Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer? For information about the differences between childhood cancers and adult cancers, see Cancer in Children.

Retinoblastoma is a cancer that starts in the retina, the very back part of the eye. It is the most common type of eye cancer in children. Rarely, children can have other kinds of eye cancer, such as medulloepithelioma, which is described briefly below, or melanoma.

To understand retinoblastoma, it helps to know about the parts of the eye and how they work.

About the eye

The main part of the eye is the eyeball (also known as the globe), which is filled with a jelly-like material called vitreous humor. The front of the eyeball has a clear lens with an iris (the colored part of the eye that acts like a camera shutter), which allows light to enter the eye and focuses it on the retina.

The retina is the inner layer of cells in the back of the eye. It is made up of special nerve cells that are sensitive to light. These light-sensing cells are connected to the brain by the optic nerve, which runs out the back of the eyeball. The pattern of light (image) that reaches the retina is sent through the optic nerve to an area of the brain called the visual cortex, allowing us to see.

Over the past few decades, research into retinoblastoma has led to great advances and much higher cure rates for this type of cancer. Still, not all children are cured, and even those who are cured might still have long-term side effects from treatment, so more research is needed.

Research on retinoblastoma is being done at many medical centers, university hospitals, and other institutions around the world.

Genetics, genetic counseling, and gene therapy

The defective gene responsible for nearly all retinoblastomas (the RB1 gene) was identified in 1986. This discovery, along with technical advances in finding DNA changes, has made genetic testing for hereditary retinoblastoma possible.

A great deal of research has gone into figuring out how certain DNA changes in retinal cells cause them to become cancerous. Scientists understand these changes better for retinoblastoma than for most other cancer types. Although probably still years away, researchers hope that this understanding will one day lead to gene therapies, very specific treatments that can repair or counteract these DNA changes.

For example, researchers have found that an oncogene known as SYK is overactive in retinoblastoma cells. Drugs that target the protein this gene makes are now being developed. Another gene called MDM4 also seems to be involved in the development of retinoblastoma, and drugs aimed at blocking its effects are being studied.

Recently, researchers have found that a very small portion of retinoblastomas don’t seem to have changes in the RB1 gene, but instead have too many copies of another gene called MYCN. It is not yet clear if these cancers are different in any important ways from those with RB1 gene changes.

Treatment

Research is building on the progress made in treating retinoblastoma over the past few decades.

Radiation therapy

External radiation therapy can be used to treat retinoblastoma, but it can cause side effects because the radiation often reaches nearby tissues as well. Newer forms of radiation therapy such as intensity modulated radiation therapy (IMRT) and proton beam therapy can better target the tumor and spare nearby normal tissues. These techniques, which are described in the section Radiation Therapy for Retinoblastoma, may help doctors limit the side effects from radiation therapy.

Other local treatments

Doctors continue to improve the instruments used for cryotherapy, laser therapy (photocoagulation), thermotherapy, and other local treatments. The goal is to kill tumor cells more precisely while sparing other parts of the eye.

Chemotherapy

Chemotherapy (chemo) has played a larger role in treating many retinoblastomas in recent years.

Systemic chemotherapy

Chemo given into a vein (IV) is now commonly used to shrink tumors before local treatments such as cryotherapy or laser therapy. Doctors are now studying whether giving chemo after local treatments (known as adjuvant chemotherapy) might help prevent the recurrence of retinoblastoma, especially outside the eye. Doctors are also studying the use of different chemo drugs such as topotecan, as well as new ways of combining current drugs, to try to improve how well chemo works.

Localized chemotherapy

Chemo can help shrink most retinoblastomas, but when it’s given into the bloodstream it can cause side effects in different parts of the body. This limits the doses that can be given. Newer techniques help keep the chemo concentrated in the areas around the tumors. This can help doctors get higher doses of chemo to the tumors while reducing some of these side effects. Some of these techniques are described in the section Chemotherapy for Retinoblastoma.

