Staging is the process doctors go through to work out whether your cancer has spread to another part of the body.
As uveal melanoma spreads through the bloodstream, there are generally only two main stages used. Stage I is when the tumour is in the eye, and Stage IV is when it has spread to distant organs, such as the liver.
The ocular oncologists may also use other staging systems to record how large/thick the tumour is and whether it has grown into the tissues around the eye.
Ocular oncologists may order scans as part of their assessment, although not everyone will need them. Below you can find out more about the different types of scan that may be offered.
An ultrasound scan may be performed on the abdomen, primarily to check the liver. The advantage of ultrasound is the speed at which results can be known, so it makes a good staging scan. Usually, if an ultrasound scan comes back as suspicious in some way, a more detailed scan will be ordered. The disadvantage of ultrasound is that it is operator-dependent and therefore, sometimes it is difficult to compare findings between different scans.
An MRI of the liver may be ordered, especially if you are a high risk patient. There may be a wait for the scan itself and for the results. MRI may be used at staging so that the natural anomalies within your liver can be recorded, and future scans compared against the original “baseline” scan. Sometimes an injection of contrast agent may be given to enhance the scan.
The abdomen/liver MRI with contrast lasts approx 45 mins. You have a line in your arm for the contrast to be injected through.You lie on your back with pillows under your head and feet. A board is strapped over your middle which contains the imaging equipment. You are given a panic button to press if you need help and you wear headphones. You can usually take a CD of your own to listen to. The operative will speak to you through the headphones and you can reply. There are several times when you have to hold your breath but the longest is about 24 seconds. One set of scans are taken without contrast then you are told when the injection is going in and the scans are repeated. – Christine Matthews
An X-ray may be performed on the chest to check for lung metastases. It is a good staging tool as results can be given on the same day. If doctors see something suspicious on the film they are likely to order a more sensitive test, such as a CT scan. An X-ray may be ordered as part of an anaesthetic assessment.
A CT scan is a series of X-rays taken from different angles, and put together by computer for a detailed picture. It can be a good way of finding lung and bone metastases, however, it does involve a small dose of radiation so it may be more suited to staging than follow-up. CT scans are not recommended for detecting liver metastases.
Some centres may have PET-CT scans available. This scan is like a CT scan, but with the addition of a small amount of a radioactive drug injected into the patient. This gives very detailed information about how the tissues in the body are working.
Blood tests are now accepted to be of little use in screening for ocular melanoma metastases, however, you are still likely to have blood tests as part of your initial investigations at diagnosis.