Choroidal malignant melanoma is the most common primary malignancy in the adult eye. It accounts for 85% of uveal malignant melanomas. The average age of onset is about 50 years, with 50% occurring after the age of 50. The incidence is similar in men and women, and the incidence is the same in the left and right eyes; it is rare for both eyes to develop simultaneously or sequentially. The incidence is higher in Caucasians than in other people of color, with an incidence rate of 6-7 per million, and rare in blacks.
Pathogenesis】Most of the tumors start in the choroidal macrovascular layer. Regarding the origin of tumor cells, it is generally believed that there are two possibilities, one from the ciliary nerve sheath membrane (Schwann cells) and the other from the stromal melanocytes (stromal melanoblast). The former has a high incidence, accounting for about 4/5 of all choroidal malignant melanomas, while the latter is only 1/5. The malignant transformation of choroidal melanocytes by tumorigenic factors leads to the formation of tumor-like nodules.
Disease Classification】There are two ways of clinical growth.
1.Confined: confined growth between the sclera and the vitreous membrane of the choroid, with a flattened oval shape. If it penetrates the vitreous membrane, it will expand rapidly in the subretinal cavity and form a mushroom-like tumor with a large base and a thin neck and head.
2.Diffuse: Characterized by extensive diffuse infiltration, tumor cells infiltrate through blood vessels and lymphatic sheaths and expand along the choroidal plane, so the course of the disease is longer and slower than that of the limited ones. In addition to irregular pigmentation of the fundus, there is no significant elevation.
The tumor cells are usually classified into 5 types according to their different morphology:
1. The spindle cell type is the most common and consists of different proportions of spindle A and spindle B tumor cells. It is generally believed that the higher the proportion of spindle A tumor cells in the tumor, the better the prognosis.
The epithelioid cell type is generally classified as this type when the proportion of epithelioid cells in the tumor is >75%, and malignant melanoma consisting of epithelioid cells alone is rare. The prognosis of this type is poor, and the choroidal malignant melanoma with diffuse flat growth is mostly epithelioid cell type.
3, mixed cell type, consisting of different proportions of spindle and epithelioid cells. It is further divided into:
(1) spindle cell dominant type: dominated by spindle cells. But <75%.
(2) Spindle cell and epithelioid cell homogeneous type;
(3) epithelioid dominant type: predominantly epithelioid cells, but <75%. The degree of cell malignancy increased from spindle a, spindle b to epithelioid cells in descending order.
4. The necrotic type is less common and is characterized by a large number of necrotic tumor cells within the tumor. The cause of necrosis may be related to insufficient blood supply and immune response. Necrotic tumor cells can cause intraocular inflammatory reactions, which can be easily misdiagnosed as uveitis or endophthalmitis.
5. Balloon cell type is rare, and most of the tumors are composed of “balloon tumor cells”, which may be a transitional form of tumor cells transforming into degenerative tumor cells.
Clinical manifestations
1.Symptoms and signs: Most of the patients complain of vision loss or visual field loss and drifting black shadows in front of the eyes, the degree of vision change depends on the location of the swelling and pain, the size of the tumor and the scope of the combined retinal detachment. In early stages of choroidal malignant melanoma in the periphery, patients may not have any conscious symptoms. If the tumor is located near the macula and the optic papilla in the posterior pole, visual impairment symptoms may appear early. Posterior choroidal melanoma rarely causes glaucoma, but anterior choroidal melanoma can cause glaucoma when the tumor squeezes the lens iris forward and closes the atrial angle, and can cause pain and congestion. Anterior tumors can also develop granulomatous iridocyclitis and secondary anterior chamber hemorrhage, which can be easily misdiagnosed.
The main sign of choroidal malignant melanoma is an occupying solid lesion in the fundus. Choroidal malignant melanoma presents as a nodular well-defined black bulging mass in the choroid, which may form a characteristic mushroom shape and may be located in any quadrant of the fundus. Patients are often misdiagnosed due to secondary retinal detachment and vitreous opacities that interfere with fundus observation. The pigmentation of the tumor surface varies, with a small percentage of patients having no pigment at all. Atrophic loss and proliferation of the retinal pigment epithelium may occur, and some patients may also have subretinal choroidal neovascularization and limited detachment from the RPE. The finding of a tumor rich in brownish-black pigment can help diagnose this disease. Scleral transillumination tests show that the tumor is radiopaque. Smaller tumors usually do not have fundus hemorrhage. Intra- or peritumoral hemorrhage may occur when the tumor is large or growing rapidly, or when the vortex vein is obstructed. Exudation and edema around the tumor are rare. One rare type of choroidal malignant melanoma is the diffuse growth type, where the bulging mass is not visible on fundus examination and is easily missed. Patients with this type are prone to exudative retinal detachment, high malignancy, poor prognosis, and easy to invade the optic nerve outside the sclera and develop behind the globe.