Intra-arterial chemotherapy: In this approach, chemo is injected directly into the ophthalmic artery, the main artery feeding the eye, using a long, thin catheter. When intra-arterial chemotherapy is used, the dose of the chemo drug is much lower than when it is given by vein, and the side effects related to the chemo are minimal.

Intravitreal chemotherapy: Some doctors are studying injecting chemotherapy directly into the jelly-like fluid inside the eyeball (the vitreous humor) to treat tumors that are widespread within the eye and not helped by other treatments. The main concern with this technique is that placing the needle into the eye to give the chemo might open a small hole that could allow tumor cells to spread outside of the eye, so doctors are being very cautious with this approach. Some doctors are studying the use of cryotherapy (using very cold temperatures) at the site of injection to limit this risk. Intravitreal chemotherapy is still in the early stages of testing.

Retinoblastomas are usually found when a child is brought to a doctor because he or she has certain signs or symptoms.

For most types of cancer, the diagnosis is made with a biopsy. During a biopsy, the doctor removes a sample from the tumor and sends it to a lab to be looked at under a microscope.

But biopsies are not usually done to diagnose retinoblastoma for 2 reasons. First, taking a biopsy specimen from a tumor in the eye can’t be done easily without harming the eye and risking spreading cancer cells outside the eye. Second, retinoblastoma can usually be diagnosed accurately without a biopsy by doctors who have experience with this disease, and it’s unlikely to be confused with other eye problems in children.

Medical history and physical exam

If your child has signs or symptoms of retinoblastoma, the doctor will examine your child’s eyes and get a complete medical history. The doctor will ask about the child’s symptoms and may ask about any family history of retinoblastoma or other cancers. This information is important when deciding if more tests and exams are needed. Your family history is also useful for determining whether other relatives could possibly pass the retinoblastoma (RB1) gene change on to their children or develop this cancer themselves (if they are young children) and might benefit from genetic counseling.

If a retinoblastoma is suspected, the doctor will refer you to an ophthalmologist (a doctor who specializes in eye diseases), who will examine the eye closely to be more certain about the diagnosis. The ophthalmologist will use special lights and magnifying lenses to look inside the eye. Usually, the child needs to be under general anesthesia (asleep) during the exam so that the doctor can take a careful and detailed look.

If a diagnosis of retinoblastoma seems likely based on the eye exam, imaging tests will be done to help confirm it and to find out how far it may have spread within the eye and possibly to other parts of the body. Usually an ophthalmologist who specializes in treating cancers of the eye (called an ocular oncologist) will make the final determination. This doctor should also be part of the team of doctors treating the cancer.

Imaging tests

Imaging tests use x-rays, sound waves, magnetic fields, or radioactive substances to create pictures of the inside of the body. Imaging tests may be done for a number of reasons, including:

• To help tell if a tumor in the eye is likely to be a retinoblastoma
• To determine how large the tumor is and how far it has spread
• To help determine if treatment is working

Children thought to have retinoblastoma may have one or more of these tests.

Ultrasound

Ultrasound uses sound waves to create images of tissues inside the body, such as the inner parts of the eye. For this test, a small ultrasound probe is placed up against the eyelid or eyeball. The probe gives off sound waves and detects the echoes that bounce off the tissues inside and around the eye. The echoes are converted by a computer into an image on a computer screen.

Ultrasound is one of the most common imaging tests for confirming the diagnosis of retinoblastoma. It is painless and does not expose the child to radiation, but the child may need to be given medicine to help keep them calm or even asleep so the doctor can get a good look at the eye. This test can be very useful when tumors in the eye are so large they prevent doctors from seeing inside the whole eye.

Optical coherence tomography (OCT) is a similar type of test that uses light waves instead of sound waves to create very detailed images of the back of the eye.

Magnetic resonance imaging (MRI) scan

MRI scans are often used for retinoblastomas because they provide very detailed images of the eye and surrounding structures without using radiation. This test is especially good at looking at the brain and spinal cord. Most children with retinoblastoma will have at least one MRI scan. For children with bilateral retinoblastomas (tumors in both eyes), many doctors continue to do MRI scans of the brain for several years after treatment to look for tumors of the pineal gland (sometimes called trilateral retinoblastoma).

