Nasal Cavity and Sinus Cancer

Symptoms

Early cancer symptoms are often the same as non-cancerous conditions. Early cancer symptoms that mimic common conditions of the sinuses include:

• A nose bleed from one nostril
• Blockage of a nostril
• Runny nose on one side

Symptoms that can indicate an advanced cancer tumor are:

• A persistent headache
• Changes in vision or double vision

Causes and Risk Factors

Men are affected one-and-one-half more often then women. The disease is more common in people between 45 and 85 years of age.

Approximately 60 to 70 percent of sinus cancers occur in the maxillary sinus. About 20 to 30 percent begin in the nasal cavity, and 10 to 15 percent in the ethmoid sinuses. Less than 10 percent are found in the frontal and sphenoid sinuses.

Squamous cell carcinoma and adenocarcinoma are associated with exposure to products found in furniture making, the leather industry, and the textile industry:

• Wood dust, nickel dust
• Mustard gas
• Isopropyl oil
• Chromium
• Dichlorodiethyl sulfide

Some viral infections can cause sinus cancer. The human papilloma virus (HPV) can produce a benign (non-cancerous) sinus tumor called inverted papilloma.

Diagnosis

To make a diagnosis of nasal cavity cancer or sinus cancer the doctor will ask questions about your symptoms, medical history, and examine your mouth.

An examination of the ears, nose, and neck is also needed to help determine if the tumor has spread.

If your examination needs further investigation, your doctor may order a biopsy in order to diagnosis the type of cancer present. A Biopsy is conducted with tissue that is removed so that a pathologist may examine its cells under a microscope.

Doctors may order a traditional X-ray and other imaging tests to gather information about the tumor. Those tests include:

• CT scan - A special type of X-ray that makes a series of detailed pictures, with different angles, of areas inside the mouth and neck. A computer is linked to the X-ray machine. A dye may be injected into a vein or swallowed in a pill to help the organs or tissues show up on the X-ray. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Magnetic Resonance Imaging (MRI) - A machine that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the mouth and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET Scan - A PET scan helps determine if a tumor has spread to other areas in the body. During a positron emission tomography scan (PET), a small amount of radioactive sugar (glucose) is injected into a vein. The scanner makes computerized pictures of the areas inside the body. Cancer cells absorb more radioactive glucose than normal cells, so the tumor is highlighted on the pictures.

Many types of cancer grow in the sinuses and can metastasize (spread to other parts of the body):

• Inverted papilloma (not cancer but can become cancerous)
• Squamous cell carcinoma
• Verrucous carcinoma
• Basaloid squamous cell carcinoma
• Spindle cell carcinoma
• Transitional cell or cylindrical cell carcinoma
• Adenocarcinoma
• Sinonasal undifferentiated carcinoma (SNUC)
• Small-cell carcinoma
• Lymphoma
• Malignant melanoma
• Salivary-type neoplasms
• Sarcoma
• Metastic tumors

Treatment

The exact treatment depends on the location and severity of the cancer. Sinus surgery, chemotherapy, and radiation for head and neck cancers are used to remove the cancer and help prevent recurrence.

Nasal Cavity Cancer Surgery

Nasal cavity cancers are usually removed by a wide local excision. A wide local excision includes the area around the tumor to assure all cancer cells are removed:

• Nasal septum. If the tumor involves the dividing wall of the nasal cavity (the nasal septum) either a portion or the entire septum is removed.
• Nasal cavity. If the tumor is growing on the side wall of the nasal cavity, the wall must be removed. Sometimes the surgeon can remove the tumor by cutting under the upper lip so visible incisions are not needed. If this is not possible, the surgeon will cut through the skin on the side of the nose. Then the skin and nose are folded back to remove the tumor.
• If the cancer has grown into the tissue, part of the nose or the entire nose might need to be removed. A reconstructive surgeon rebuilds the nose with the surrounding facial tissues or from artificial materials (prosthesis).

Paranasal Sinus Surgery

• Ethmoid sinuses. If the tumor is very small, and is located within the ethmoid sinuses only, the surgeon can remove the tumor through the nostril with an endoscope (a thin lighted tube). If the tumor is much larger, an incision on the side of the nose may be necessary.
• Maxillary sinus. If the tumor involves the maxillary sinus, a maxillectomy is needed. The type of maxillectomy depends on the exact location of the tumor. If the tumor is small and toward the middle of the sinus, the surgeon can remove the tumor through the nostril with an endoscope. If the tumor is larger, the surgeon will make the incision along the side of the nose or under the upper lip. The surgeon might need to remove bone from the hard palate, the upper teeth on one side of the mouth, part or all of the orbit (eye socket), part of the cheekbone, and/or the bony part of the upper nose.

A craniofacial resection may be needed if the cancer involves the ethmoid sinuses, frontal sinuses, and the sphenoid sinuses. A craniofacial resection requires both a head and neck surgeon and a neurosurgeon. If the tumor is located in the roof the nasal cavity, and invades into the brain, surgeons will need to remove the tumor from the nose and the brain.

Endoscopic Surgery

Endoscopic surgery is less destructive to normal tissue than conventional operations. The surgeon inserts a thin lighted tube (endoscope) into the nasal cavity, or sinus, instead of opening the area with an incision. The image is enlarged on a computer screen. Small (micro) instruments are used with the endoscope.

Surgeons are using the endoscopic method increasingly more often for treatment of nasal tumors, ethmoid tumors, and for nasal cavity cancer.
Radiation treatments are usually needed after surgery.

If cancer has affected the lymph nodes in the neck, a neck dissection (removal of the lymph nodes) might be needed during any type of head and neck cancer surgery.

Radiation

Radiation therapy stops cancer cells from dividing. The growth of the tumor is slowed. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors.

Chemotherapy

Chemotherapy is prescribed for different reasons:

• Together with radiotherapy as an alternative to surgery (called chemoradiation)
• After surgery to decrease the risk of the cancer returning
• To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment)
• The combination of surgery, radiation or chemotherapy depends on the size, the location and the type of tumor

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