2.Auxiliary examination.
(1) Scleral transillumination test: choroidal malignant melanoma and thick hemorrhage are not transilluminating, while exudative retinal detachment and exudative choroidal detachment and non-pigmented tumor are transilluminating. This has significant implications for the diagnosis of choroidal malignant melanoma. Also, scleral transillumination test helps to design the size and scope of local excision of choroidal malignant melanoma and the location of radioactive scleral plate placed on the scleral surface.
(2) Fundus photography and fundus fluorescence angiography (FFA): Fundus color or stereoscopic photography is of great importance to determine whether the choroidal malignant melanoma mass is enlarged and thickened during observation. Small choroidal malignant melanomas may have a normal FFA when the retinal pigment epithelium is intact on their surface. Once the tumor affects the RPE, typical fluorescence imaging changes occur: in the arterial or early venous phase, the tumor site shows speckled hyperfluorescence and the corresponding tumor surface orange pigment is hypofluorescent; in the venous phase, the speckled hyperfluorescence gradually expands and becomes more pronounced, and does not fade later. The surface orange pigment may remain hypofluorescent or mildly hyperfluorescent. The subretinal fluid on the surface of the tumor may appear stained at a later stage. In mushroom-shaped choroidal malignant melanoma with abundant choroidal vessels, the “double ring sign” with high diagnostic specificity may appear: in the arterial phase or early venous phase, it shows the intra-tumor choroidal macrovascular shadow, and when the retinal vessels are fully filled, the choroidal vessels and retinal vessels are filled at the same time, i.e. “double ring sign”. sign”. In the later stage, the fluorescence in the retinal and choroidal vessels has been emptied, and the periphery gradually appears speckled with high fluorescence, resulting in vascular shadow changes in the large vessels.
Indocyanine green choroidal angiography (ICGA): ICGA of choroidal malignant melanoma varies according to the amount of pigment in the tumor, the thickness of the tumor and the number of blood vessels in the tumor. Usually, the thicker the tumor, the more likely it is to show the blood vessels within the tumor and appear hyperfluorescent. Non-pigmented malignant melanoma can be hyperfluorescent, normal fluorescence or hypofluorescent, but in most cases ICGA will show vascular fluorescence within the tumor, usually within 20s, and after 20-30min (late), vascular leakage will appear. Vessels within the tumor are non-directional, vary in size, markedly dilated, and can form hairpin-like turns, random crossings of vessels, and cockle-like vascular ring structures, while mushroom-like masses often have highly dilated intra-tumor vessels at the top of the tumor, with leakage in later stages. This type of vascularity is highly suggestive of a malignant melanoma lesion. Anaplastic malignant melanomas with low augmentation do not show the intra-tumor vessels and remain hypofluorescent or appear normal during imaging. If hemorrhage, necrosis and limited retinal pigment epithelial proliferation occur within the tumor, it appears as an island-like hypofluorescent area within the tumor.
(3) Ultrasound: Ultrasound A shows high incident waves with low to moderate internal reflection and significant attenuation, ultrasound B shows solid intra-orbital masses with choroidal hollowing and indentation, mushroom-like shape when the tumor breaks through Bruch’s membrane, and concomitant retinal detachment and extra-orbital extension. Color Doppler ultrasound shows branching vascular flow within the tumor, and the spectrum shows a high resistance flow waveform that is identical to arterial flow. If the tumor is large with intra-tumoral tissue necrosis, there may be no or sparse blood flow within the tumor. This is similar to choroidal metastatic carcinoma, but differs from choroidal hemangioma. In the latter case, the tumor is quite rich in blood flow. URM ultrasonography can also show whether there is ciliary body and iris invasion.
(4) CT examination: CT can detect malignant melanoma of the uvea >3 mm thick, which presents as an intraocular occupying lesion. Enhancement can be mildly enhanced and also detects the presence of extraspheric extension. However, CT is not as accurate as ultrasound for the diagnosis of uveal melanoma.