Unlike CT scans (described next), MRI scans use radio waves and strong magnets to create images instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to show details better.

MRI scans can take up to an hour. Your child may have to lie inside a narrow tube, which is confining and can be upsetting. Newer, more open MRI machines can help with this, but the test still requires staying still for long periods of time. The machines also make buzzing and clicking noises that may be disturbing. Young children may be given medicine to help keep them calm or even asleep during the test.

Computed tomography (CT) scan

CT scans use x-rays to make detailed images of parts of the body. CT scans can help determine the size of a retinoblastoma tumor and how much it has spread within the eye and to nearby areas.

Normally, either a CT or an MRI scan is needed, but usually not both. Because CT scans give off radiation, which might raise a child’s risk for other cancers in the future, most doctors prefer to use MRI. However, a CT scan can show deposits of calcium in the tumor much better than an MRI, which can be very helpful when the diagnosis of retinoblastoma is not clear.

Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around your child while he or she lies on a table. A computer then combines these pictures into images of slices of the part of the body being studied.

Before the scan, your child may get an IV (intravenous) injection of a contrast dye that helps better outline structures in the body. The dye can cause some flushing (a feeling of warmth, especially in the face). Some people are allergic and get hives. Rarely, more serious reactions like trouble breathing or low blood pressure can occur. Be sure to tell the doctor if your child has any allergies (especially to iodine or shellfish) or has ever had a reaction to any contrast material used for x-rays.

CT scans take longer than regular x-rays, but not as long as MRI scans. A CT scanner has been described as a large donut, with a narrow table that slides in and out of the middle opening. Your child will need to lie still on the table while the scan is being done. Your child may be given medicine to help them stay calm or even go to sleep during the test to help make sure the pictures come out well.

Bone scan

A bone scan can help show if the retinoblastoma has spread to the skull or other bones. Most children with retinoblastoma don’t need to have a bone scan. It is normally used only when there is a strong reason to think retinoblastoma might have spread beyond the eye.

For this test, a small amount of low-level radioactive material is injected into a vein (intravenously, or IV). (The amount of radioactivity used is very low and will pass out of the body within a day or so.) The material settles in abnormal areas of bone throughout the body over the course of a couple of hours. Your child then lies on a table for about 30 minutes while a special camera detects the radioactivity and creates a picture of the skeleton. Younger children may be given medicine to help them stay calm or even go to sleep during the test.

Areas of active bone changes appear as “hot spots” on the scan. These areas may suggest cancer is in an area, but other bone diseases can also cause the same pattern. To help tell these apart, other tests such as plain x-rays or MRI scans of the bone might be needed.

For more details on imaging tests, see Imaging (Radiology) Tests.

Other tests

Other tests are not often needed for retinoblastomas, but they may be helpful in some situations.

Biopsy

For most cancers, a biopsy (removing a tissue sample from the tumor and looking at it under a microscope) is needed to make a diagnosis. Trying to biopsy a tumor at the back of the eye can often damage the eye and may spread tumor cells, so this is almost never done to diagnose retinoblastoma. Instead, doctors make the diagnosis based on eye exams and on imaging tests such as those listed above. This is why it is very important that the diagnosis of retinoblastoma is made by experts.

Lumbar puncture (spinal tap)

Retinoblastomas can sometimes grow along the optic nerve, which connects the eye to the brain. If the cancer has spread to the surface of the brain, this test can often find cancer cells in samples of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord). Most children with retinoblastoma don’t need to have a lumbar puncture. It is used mainly when there is a reason to think retinoblastoma might have spread into the brain.

For this test, the child is typically given anesthesia so they will be asleep and not move during the procedure. This can help ensure the spinal tap is done cleanly. The doctor first numbs an area in the lower part of the back over the spine. A small, hollow needle is then placed between the bones of the spine to withdraw a small amount of the fluid. The fluid is then looked at under a microscope to check for cancer cells.

