Retinoblastoma in an older child

Hui-Kuo G. Shu, MD, PhD
Last Modified: January 20, 2002


Dear OncoLink "Ask The Experts,"

My daughter had just turned 4 years old when diagnosed with unilateral Retinoblastoma had her right eye removed in August 2000. My understanding is that children much younger are diagnosed with this usually. How is it an older child develops this? Also, I'm told this is rare, but so far, 3 cases have been diagnosed from my area alone. How can we better inform parents of this, so children can be treated earlier so maybe sight can be saved?  


Hui-Kuo G. Shu, MD, PhD, an Assistant Professor in the Department of Radiation Oncology at the University of Pennsylvania, responds:

While most cases of retinoblastoma present before the age of 3, it is certainly not unheard of for a 4-year-old child to be diagnosed with retinoblastoma. As would be expected, older patients diagnosed with this disease will invariably have a unilateral, non-hereditary process. Keep in mind that nothing in medicine is 100%. While the cells that can potentially become cancerous and cause retinoblastoma decrease with age, it certainly does not go to zero as is clearly evidenced by the diagnosis of this disease in older children.

As far as better informing other parents regarding this disease, I would suggest that they take their children to see their pediatrician on a regular basis (well child care checks). It is during these checks when retinoblastoma is often initially found. In babies and toddlers, it is often difficult for parents to know if any visual impairment is present. However, if any visual impairment is suspected, it should be brought to the attention of their physician.

Finally, retinoblastoma frequently presents with a white pupillary reflex. This is most frequently seen as a white pupil in flash photography (as opposed to "red eye" we often see in normal flash photographs). If this sign is noticed, then it should also be brought to the attention of the child's pediatrician.


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