(5) MRI: MRI is better than CT for the diagnosis of choroidal malignant melanoma and has certain characteristics: T1-weighted is high signal relative to the vitreous. T2-weighted is low signal relative to the vitreous. MRI is also better than CT for analyzing whether the disease has extra-spherical extension, but it is difficult to differentiate from choroidal osteoma because it does not easily show the bony component.
(6) 32P absorption test: It is very important to distinguish uveal malignant melanoma from other benign intraocular tumors. When the patient’s refractive interstitium is not clear. The only diagnostic tool is ultrasound. If ultrasound still cannot identify the nature of the tumor, then the 32P absorption test can be used. Malignant melanoma of the uvea will show positive results, while benign swelling will be negative. It has a diagnostic accuracy of 99%. However, since this method is an invasive diagnostic method, it cannot be used for those who can make the diagnosis by other methods.
(7) Biopsy: Fine needle aspiration biopsy or partial excisional biopsy can be used in difficult cases to help diagnose and avoid mistaken removal of the eye or missed diagnosis of uveal malignant melanoma.
Diagnosis】Typical cases are: middle-aged or older patients complaining of gradual loss of vision in the affected eye, fundus examination showing gray-brown or gray-black hemispherical or mushroom-shaped substantial elevated mass, positive scleral transillumination test, solid intraocular occupying lesions seen on ultrasound, choroidal depression and hollow control phenomenon may be present, FFA showing characteristic “double ring sign” The FFA shows a characteristic “double ring sign” with mottled hyperfluorescence in the arterial phase or early venous phase, which gradually fuses into a sheet in later stages. It can be enhanced by enhancer.
Diagnostic notes:
1. Detailed whole body examination to exclude systemic metastasis or whether it is a systemic primary tumor metastasis to the choroid. If the choroidal malignant melanoma metastases systemically, more than 95% are liver or lung metastases.
2. To routinely do dilated fundus examination of the other eye. Although choroidal malignant melanoma usually develops in one eye, examination of the other eye is very useful for differential diagnosis. For example, if age-related macular degeneration and degenerative retinal fissures are bilateral, when the other eye shows this lesion, it is important to note that the eye suspected of choroidal melanoma may not be a true melanoma, but a symmetrical fundus disease.
3. Pay attention to the manifestations of choroidal malignant melanoma affecting the anterior segment of the eye: restricted scleral surface with dilated vessels, forward expansion of the iris, incomplete dislocation of the lens, limited clouding of the lens, atrial cells with anterior chamber hemorrhage caused by tumor necrosis or secondary hemorrhage, etc. However, these manifestations are rarely seen.
Differential diagnosis:: It has been reported that about 10% of patients with choroidal malignant melanoma are not diagnosed promptly because of similarities to other lesions, but are found to be malignant melanoma only after pathological examination following ophthalmologic removal. It has also been reported that 21% of patients with choroidal malignant melanoma have a cloudy refractive interstitium at the time of ophthalmopexy, and patients with a cloudy refractive interstitium are easily missed. On the contrary, some patients with non-malignant melanoma were misdiagnosed as malignant melanoma and had their eyes removed. Shields et al. reviewed 5889 patients with choroidal malignant melanoma in the United States from 1962 to 1969, and the diagnosis relied mainly on fundus examination, with a 20% misremoval rate. However, when modern ancillary examination tools were applied, Shields concluded that only a 1.9% misdiagnosis rate was found at wills Eye Hospital. However, even in the United States, >50% of cases referred by primary care hospitals with a suspected choroidal malignant melanoma are not choroidal malignant melanoma. Therefore, the differential diagnosis of choroidal malignant melanoma is very important. In clinical practice, the following lesions similar to choroidal malignant melanoma must be identified with care.
1. Many benign and malignant tumors in the eye can resemble choroidal malignant melanoma. The common ones are:
(1) choroidal melanoma: the thickness of melanoma is generally <2mm. its edge and normal tissue are gradually migrating, rarely accompanied by subretinal fluid, the surface often has glass spots, regular observation generally does not increase, ffa shows as obscured fluorescence; while the thickness of choroidal malignant melanoma is generally >2mm, its edge is suddenly raised from the normal surrounding tissue. The choroidal malignant melanoma is usually >2mm in thickness, and its margin is a sudden elevation from normal surrounding tissue. There is an indistinct border of orange pigment on the surface, accompanied by more subretinal fluid, and the tumor is regularly observed to increase in size, and FFA shows early mottled hyperfluorescence, and late dots gradually fuse without fading, partly with the typical “double ring sign”.
