Making tough ocular treatment decisions

“You’re practical,” she said, when I told her I didn’t see any point in doing a biopsy of my left eyeball. My ocular oncologist readily agreed with me, and I think you may, too, after I give you more details. From there, she laid out my treatment course.

First, why would I need a biopsy at all? Because after all the cancer diagnostic tests I’ve undergone in the past two and a half months—an MRI of the liver, a CT scan of my abdomen, a mammogram, a full-body PT-CT scan, and, most recently, an MRI of my brain—it is clear I currently do not have a primary cancer site outside of my eye. Exactly what I want to hear!

But it leaves the atypical mass in my left eye still to be a bit of a mystery.

I spent the afternoon at the eye clinic yesterday. First, I got an ultrasound to examine the internal structures of the eye and measure the tumor. Then an optical coherence tomography (OCT), which provides detailed images of the eye’s structure; followed by a fluorescein (organic neon yellow dye) angiography to view the blood vessels and flow in the eye.

All that took a couple of hours, but served to reveal only that nothing much had changed in my eye since my last batch of eye tests in October. And didn’t solve the mystery.

A lot of people asked me if it was frustrating not having a clear specific diagnosis, but I didn’t mind, I just chose the most optimistic diagnosis.

Karen Duffy

The only possible test left, therefore, would be to do a biopsy to determine whether the mass is a metastasis from my breast cancer or a choroidal melanoma (primary cancer). The treatment for both, when there is no other primary cancer site, is localized radiation, but not the same strength and type of radiation.

About the biopsy, in brief: Local or general anesthesia is used to perform a biopsy of the eye. An ocular surgeon makes a slight, precise cut in the eyeball to access the targeted area, i.e. the mass. With specialized microsurgical instruments, they go in and carefully remove a tiny piece of tissue from the eye. The incision is closed, often with fine sutures. And finally, a pathologist determines the nature of the tissue by looking at the cell structure.

Picturing that process is uncomfortable, isn’t it? Yuck! I get why from the start my doctor wanted to avoid a biopsy!

In my rare case, a biopsy is even more precarious than usual. The mass sits in the back of my eye and close to my optic nerve. To get to it, the surgeon would have to maneuver around my optic nerve, a demanding task involving a high risk of further eye damage. All that, and there’s only a 50-50 chance enough tissue could be picked up to do a proper analysis!

So my brain screamed, no thanks! I felt grateful the good doctor instantly agreed.

We moved on to talk about treatment: radiation really is the only option for me.

Some people with similar cases decide to do nothing, I was astonished to learn… perhaps out of fear of pain? That feels foolish to me.

Choosing to avoid uncomfortable feelings offers immediate short-term relief, but avoidance can lead to long-term consequences.

Amy Morin

While it’s probable that nothing will bring my left eyesight back, I’m not willing to increase the risk of having this tumor develop into a new site for cancer that spreads to other parts of my body. And yet, you may recall I find these medical procedures and our decisions made quite a crap shoot. There is no certainty.

My ocular oncologist explained she wanted to treat my eye with plaque brachytherapy. It is the most common radiation treatment for most eye melanomas. (As an aside, I am thankful to be in Canada, as my ocular oncologist in the Philippines told me plaque therapy is not yet available there.)

The procedure involves surgically placing and sewing (!!) a small disc (about the size of a quarter) containing radioactive “seeds” (known as a plaque) on my eyeball near the tumor. I’ll go under general anesthesia for this part—whew, can you feel my relief?

The goal is to get high doses of radiation (gamma rays) precisely on the tumor, while minimizing exposure to surrounding healthy tissues—including my brain!

The radiation dose is higher for melanomas than metastasis, almost double. I asked whether we could consider using the lower dose, and if that didn’t shrink the mass, go for the higher—not that I was eager to undergo this procedure twice! Her answer was no, they could not attach the disc a second time if it failed the first time.

I then asked about the risk of using the higher dose if the tumor was metastasis (can’t write “only,” can I!). None on top of the main risks of higher doses—increased possibility of side effects like cataracts, dry eye, burst blood vessel, or vision loss. Since she had already made it clear that I wasn’t likely to get my vision back anyway, I choose to ignore this for now and hope for the best outcome.

Don’t obsess over risks. Keep your focus on positive outcomes.

Deepak Chopra

So there’s a plan. On February 1, I go into the hospital for the disc insertion. I stay in the hospital under observation overnight. The disc will stay in for a week. Then I go back into the hospital as an outpatient to remove the disc.

