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Orbital Tumors

What to Expect at Your Doctor’s Visit

Orbital tumors are typically managed by a team of doctors that will include head and neck surgeons, oculoplastic surgeons, radiologists and medical oncologists.

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the problem been there?
  • Is it getting worse, better or staying the same?
  • Does it come and go?
  • Have you tried anything to make it better?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face or mouth?
  • Do you have any lumps or bumps in your neck?
  • Are you losing weight?
  • Do you have any other medical conditions?
  • Have you had any surgeries in the past?
  • What medications do you take? And do you have any allergies?
  • Have you ever been exposed to radiation in the head and neck?
  • What do you (or did you) do for a living?
  • Do you have a family history of cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern.

The eye will be examined by an ophthalmologist. The orbit can be a little difficult to examine, and your doctors will rely heavily on imaging (scans). However, tests of eye movement, visual acuity and sensation will be part of the physical exam.

Depending on where the area of concern is, a few special things to expect in your physical exam might include:

  • Sinonasal endoscopy: This is essentially a way to look far inside and around your nose and into the openings of the different sinuses. This can be important because the tear duct drains into the nose, and the inner part of the orbit is actually formed by the outer wall of the ethmoid sinus. A sinonasal endoscopy can be done in a few different ways. In all cases, your doctor will probably decongest and numb your nose.
    • Flexible sinonasal endoscopy: This method uses a tiny flexible camera (the same one as for flexible laryngoscopy). The camera is inserted into one of the nostrils. Then your doctor will move the camera along the septum as well as the floor, side wall and roof of the nasal cavity.
    • Rigid sinonasal endoscopy: In this method, a thin steel rod telescope is inserted into one of the nostrils. Then the exact same examination as flexible sinonasal endoscopy is performed. The advantage of this technique is that it is easier for your doctor to use another forcep to take a sinonasal biopsy if necessary. Your doctor may choose this exam if your orbital tumor is growing into your nose.
  • Eye tests: These might include testing your vision, looking in the back of your eye at the retina and checking the pressure of the fluid inside your eye. These tests are best done by an ophthalmologist (eye specialist).

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

Part of the next steps will probably involve seeing a doctor specializing in the eye. This is particularly important if the cancer is actually starting within the orbit itself rather than spreading into it from another site.

References

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