(2) Choroidal hemangioma: Choroidal hemangioma is usually sown red and not highly elevated. FFA shows that there is a high fluorescence of large choroidal vessels in the pre-arterial or arterial phase, and in the early stage of ICGA (10-20S), there is a small vascular network in the tumor area, and the whole tumor is completely filled with significant high fluorescence within 30s to] min, and the fluorescence gradually starts to fade after 6-10 min, and most of them have “washout” around 30 min. Ultrasound A shows high human wave and high internal reflection wave, while ultrasound B shows high internal reflection echo without choroidal depression sign. Choroidal malignant melanoma is often dome-shaped or mushroom-shaped, and there is no hemangioma-like hyperfluorescence in the early stage of FFA, and ultrasound phi has different characteristics.
(3)Choroidal metastatic carcinoma:Metastatic carcinoma is usually a flat, non-pigmented mass, mostly dull yellow in color, which can occur bilaterally or in a multifocal manner, and the combined subretinal fluid is more widely diffused and metastatic foci can be detected.
(4) Choroidal osteoma: Mostly seen in young women under 30 years of age, 20% of them are bilateral, most of them are located in the optic papilla and grow around the optic papilla, orange in color with clear borders, and characteristic bony changes can be detected by ultrasound and CT.
(5) Melanocytoma of the optic papilla: black, with clear borders, usually not increasing in size under regular observation, and FFA shows obscured fluorescence.
(6) Others: such as retinal hemangioma, choroidal nerve sheath tumor, choroidal smooth muscle tumor and smooth muscle sarcoma, as well as retinal chromosomal epithelial lesions such as congenital retinal pigment epithelial hyperplasia, reactive retinal pigment epithelial hyperplasia and retinal pigment epithelial adenoma and adenocarcinoma.
2, hemorrhagic vascular lesions: retinal pigment epithelial hemorrhage and other lesions are easily misdiagnosed as choroidal malignant melanoma due to the dark black color, the most common one is age-related macular degeneration, followed by retinal pigment epithelial or neuroepithelial hemorrhagic detachment. Age-related macular degeneration is usually bilateral, with subretinal hemorrhage and exudation centered on the macula, and the hemorrhage tends to break through the inner retinal boundary membrane causing vitreous hemorrhage, which is very rare in choroidal malignant melanoma. The augmentation is also not high and is best identified by FFA, which shows macular hemorrhage as obscured fluorescence with choroidal neovascularization. Hemorrhagic retinal pigment epithelial detachment is also similar to choroidal malignant melanoma, but the FFA of hemorrhagic retinal pigment epithelial detachment shows obscured hypofluorescence, and the fundus shows yellowish fibrous tissue when the hemorrhage is gradually absorbed.
3, Inflammatory lesions: posterior sclerositis sometimes resembles choroidal malignant melanoma. However, posterior sclerositis is often accompanied by ocular inflammation, and fundus examination shows retinal folds, whose color is consistent with the choroidal background, and the lesions fade quickly after hormonal treatment. The scleral transillumination test can transmit light. In addition, choroidal retinal granulomatous inflammation such as trauma, tuberculosis, sarcoma, etc. are also easily confused with choroidal malignant melanoma, which is usually accompanied by inflammatory changes such as atrial water glitter, vitreous clouding, and yellow-white lesions.
4, choroidal detachment: choroidal detachment mostly occurs after trauma or surgery, often multi-lobed, with low intraocular pressure, scleral transillumination test shows transillumination, but hemorrhagic choroidal detachment is not transillumination. Color Doppler ultrasonography can make the distinction: hemorrhagic choroidal detachment shows no blood supply; whereas malignant melanoma often has a rich blood supply. If it is difficult to differentiate clinically, 32P absorption test can be done.
5. Other uveal leakage syndrome, fissure-derived retinal detachment, vitreous hemorrhage, and intraorbital tumor compression of the eye are sometimes misdiagnosed as choroidal malignant melanoma, but as long as the characteristics of each lesion are recognized, it is not difficult to identify them. In addition, conjunctival chromatophore nevus and anterior scleral chyloma are easily misdiagnosed as extraocular metastases of choroidal malignant melanoma, so pay attention to the difference.
