The diagnosis of orbital cancer can be difficult and overwhelming. Further testing will be necessary to obtain a diagnosis and determine next steps.
As described in the anatomy page, the orbital area is made up of multiple components, including bones of the eye socket, tear glands, and muscles that move the eyeball. A physical examination is always the first step of diagnosis; however, these structures can sometimes be difficult to see and examine in an office setting.
A combination of endoscopy, imaging, and biopsy is generally the standard diagnostic approach. Patients can expect their doctor to have a discussion with them about the risks, benefits, and alternatives to each of the following approaches.
Endoscopy
An endoscope is a device that allows doctors to examine inside the body. It is made up of a thin flexible or rigid tube with a camera and light attached on the end. The lenses inside the endoscope provide magnification, allowing doctors to detect even small changes in the lining of the nasal passageways. “Endoscopy” is simply the process of using an endoscope to visualize a particular part of the body.
Because of the close proximity of the orbit to the nasal cavity and sinuses, sometimes cancers affecting the orbit can be visualized through the nose. In these cases, either a flexible or a rigid endoscope may be used to visualize the tumor and sometimes to perform a biopsy.
Imaging
Imaging scans, also known as radiologic studies, provide the doctor with a view of the inside of the body. Imaging of the head and neck will be required to determine the extent as well as the behavior of a growth, and is a vital step prior to treatment of any tumor in the orbit. The most common imaging tests used are CT and MRI scans. A more advanced imaging study called a PET/CT may also be performed to evaluate if an orbital tumor has spread to other sites in the body, as well as to determine if lymph nodes in the neck are likely to harbor cancer cells.
Biopsy
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. A biopsy of a suspicious growth in the orbital area is needed prior to treatment. There are a few different techniques that can be used to take a biopsy in the orbit. These include:
- Open surgical biopsy
- Fine needle aspiration (FNA) biopsy
- Transnasal endoscopic biopsy