I’m forewarned not to expect to know the full effect of the radiation on the tumor for three to six months.

That’s all I’ll write today. I plan to focus on joyful things for the next two weeks, and not ruminate on what I imagine won’t be the most pleasant thing to go through. But in my next post I’ll share more on this part of my heroine’s journey, when it’s happening.

Have you or someone you know faced a similar journey? I’d like to hear about your experiences and how you navigated the challenges. Please share your stories in the comments below. Also, if you have questions about my experience or want to know more about any aspect of my treatment journey, feel free to ask. Let’s support each other through our shared experiences.

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  • When fear arises let it go 100 times a day if necessary. Hand everything over to Spirit who is always with you and knows your life plan.

    • Thanks for your caring words, Janice. No worries, no fear here. Just eager to get this over with: time to roll the dice, as my friend Lable in the comments put it. 🌸🙏🌸

  • Dearest Francisca,
    I am so fortunate that our paths crossed quite serendipitously at the conference in Vancouver in 2019. I think the whole purpose of going there was to meet you. Whenever we connect, I feel so supported and so much love from you. I feel like a weary traveler who finds shade and solace after traversing difficult terrain in the desert. Thank you for your wisdom and all the practical guidance you have given me over the years.

    Your courage, ability to stay steady, and willingness to move forward amidst uncertainty – all of these qualities inspire me tremendously. I hold you and Lordson in my love and prayers and hope for the best possible outcome tomorrow.

    With much love,

    • I love you, too, Seema. 💜 We are both fortunate for having our special friendship. You inspire me, too. And thanks for the well wishes. 🌸🙏🌸

  • You know what I will always say – what I freely and generously give to my bestest of friends – much love in my heart and thoughts for you (in lieu of a big, tight hug that I so wish I could give to you just now) = and lots and lots of prayers for you as you go through this whole ordeal. I am glad to read the strength and optimism in your words, and derive the very same strength and optimism as I stay in the sidelines, wishing you only the very best outcomes. Thank you for your example of how to face life head-on – you are such an inspiration, Ciscs! Thank you, with my love! xo

  • Wowee 🙂 I learned a lot from this post, ‘Cisca. Thanks for your clarity, frankness and strength of character. As always.

    – Jenniekins

  • Sounds like you and they are zeroing in on a plan. Personally, I like the point when it’s time to roll the dice. For me it’s a movement from passive diagnosis to active engagement. Maybe it’s my classical lit. background but I always think of Caesar crossing the Rubicon and shouted “The die is cast!” What a relief it was for him to no longer have to deal with planning, consultation, and options and to be free to pursue a particular path.

    I’m fervently wishing you the best outcome from all this – whatever that may be. Sending lots of love.


    • Oh, yes, Lable! You’ve hit my sweet spot with: it’s time to roll the dice! You words revealed to me that there has been an impatience growing in me, a desire to get on with it, to take the next step towards some kind of resolution. Enough testing! And even though the next step is not particularly pleasant, I *am* relieved to take it. There’s a feeling of freedom in that. And your love and hugs are returned. 🤗🌸💜🌸🤗

  • I know Judi nailed it when she said you see best with your inner eye! You now have your own page in my ‘tiny book of prayers!’ Although you have long been in my heart. I am grateful for the courage with which you share your journey with the world. I’m am just sorry that such a gift comes at such a price.

  • Just read your blog Francisca. All the best on the procedure! With lots of prayers, Rosa

  • Good gosh, Francisca! Sounds uncomfortable for sure. I am glad there is an option which may save your eye, even if it won’t work afterwards. You see the best in people with your inner eye anyway. Let’s ‘see’ how this goes and hope for the very best outcome. It all sounds pretty miraculous and soon over with. Much love, my dear friend.

  • Wishing you a successful operation, and I also hope for a positive outcome !
    Probably a stupid question (also because of my limited knowledge of your case) but if you have no vision or a very limited vision in one of your eye would it not be better to remove the eye completely and replace it with an artificial one.
    This way the tumor is gone, radiation can’t affect other parts and there can’t be more issues in the future.

    • Not a stupid question at all, Sidney, and that might indeed be the final solution. The science at the moment says that this plaque therapy is nearly as effective as a complete eye removal. My doctor mentioned that possibility in our first meeting. So, we’ll see. Thanks for the good wishes. 🌸🙏🌸

  • Sending you healing light from Manila. And hoping and praying for the best ever outcome ❤️

By Francisca

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