Treatment】In the past, ophthalmic removal of choroidal malignant melanoma was the most common treatment method. Nowadays, various methods of preserving the eye such as regular observation of small tumors, laser photocoagulation. Shields et al. summarized 3,000 cases of posterior uveal malignant melanoma at Wills Eye Hospital in the United States from 1970 to 1990, and the ophthalmoscopic removal rate was 95% in 1970, which decreased year by year. 9% had local excision of the swelling, 13% were observed and followed up, and 1% were treated with laser photocoagulation. At present, eye removal is still the main treatment method in China, and other methods of preserving the eye have been gradually adopted in recent years.
1.Factors affecting the choice of treatment method
(1) Visual acuity: In principle, those with useful visual acuity in the affected eye should try to use the method of preserving the eye, while those with severely damaged visual acuity and large tumors should have the eye removed. If the other eye is already blind due to other reasons, the method of preserving the eyeball should be used.
(2) Intraocular pressure: High intraocular pressure often indicates that the tumor is large or extensive, and various methods of preserving the eye are not effective, so eye removal is usually used.
(3) Tumor size: The size of the tumor is the main basis for deciding the treatment method. Usually, for small tumors of 2-3 mm thickness, regular observation is recommended: for medium-sized swellings of 3-5 mm thickness, regular observation, local excision of the tumor, radiation therapy, etc.; for large tumors of 5-10 mm thickness, local excision, scleral plate radiation therapy or ophthalmopexy, etc.; for swellings >10 mm thickness or >15 mm diameter, ophthalmopexy is recommended.
(4) Tumor growth site: If small to medium-sized tumors are located near the equator, local excision, radioactive scleral plate therapy, photocoagulation, etc. can be chosen; while tumors of the same size located in the macula should be treated with radiation therapy or ophthalmic removal, because photocoagulation will destroy the visual function and local excision of the tumor is not possible; tumors located around the optic papilla generally need to be ophthalmic removal, because radiation therapy at this time will lead to optic neuropathy and make the optic nerve degenerate. (5) Tumor growth type
(5) Tumor growth type: Diffuse growth type should be removed from the eye. For medium sized tumors with small extraocular infiltrations, radioactive scleral plate bullying or local excision of the tumor can still be used. Those with large extraocular infiltrations should undergo removal of the eye including the infiltrated area, and those with extensive intraorbital infiltrations should undergo removal of the orbital contents.
(6) Tumor activity: Small inactive tumors can be observed regularly, while active tumors should be treated actively regardless of the size of the tumor. The best way to determine the activity of tumor is regular observation or ultrasound examination to find the enlargement of tumor.
The reference methods to observe the activity of choroidal malignant melanoma are.
①Tumor shape: mushroom-shaped tumor is due to rapid growth of tumor growth breaking through Bruch’s membrane, and the surface is active; in addition, the tumor border bulge is obvious in active individuals.
②Complicated large amount of subretinal fluid indicates tumor activity, while stationary tumors usually have no subretinal fluid.
③Those with more vitreous warts on the surface of tumor indicate resting stage, and those without vitreous warts have high activity.
④The tumor surface orange pigment boundary is unclear in active patients, and the boundary is clear in quiescent patients.
2.The indications of various treatment methods
(1) Regular observation: For choroidal malignant melanoma sometimes regular observation is very necessary, it applies to:
① all small inactive tumors.
(ii) most inactive tumors of intermediate size.
③ For elderly and one-eyed patients. Even small or moderate sized tumors showing slow growth may be selected for periodic observation. It is usually reviewed every 3-6 months with fundus photography and A/B ultrasonography for comparison at the time of review. Tumors close to the optic papilla and macula should be reviewed every 2-3 months because tumor growth in this area can easily damage vision. Note. Even if the tumor is small, if it is active, regular observation cannot be done, but other methods of treatment should be actively used.
(2) Laser photocoagulation and scleral plate dressing radiotherapy: Indications for photocoagulation therapy:
(1) small tumor, fundus observation or ultrasound shows tumor growth, or no growth but clinical examination shows tumor is active and tumor is >3mm from macula and not at the edge of the optic papilla.
②Partial medium-sized swelling with tumor >3mm from maculaI
③Adjunctive photocoagulation when other methods such as radioactive scleral plate and local excision of the tumor cannot completely destroy the tumor.
The above mentioned patients who are suitable for photocoagulation are also suitable for low energy radioactive scleral plate dressing treatment.
