdomyosarcoma, osteosarcoma, chondrosarcoma,
liposarcoma and angiosarcoma.

14. CAUSES OF ORBITAL
TUMOUR
The cause of primary orbital tumors is unknown. In children
most orbital tumors result from developmental
abnormalities. When visual loss or deterioration occurs with
an orbital tumor, it may result from either mass effect,
compromise of the vasculature to the optic apparatus as a
result of the tumor, or invasion of the optic nerve by the
tumor.

15. SYMPTOMS OF
ORBITAL TUMOUR
Many people with tumour don't have symptoms unless the
tumour grows in certain parts of the eye or becomes more
advanced.
1. Blurred vision.
2. Redness of the eye
3. Shadows, flashes of light
4. A dark patch in the eye that's getting bigger.
5. Partial or total loss of vision.
6. Bulging of one eye ,sudden proptosis
7. A lump on eyelid or in your eye that's increasing in size.
8. Pain in or around eye, although this is rare.

16. Diagnostic tests
Diagnostic tests
In addition to a physical examination, the following tests
may be used to diagnose eye cancer:
Eye examination.
Most cases of melanoma are found during a regular eye
examination. The doctor will examine the eye with a lighted
instrument called an ophthalmoscope and a slit lamp,
which is a microscope with a light attached to it.

17. Diagnostic tests.
Ultrasound. An ultrasound uses sound waves to create a
picture of the eye.
Fluorescein angiography. This procedure takes a picture
of the blood vessels in the eye. Fluorescein angiography
may be used to rule out eye problems other than cancer
Fine needle biopsy. This procedure removes tumor cells
from the eye with a needle. This allows the doctor to look at
the cells under a microscope.

18. Diagnostic tests
Cytogenetics and gene expression profiling. Doctor's
may recommend this type of test to help gather more
information about your prognosis (chance of recovery) and
treatment options. Cytogenetics or gene expression
profiling tests are done using a tissue sample removed
during either a biopsy or surgery.
Computed tomography (CT) scan. A CT scan creates a
three-dimensional picture of the inside of the body . it
provides a detailed, cross-sectional view that shows any
abnormalities or tumors.

19. Diagnostic tests
Magnetic resonance imaging (MRI). An MRI uses
magnetic fields to produce detailed images of the body.
MRI can also be used to measure the tumor’s size. A
special dye called a contrast medium is given before the
scan to create a clearer picture. This dye can be injected
into a patient’s vein or given as a pill to swallow.

20. Diagnostic tests
Positron emission tomography (PET) scan. The doctor
may also order a positron emission tomography (PET)
scan. A PET scan is a way to create pictures of organs and
tissues inside the body. A small amount of a radioactive
sugar substance is injected into a patient’s body. This sugar
substance is taken up by cells that use the most energy.
Because cancer tends to use energy actively, it absorbs
more of the radioactive substance. A scanner then detects
this substance to produce images of the inside of the body.

21. PROGNOSIS
PROGNOSIS
Surgical removal is curative for many orbital tumors and the
cosmetic results can be excellent. The outcome and
prognosis ultimately depends on the pathological
diagnosis. Some orbital tumors may require additional
therapy rather than biopsy or removal this may include
conventional "external beam" or Gamma Knife
Radiotherapy. Occasionally chemotherapy may also be
necessary.

22. MEDICAL AND SURGICAL
MANAGEMENT
GOALS
To prevent a malignancy from progressing to a life-
threatening stage
To preserve vision, and preserve the eye
To alleviate the symptoms of an orbital tumor and restore
the patient to good health

23. SURGICAL
MANAGEMENT
1. Radiotherapy
2. Chemotherapy
3. Gamma Knife Radiosurgery
4. Surgical excision
Surgical removal of the cancer is often the first line of
treatment for head and neck cancers.
Orbitotomy. A surgical incision made into the orbit to allow
the removal of a tumour or foreign body, to treat a lesion, or
to drain an abscess.

24. MEDICAL AND SURGICAL
MANAGEMENT
Evisceration
Evisceration is the removal of the inside of the eyeball but
not the outer layers.
Exenteration
Orbital exenteration is the removal of the entire eye socket,
optic nerve and even bones surrounding the eye.
Enucleation
Enucleation is the removal of the eye but leaving the eye
socket in place.

25. BIBLIOGRAPHY
1. Brunner and Suddarth’s, “Medical Surgical Nursing”
Published by Lippincott, 10th edition.
2. Lewis, Heitkemper and Dirksen’s , “Medical surgical
nursing”, Published by Mosby, 6th edition.
3. Head and neck cancer guide.com
4. Nursesoutlook.blogspot.com
5. American cancer journal