Bone marrow aspiration and biopsy

These 2 tests may be done to see if the cancer has spread to the bone marrow, the soft, inner part of certain bones. These tests are usually not needed unless the retinoblastoma has grown outside the eye and doctors suspect that the cancer may have also spread through the bloodstream to the bone marrow.

The tests are typically done at the same time. The samples are usually taken from the back of the pelvic (hip) bone, but in some cases they may be taken from other bones.

In bone marrow aspiration, the skin over the hip and the surface of the bone may be numbed with a local anesthetic. This test can be painful, so the child will probably be given other medicines to reduce pain or even be asleep during the procedure. A thin, hollow needle is then inserted into the bone, and a syringe is used to suck out (aspirate) a small amount of liquid bone marrow.

A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is pushed down into the bone. Once the biopsy is done, pressure is applied to the site to help stop any bleeding.

The samples are then looked at under a microscope to see if they contain cancer cells.

Retinoblastomas nearly always occur in young children. They are often found when a parent or doctor notices a child’s eye looks unusual.

White pupillary reflex

This is the most common early sign of retinoblastoma. Normally when you shine a light in the eye, the pupil (the dark spot in the center of the eye) looks red because of the blood vessels in the back of the eye. In an eye with retinoblastoma, the pupil often appears white or pink instead, which is known as a white pupillary reflex (or leukocoria).

This white glare of the eye may be noticed by a parent after a flash photograph is taken, especially if the pupils are different colors. It also might be noted by the child’s doctor during a routine eye exam.

Lazy eye

Sometimes the eyes don’t appear to look in the same direction, a condition often called lazy eye. (Doctors call this strabismus.) There are many possible causes of this in children. Most of the time lazy eye is caused by a mild weakness of the muscles that control the eyes, but it can also be caused by retinoblastoma.

Other possible signs and symptoms

Less common signs and symptoms of retinoblastoma include:

• Vision problems
• Eye pain
• Redness of the white part of the eye
• Bleeding in the front part of the eye
• Bulging of the eye
• A pupil that doesn’t get smaller when exposed to bright light
• A different color in each iris (the colored part of the eye)

Many of these signs and symptoms are more likely to be caused by something other than retinoblastoma. Still, if your child has any of these, check with your child’s doctor so the cause can be found and treated, if needed.

Hereditary retinoblastoma

Children with the hereditary form of retinoblastoma have a much higher risk for developing other types of cancer throughout their lives. This is because each cell in the body has an abnormal RB1 tumor suppressor gene, which would normally help stop some of these cancers from forming.

The risk for these cancers is even higher in any parts of the body that received radiation during treatment for retinoblastoma. Younger children treated with radiation therapy are more likely than older children to develop side effects such as second cancers or problems with bone growth in the irradiated area. Chemotherapy with certain drugs can also increase the risk of some cancers.

Most of these cancers are very treatable if detected early, which is why it is very important that these children are followed closely throughout life. The entire body must be examined carefully to avoid missing these second cancers.

The most common second cancers among retinoblastoma survivors include:

• Osteosarcoma (a type of bone cancer)
• Soft tissue sarcomas (cancers that develop in muscle, tendons and ligaments, and fatty tissue)
• Melanoma (a type of skin cancer)
• Lung cancer
• Lymphoma
• Bladder cancer
• Uterine cancer
• Breast cancer
• Brain tumors
• Cancers in the mouth or nose

Because of the increased risk these children face, it’s important that they’re taught about other factors that might increase their risk of cancer as they get older. For example, too much sun exposure can increase the risk of melanoma even further, and smoking can increase lung cancer risk, so avoiding these types of risk factors is very important. It’s also important to know what types of cancer screening tests these children might need as they get older. Of course, these children are also at risk of other cancers as they get older, just like children who did not have retinoblastoma.

