Stages of eye cancer

Find out more about staging cancer.

Melanoma of the eye is staged differently depending on what part of the eye it starts in.

Conjunctival melanoma and orbital melanoma are not assigned stages. Doctors describe these tumours by where they started in the eye and where they have spread.

Melanoma of the eyelid is staged like melanoma skin cancer in any other part of the body. Find out about stages of melanoma skin cancer.

Uveal melanoma is most commonly staged using the American Joint Committee on Cancer (AJCC) TNM staging system. For uveal melanoma there are 4 stages. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the larger the cancer is or the more the cancer has spread.

Sometimes doctors use the Collaborative Ocular Melanoma Study (COMS) classification system to stage uveal melanoma. This is a simpler system that classifies the tumour based on width and thickness (height). It uses the terms small, medium or large when describing a tumour. The COMS system is used less often than the TNM system.

• Small means the tumour is 5 to 16 mm wide and 1 to 3 mm thick.
• Medium means the tumour is less than 16 mm wide and 3.1 to 8 mm thick.
• Large means the tumour is more than 16 mm wide and 8 mm thick.

The following stages are used for melanoma in the choroid or ciliary body (also called posterior uveal melanoma).

An important part of staging these tumours is the size category (T). The size category is based on the thickness (height) and largest diameter at the base of the tumour. The higher the number, the larger the tumour is.

A size category T1 tumour is either:

• 3 mm thick or less and no more than 12 mm wide
• 6 mm thick or less and no more than 9 mm wide

A size category T2 tumour is one of the following:

• 3 mm thick or less and 12.1 to 18 mm wide
• 3.1 to 6 mm thick and 9.1 to 15 mm wide
• 6.1 to 9 mm thick and no more than 12 mm wide

A size category T3 tumour is one of the following:

• 15.1 to 18 mm wide and 3.1 to 6 mm thick
• 12.1 to 18 mm wide and 6.1 to 9 mm thick
• 3.1 to 18 mm wide and 9.1 to 12 mm thick
• 9.1 to 15 mm wide and 12.1 to 15 mm thick

A size category T4 tumour is one of the following:

• more than 15 mm thick
• more than 18 mm wide
• more than 12.1 mm thick and more than 15.1 mm wide

In the description of the stages below, the cancer is assumed to have begun in the choroid. Posterior uveal melanoma very rarely occurs in the ciliary body without also being in the choroid. If you have posterior uveal melanoma cancer that started in the ciliary body and is not in the choroid, your healthcare team will explain how the cancer is staged for this cancer specifically.

The tumour is size category T1. There is no cancer in the ciliary body or outside of the eyeball.

The tumour is size category T1. The tumour has grown into the ciliary body but not outside of the eyeball.

OR

The tumour is size category T1. The tumour has grown outside of the eyeball but has not grown into the ciliary body. The part of the tumour that is outside the eyeball is 5 mm thick or less.

OR

The tumour is size category T1. The tumour has both grown into the ciliary body and grown outside of the eyeball. The part of the tumour that has grown outside of the eyeball is 5 mm thick or less.

OR

The tumour is size category T2. There is no cancer in the ciliary body or outside of the eyeball.

The tumour is size category T2. There is cancer in the ciliary body, but it has not grown outside of the eyeball.

OR

The tumour is size category T3. There is no cancer in the ciliary body or outside of the eyeball.

The tumour is size category T2. The tumour has grown outside of the eyeball but has not grown into the ciliary body. The part of the tumour that is outside of the eyeball is 5 mm thick or less.

OR

The tumour is size category T2. The tumour has grown into the ciliary body and grown outside of the eyeball. The part of the tumour that has grown outside of the eyeball is 5 mm thick or less.

OR

The tumour is size category T3. The tumour has grown into the ciliary body but not outside of the eyeball.

OR

The tumour is size category T3. The tumour has grown outside of the eyeball but has not grown into the ciliary body. The part of the tumour that has grown outside of the eyeball is 5 mm thick or less.

OR

The tumour is size category T4. There is no cancer in the ciliary body or outside of the eyeball.

The tumour is size category T3. The tumour has grown into the ciliary body and grown outside of the eyeball. The part of the tumour that has grown outside of the eyeball is 5 mm thick or less.

OR

The tumour is size category T4. The tumour has grown into the ciliary body but not outside of the eyeball.

OR

The tumour is size category T4. The tumour has grown outside of the eyeball but has not grown into the ciliary body. The part of the tumour that is outside of the eyeball is 5 mm thick or less.

The tumour is size category T4. The tumour has grown into the ciliary body and grown outside of the eyeball. The part of the tumour that has grown outside of the eyeball is 5 mm thick or less.

OR

The tumour can be any size category. The tumour has grown outside of the eyeball. The part of the tumour that is outside of the eyeball is more than 5 mm thick.

Cancer has spread to 1 or more of the nearby (regional) lymph nodes.

OR

Cancer has spread to other parts of the body (called distant metastasis) , such as to the lungs, liver or brain. Cancer that has spread to other parts of the body is also called metastatic eye cancer.

The following stages are used for melanoma in the iris (also called anterior uveal melanoma).

The tumour is only in the iris and is no more than 1/4 of the size of the iris.

The tumour is only in the iris but is more than 1/4 of the size of the iris.

OR

The tumour is only in the iris and is causing glaucoma (an increase in eye pressure).

OR

The tumour has grown into the ciliary body but is not causing glaucoma.

The tumour has grown into the ciliary body and choroid but is not causing glaucoma.

The tumour has grown into the ciliary body or choroid and is causing glaucoma.

OR

The tumour has grown into the sclera. It may also have grown into the ciliary body or choroid.

OR

The tumour has grown outside of the sclera 5 mm or less.

The tumour has grown outside of the sclera more than 5 mm.

Cancer has spread to 1 or more of the nearby (regional) lymph nodes.

OR Cancer has spread to other parts of the body (called distant metastasis) , such as to the lungs, liver or brain. Cancer that has spread to other parts of the body is also called metastatic eye cancer.

Lymphoma of the eye is staged like that type of lymphoma in any other part of the body.

For example, lymphoma of the eye that is a type of non-Hodgkin lymphoma (NHL) is staged like NHL in any other part of the body. Find out about the stages of non-Hodgkin lymphoma.

Squamous cell carcinoma (SCC) of the eye (conjunctival SCC) is not staged. Doctors describe these tumours by their location and spread.

When SCC affects the eyelid, it is staged as non-melanoma skin cancer. Find out about stages of non-melanoma skin cancer.

Recurrent eye cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.