Clinical Characteristics, Staging, and Treatment Outcomes of Retinoblastoma at a National Referral Center in Tanzania: A Retrospective Study (2023–2025)

In the quiet corners of childhood development, a rare but serious threat can emerge within the eye itself. This threat is retinoblastoma, a cancer that forms inside the retina, the light-sensitive layer at the back of the eye. It is the most common type of eye cancer found in children. In wealthier nations, where families have easy access to regular medical checkups and specialized care, this disease is often caught early. When found at an early stage, doctors can frequently save the child's life and often preserve their vision using targeted treatments. However, in many parts of the world, the story is different. Delays in recognizing the first signs, combined with limited access to hospitals, often mean that children arrive at the doctor only after the cancer has grown large and spread. This late arrival makes the disease much harder to treat, often forcing doctors to remove the eye to save the child's life, and in the worst cases, the cancer spreads to other parts of the body, leading to death. Understanding exactly how this plays out in specific regions is crucial for saving lives, as it reveals where the system is failing and where help is needed most.

Researchers at Muhimbili National Hospital in Dar es Salaam, Tanzania, recently looked back at the records of children treated there between 2023 and 2025 to understand the current reality of this disease in their country. They studied 111 children, all between the ages of zero and five, who had been diagnosed with or suspected of having retinoblastoma. The team gathered information from the children's medical files, noting their age, where they came from, what symptoms brought them to the hospital, how advanced the cancer was when they arrived, and what treatments they received. By organizing this data, the researchers could paint a clear picture of the challenges facing families and doctors in this region.

The results of this review were stark. The average age of the children when they were diagnosed was just under two and a half years old. More than half of the patients were boys. While the children came from every region of Tanzania, with the largest groups traveling from the northern and eastern zones, the timing of their arrival at the hospital was the most telling factor. The vast majority of these children presented with advanced disease. When the doctors examined the eyes, they found that the cancer had already spread significantly within the eye in more than half of the cases. In nearly one out of every ten children, the cancer had already broken through the wall of the eye and begun to grow into the surrounding tissues of the face and skull.

The first sign that alerted parents to the problem was almost always a change in the appearance of the eye. In about seven out of ten cases, the child showed a white glow in the pupil, a sign known as leukocoria, which is often visible in photographs taken with a flash. This white reflection is the most common warning sign of the disease. Other children arrived with red or swollen eyes, eyes that were crossed, or complaints of vision loss. Because the disease had progressed so far by the time the children reached the national referral center, the treatment options were often limited. While the medical team used chemotherapy, which uses medicine to kill cancer cells, in most cases, they also had to perform surgery to remove the affected eye in more than half of the patients. This high rate of eye removal highlights that the cancer was too advanced to be saved by less invasive methods.

The outcomes of these treatments reflected the difficulty of the situation. At the time the researchers finished their review, only about a quarter of the children were alive with no sign of the disease remaining. Another quarter were still actively undergoing treatment, and a significant portion had either residual cancer or a recurrence of the tumor. Tragically, the overall death rate for the group was fifteen percent, meaning that one in every six or seven children in this study did not survive. The study found a clear link between the age of the child and the side of the eye affected, the initial symptoms they showed, and the stage of the disease, confirming that the timing of diagnosis is the single most important factor in survival.

This research underscores a critical gap in the healthcare journey for children with eye cancer in Tanzania. The children are not arriving at the hospital too late because the doctors cannot treat them; rather, they are arriving too late because the disease is not being caught in its earliest, most treatable stages. The authors conclude that to change these numbers, the focus must shift to the very beginning of the process. They recommend that simple checks for the white glow in the pupil become a routine part of basic child healthcare, that communities are educated to recognize this sign immediately, and that clear, fast pathways are established to get children from rural villages to specialized hospitals without delay. Until these steps are taken, the cycle of late presentation and difficult outcomes is likely to continue.