Children with hereditary retinoblastoma also have a small risk of developing a tumor in the pineal gland within a few years. (This is known as trilateral retinoblastoma.) The pineal gland is a bean-sized structure lying under the middle of the brain. It can have cells similar to retina cells, which is why tumors can start there. This is why doctors often recommend that MRI scans of the head be done regularly for up to 5 years to try to detect such tumors as early as possible.

Non-hereditary (sporadic) retinoblastoma

Children who do not have the hereditary form of retinoblastoma don’t have the RB1 gene change in all of their cells, so they don’t have such a high risk of other cancers. Still, their risk of some cancers might be higher from getting chemotherapy and/or radiation therapy. These children are also at risk for other cancers as they get older, just like children who did not have retinoblastoma.

Retinoblastoma is a rare disease. Only about 200 to 300 children are diagnosed with retinoblastoma each year in the United States. It is more common in infants and very young children than in older children. The average age of children when they are diagnosed is 2. It rarely occurs in children older than 6.

About 3 out of 4 children with retinoblastoma have a tumor in only one eye. In about 1 case in 4, both eyes are affected.

Retinoblastoma occurs about equally in boys and girls and in different races and ethnicities. It also occurs equally in the right or left eye.

Overall, more than 9 out of 10 children with retinoblastoma are cured, but the outlook is not nearly as good if the cancer has spread outside of the eye.

A risk factor is anything that affects a person’s chance of getting a disease such as cancer. Different cancers have different risk factors.

Lifestyle-related risk factors such as body weight, physical activity, diet, and tobacco use play a major role in many adult cancers. But these factors usually take many years to influence cancer risk, and they are not thought to play much of a role in childhood cancers, including retinoblastomas.

There are very few known risk factors for retinoblastoma.

Age

Most children diagnosed with retinoblastoma are younger than 3 years old. Most congenital or hereditary retinoblastomas are found during the first year of life, while non-inherited retinoblastomas tend to be diagnosed in 1- and 2-year-olds. Retinoblastomas are rare in older children and in adults.

Heredity

About 1 out of 3 retinoblastomas is caused by a mutation (change) in the RB1 gene that is present in all the cells of the child’s body. But of these cases, only about 1 in 4 is inherited from one of the child’s parents. In the rest, the gene mutation is not inherited, but occurs during early development in the womb. Children born with a mutation in the RB1 gene usually develop retinoblastoma in both eyes. Regardless of whether the mutated RB1 gene was inherited from a parent or not, because these children have the mutated gene in all of their cells, they have a 1 in 2 chance of eventually passing it on to their children.

Most of the remaining 2 out of 3 retinoblastomas occur as a result of a random RB1 gene mutation that occurs only in one cell of one eye. These mutations are not inherited from a parent, and children who have them do not pass on a greatly increased risk of retinoblastoma to their children. Non-hereditary retinoblastomas always affect one eye only.

The way in which inherited gene changes make certain children likely to develop retinoblastoma is explained in the section Do We Know What Causes Retinoblastoma?

Retinoblastoma is caused by mutations (changes) in certain genes. Over the past few decades, scientists have learned how certain changes in a person’s DNA can cause cells of the retina to become cancerous. The DNA in each of our cells makes up our genes, which are the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects much more than how we look.

Some genes control when our cells grow, divide into new cells, and die at the right time. Certain genes that help cells grow, divide, or stay alive are called oncogenes. Others that slow down cell division or cause cells to die at the right time are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes.

The most important gene in retinoblastoma is the RB1 tumor suppressor gene. This gene makes a protein (pRb) that helps stop cells from growing too quickly. Each cell normally has 2 RB1 genes. As long as a retinal cell has at least one RB1 gene that works as it should, it will not form a retinoblastoma. But when both of the RB1 genes are mutated or missing, a cell can grow unchecked. This can lead to further gene changes, which in turn may cause cells to become cancerous.

Hereditary or bilateral retinoblastoma

About 1 out of 3 children with retinoblastoma have a germline mutation in one RB1 gene; that is, all the cells in the body have a defective RB1 gene. In most of these children (75%), this mutation developed after conception while in the womb. The other 25% of children have inherited it from one of their parents.