(3) Local excision of tumor: Indications for local excision of tumor.
①Tumor located in the ciliary body and/or peripheral choroid, involving no more than 4 clock points;
(ii) The maximum diameter of choroidal melanoma does not exceed 16 mm, and the posterior margin of the tumor does not exceed 7 mm of the equatorial part.
③No signs of retinal invasion or vitreous tumor implantation;
④Good general condition, no manifestation of systemic metastasis. However, these are also applicable to radiotherapy, so when the patient has a small tumor base, and the thickness is high and anterior, local excision is done; on the contrary, when the tumor base is large. On the contrary, when the tumor base is large, but the thickness is not high and the position is backward, then radiation therapy is done.
Local tumor resection is a difficult and time-consuming operation, requiring good surgical equipment and surgical skills. Common complications of surgery include vitreous hemorrhage, expulsion of choroidal hemorrhage, and complications of cataract. Retinal detachment, etc. Comparison of postoperative outcomes reveals that the 5-year morbidity and mortality rate after treatment is no different from that of local radiation therapy and ocular removal therapy, and that some visual acuity can be maintained or preserved after surgery.
(4) Indications for ophthalmic removal:All large ciliary and choroidal malignant melanomas over the range of 4 bells and whistles, which cannot be treated by other methods of preserving the eye such as local excision of the mass or radioactive scleral plate, and in which vision has been lost. Small or moderate sized tumors, but the tumor has invaded the optic nerve. All eyes should be removed. If the tumor only reaches the edge of the optic nerve then radiation therapy can be done. In addition to the above factors, the patient’s age and psychological factors should also be taken into consideration.
(5) Indications for orbital enucleation: The patient has extensive orbital infiltration, no systemic metastasis or tumor recurrence in the orbit after removal of the eye, no systemic metastasis.
(6)Photodynamic therapy:Due to the characteristics of the optical structure of the eye. Uveal malignant melanoma is suitable for photodynamic therapy. Recent clinical trials have shown that photodynamic therapy is more effective for smaller and light-colored tumors, while the recurrence rate is high for larger and deeply pigmented tumors.
(7) Transpupillary thermotherapy (TTT): TTT is an infrared laser of 810 nm acting on the target tissue to warm it up to damage the tumor cell membrane and DNA. it mainly works on small tumors with thickness <3 mm and the edge of the lesion >3 mm from the central macular recess. complications of TTT include: macular folds, edema, retinal vein obstruction, vitreous and subretinal hemorrhage, etc.
(8) Treatment of systemic metastases: Choroidal malignant melanoma is a malignant tumor with high mortality, and liver metastases from the tumor are detected early in about 40% of patients. The 5-year survival rate of patients with liver metastasis is only 50~80%. TTT and local radiation therapy can only reduce or maintain the intraocular tumor volume in a limited way, and surgery can locally remove the tumor but cannot stop the micro-metastasis of tumor cells. At present, the clinical efficacy of chemotherapy alone is not satisfactory for this disease. A combination of chemotherapy and immunotherapy can be used to treat the disease, but the efficacy needs to be further observed.
Prognosis】Treatment of uveal malignant melanoma has been improved since the 1970s, but regardless of the treatment, the prognosis of uveal malignant melanoma is still very poor, and the death rate is still as high as 40%-50%. The prognosis of uveal malignant melanoma and the analysis of related factors need to be further investigated because its biological behavior is not yet understood.
Metastases from uveal malignant melanoma occur relatively late, with 5-, 10-, and 15-year survival rates of 72%, 59%, and 53%, respectively. Once and metastasis occurs there is no clear and effective treatment for lifting. The disease is a hematogenous metastasis, usually to the liver, and those who have been found to have metastases clinically have an extremely poor prognosis. The prognosis for those who are prone to metastasis is very poor. The age at the time of consultation, tumor size, tumor cell type, tumor location, and blood supply within the tumor are all related. The older the age, the larger the tumor diameter, the epithelioid cell type, the anterior location of the tumor and the presence of back-to-back vascular rings and vascular networks within the tumor, the worse the prognosis.
Disease care】Keeping a good and optimistic state of mind is of great help to the treatment and prognosis of tumor. Regular physical examination, check the eye condition and the condition of chest and abdominal organs in order to grasp the changes of the disease and deal with metastasis early if it occurs. A light diet, avoid fried and stimulating foods, and moderate physical exercise can improve one’s immunity, which is helpful to the recovery of the disease.