About 9 of 10 children who are born with this RB1 germline mutation develop retinoblastoma. This happens when the second RB1 gene is lost or mutated. Most often the retinoblastoma is bilateral (in both eyes), but sometimes it is found early enough that it is still only in one eye.

These children have hereditary retinoblastoma. All bilateral retinoblastomas are considered hereditary, although not all hereditary retinoblastomas are bilateral when they are found.

Every person has 2 RB1 genes but passes only 1 on to each of their children. (The child gets the other RB1 gene from the other parent.) Therefore there is a 1 in 2 chance that a parent who had hereditary retinoblastoma will pass the mutated gene on to his or her child.

Most children with hereditary retinoblastoma don’t have an affected parent. But these children can still pass their RB1 gene mutation on to their children. This is why we call this form of retinoblastoma “hereditary” (even though neither of the child’s parents may have been affected).

Non-hereditary (sporadic) retinoblastoma

Most of the remaining 2 out of 3 children with retinoblastoma do not have the RB1 gene mutation in all the cells of their body. Instead, the RB1 mutation happens early in life and first occurs only in one cell in one eye.

Whether the changes in the RB1 gene are hereditary or sporadic, it’s not clear what causes these changes. They may result from random gene errors that sometimes occur when cells divide to make new cells. There are no known lifestyle-related or environmental causes of retinoblastoma, so it’s important to remember that there is nothing these children or their parents could have done to prevent these cancers.

Retinoblastoma is a rare cancer, and there are no widely recommended screening tests to look for retinoblastoma in children without symptoms. Still, many retinoblastomas are found early by parents, relatives, or a child’s doctor.

During children’s regular physical exams, doctors routinely check their eyes. Some of the things doctors look for include changes in how the eyes look (inside or outside), changes in how the eyes move, and changes in the child’s vision. Any of these might be a sign of retinoblastoma, although they are more often caused by something else.

Sometimes, a parent or relative may notice that a young child’s eye doesn’t look normal, prompting a visit to the doctor. It’s important for parents to be aware of the possible signs and symptoms of retinoblastoma, and to report anything unusual to the doctor as soon as possible. Most often the cause is something other than retinoblastoma, but it’s important to have it checked so that the cause can be found and treated right away, if needed.

For children in families known to carry an abnormal RB1 gene, or in families with a history of retinoblastoma who have not had genetic testing for the RB1 gene, doctors recommend regular eye exams during the first years of life to detect any tumors at an early stage. These children often have an eye exam a few days after birth, again at about 6 weeks of age, then every few months until at least age 5. The RB1 gene defect can be found by a special blood test, so most doctors now advise that children with parents or siblings with a history of retinoblastoma have this genetic test done during the first few weeks after birth. The results of the test then help define how often eye exams should be done.

Most hereditary retinoblastomas develop and are diagnosed in infants only a few months old. Usually, if tumors develop in both eyes, it happens at the same time. But in some children, tumors develop in one eye first, then a few months (or even years) later in the other eye. So even if retinoblastoma is diagnosed in only one eye, these children will still need regular exams of the other eye for several years after treatment.

If a child has retinoblastoma that is thought to be hereditary, many doctors also recommend magnetic resonance imaging (MRI) scans of the brain at regular intervals for up to 5 years to check for a trilateral retinoblastoma (a brain tumor such as a pineoblastoma). For more information, see the section How Is Retinoblastoma Diagnosed?

With major advances in treatment in recent decades, most children treated for retinoblastoma are now expected to have normal lifespans. But some of the treatments needed to cure the cancer can affect children’s health later in life, so watching for health effects as they get older has become more of a concern in recent years.

Just as the treatment of childhood cancer requires a very specialized approach, so does the care and follow-up after treatment. The earlier any problems can be recognized, the more likely it is they can be treated effectively.

Young people treated for retinoblastoma are at risk, to some degree, for several possible late effects of their cancer treatment. It’s important to discuss what these possible effects might be with your child’s medical team.

The risk of late effects depends on a number of factors, such as the specific treatments used, the doses of treatment, and the age of the child when being treated. These late effects can include:

• Reduction or loss of vision in the affected eye(s)
• Deformities in the bones around the eye (especially after surgery or external radiation)
• Reduced kidney function
• Heart problems after getting certain chemotherapy drugs
• Slowed or delayed growth and development
• Changes in sexual development and ability to have children (see Fertility and Women With Cancer and Fertility and Men With Cancer)
• Increased risk of other cancers (especially in children with hereditary retinoblastoma – see the section Second Cancers After Retinoblastoma)

Other complications from treatment are possible as well. Your child’s doctor should carefully review any possible problems with you.

Long-term follow-up care

To help increase awareness of late effects and improve follow-up care of childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what type of screening tests should be done to look for problems, and how late effects can be treated.

It’s very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also read them on the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as “Health Links”) on the site as well, but we urge you to discuss them with your doctor.

For more about some of the possible long-term effects of treatment, see Children Diagnosed With Cancer: Late Effects of Cancer Treatment.

During and after treatment for retinoblastoma, the main concerns for most families are the short- and long-term effects of the cancer and its treatment, and concerns about the cancer still being there or coming back.

It’s certainly normal to want to put the tumor and its treatment behind you and to get back to a life that doesn’t revolve around cancer. But it’s important to realize that follow-up care is a central part of this process that offers your child the best chance for recovery and long-term survival.

Follow-up exams and tests

Once treatment is finished, your health care team will discuss a follow-up schedule with you, including which tests should be done and how often. It’s very important to go to all follow-up appointments. Follow-up is needed to check for cancer recurrence, as well as possible side effects of certain treatments. Doctor visits and tests are done more often at first. If nothing abnormal is found, the time between tests can then be extended.

If a child with retinoblastoma in only one eye has been treated by enucleation (removal of the eye), regular exams are needed to look for tumor recurrence or spread, or any growth problems related to the surgery. It’s also important to have the remaining eye checked regularly so that if a second retinoblastoma develops later on it can be found and treated as early as possible.

For children who have had treatment other than removal of the eye, close follow-up exams by an ophthalmologist (eye doctor) are very important to look for signs of the cancer coming back or other problems. In children with hereditary retinoblastoma, it’s very common for new tumors to form until they are 3 or 4 years old. This is not a failure of the treatment, but the natural process in bilateral retinoblastoma. Therefore, it’s very important that even after completing all treatments, children are examined regularly by specialists.

During these exams, general anesthesia (where the child is asleep) may be needed to keep a young child still enough for the doctor to do a thorough eye exam. This is done to be certain the cancer has been destroyed, to find recurrences as early as possible, and to look for problems caused by treatments.

It’s important for you to report any new symptoms your child is having, such as pain or vision problems, to your doctor right away, since they could be an early sign of cancer coming back or long-term side effects of treatment.

Keeping good medical records after treatment for retinoblastoma

As much as you might want to put the experience behind you once treatment is done, it’s very important to keep good records of your child’s medical care during this time. This can be very helpful for your child later on as an adult and for his or her doctors. Gathering these details during or soon after treatment may be easier than trying to get them at some point in the future. Be sure your child’s doctors have the following information (and always keep copies for yourself):

• A copy of the pathology report(s) from any biopsies or surgeries
• If your child had surgery, a copy of the operative report(s)
• If your child stayed in the hospital, copies of the discharge summaries that the doctors wrote when he or she was sent home
• If chemotherapy was given, a list of the drugs, drug doses, and when they were given
• If radiation therapy was given, a summary of the type and dose of radiation and when and where it was given
• If genetic testing was done, the results of those tests
• The names and contact information of the doctors who treated your child’s cancer

It’s also very important to keep health insurance coverage. Tests and doctor visits cost a lot, and even though no one wants to think of the cancer coming back, this could happen.