Nasal Sinus Cancer

Nasal and sinus cancer is a rare condition that develops in the space behind your nose or in the hollow air-filled spaces around it, often causing symptoms that may seem like ordinary sinus problems at first.

Table of contents

• What is nasal sinus cancer?
• The nasal cavity and paranasal sinuses
• Types of nasal and sinus cancer
• Risk factors
• Signs and symptoms
• Diagnosis and testing
• Treatment approaches

What is nasal sinus cancer?

Nasal and sinus cancer is a rare cancer that starts in the space behind your nose, called the nasal cavity, or in your sinuses^[1]. The paranasal sinuses are hollow chambers around the nose, filled with air^[4]. A cancerous (malignant) tumour is a group of cancer cells that can grow into nearby tissue and destroy it. The tumour can also spread (metastasize) to other parts of the body^[4].

Most tumors of the paranasal sinuses present with advanced disease, and cure rates are generally poor^[11]. These cancers grow within the bony confines of the sinuses and are often without symptoms until they erode and invade adjacent structures^[11]. Nodal involvement is infrequent, but locoregional recurrence accounts for most cancer deaths because most patients die of direct extension into vital areas of the skull or of rapidly recurring local disease^[11].

Cancers of the maxillary sinus are the most common of the paranasal sinus cancers. Tumors of the ethmoid sinuses, nasal vestibule, and nasal cavity are less common, and tumors of the sphenoid and frontal sinuses are rare^[11].

paranasal sinus cancer, nasal cavity cancer

The nasal cavity and paranasal sinuses

The nasal cavity and paranasal sinuses are part of the respiratory system. The nasal cavity is made up of the nostrils and the hollow passageway just behind the nose. The nasal cavity filters, warms and moistens the air you breathe and gives you a sense of smell^[4].

The paranasal sinuses are hollow, air-filled spaces in the bones around the nose. The sinuses are lined with cells that make mucus, which keeps the inside of the nose from drying out during breathing^[5]. These sinuses give your voice its unique sound and protect the brain from injury^[4].

There are several paranasal sinuses named after the bones that surround them. The frontal sinuses are in the lower forehead above the nose. The maxillary sinuses are in the cheekbones on either side of the nose. The ethmoid sinuses are beside the upper nose, between the eyes. The sphenoid sinuses are behind the nose, in the center of the skull^[5].

Together the paranasal sinuses and the nasal cavity filter and warm the air, and make it moist before it goes into the lungs. The movement of air through the sinuses and other parts of the respiratory system help make sounds for talking^[5].

• Nasal cavity
• Frontal sinuses
• Maxillary sinuses
• Ethmoid sinuses
• Sphenoid sinuses

Types of nasal and sinus cancer

Cells in the nasal cavity and paranasal sinuses sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous (benign) tumours such as nasal polyps or inverting papilloma^[4].

The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma. This type of cancer forms in the thin, flat cells lining the inside of the paranasal sinuses and the nasal cavity^[5]. Squamous cell carcinoma is the most frequent type of malignant tumor in the nose and paranasal sinuses, accounting for 70 to 80 percent of these cancers^[11].

Sometimes cancer can start in the gland cells of the nose or sinuses. This type of cancer is called adenocarcinoma of the nasal cavity or paranasal sinus^[4].

Other types of paranasal sinus and nasal cavity cancer include melanomas, which are cancers that start in cells called melanocytes, the cells that give skin its natural color. Sarcomas are cancers that start in muscle or connective tissue. Inverting papillomas are benign tumors that form inside the nose, and a small number of these change into cancer^[5].

Rare types of nasal cavity and paranasal sinus cancer can also develop. These include esthesioneuroblastoma and sinonasal undifferentiated carcinoma (SNUC)^[4].

Risk factors

Data indicate that various industrial exposures may be related to cancer of the paranasal sinus and nasal cavity^[11]. Being exposed to certain chemicals or dust in the workplace can increase the risk of paranasal sinus and nasal cavity cancer^[5].

The risk of a second primary head and neck tumor is considerably increased in people who have had nasal and sinus cancer^[11]. A study has shown that a subgroup of paranasal sinus and nasal cavity squamous cell carcinomas are associated with human papilloma virus (HPV) infection and that HPV-positive patients may have a better prognosis than those who are HPV negative^[11].

Smoking during treatment such as radiotherapy may mean the treatment doesn’t work as well and you may have more side effects. Stopping smoking also reduces your risk of developing another cancer and improves your general health^[15].

Signs and symptoms

Signs and symptoms of paranasal sinus and nasal cavity cancer include sinus problems and nosebleeds^[5]. Nasal and paranasal sinus cancer can cause symptoms such as nose and eye problems, as well as other symptoms such as a lump or a growth^[6].

Symptoms of nasal cavity and sinus cancers may include chronic nasal congestion or blockage (often only on one side of the nose), nasal drainage (often only on one side of the nose), nosebleeds (often only on one side of the nose), pain around the eyes, and loss of smell^[21].

Some people may have just a chronic stuffy nose, headaches, or sinus infection-like symptoms^[21]. These cancers may only cause minor symptoms at first, which is why they are often discovered at an advanced stage.

Diagnosis and testing

Tests that examine the sinuses and nasal cavity are used to diagnose paranasal sinus and nasal cavity cancer^[5]. You usually start by seeing your GP. They will examine you and might refer you for tests or to a specialist^[6].

Tests and procedures used to diagnose nasal and paranasal tumors include using a tiny camera to see inside the nasal cavity and sinuses. Nasal endoscopy is a procedure to look inside the nose. It uses a thin tube with a light and camera. The tube is inserted into your nose. The camera sends pictures to a computer for your healthcare team to look at^[10].

A biopsy is a procedure to collect a sample of tissue for testing. For nasal and paranasal tumors, the procedure involves taking a sample of cells from inside the nose or sinuses. Often a healthcare professional gets the sample during a nasal endoscopy. Special tools can go through the tube to take the cells. Another type of biopsy uses a thin needle that’s inserted directly into the suspicious area to collect a sample of cells. The samples are sent to a lab to be tested. In the lab, tests can show whether the cells are cancerous^[10].

Imaging tests capture pictures of the inside of the body. The pictures can show the size and location of a tumor. Imaging tests used for nasal and paranasal tumors may include X-rays and scans such as CT, MRI and positron emission tomography, also called PET^[10]. Various imaging tests, such as MRIs and CT scans may be used to diagnose nasal cavity and sinus cancer^[21].

Pretreatment evaluation and staging, as well as the need for multidisciplinary planning of treatment, is very important. Generally, the first opportunity to treat patients with head and neck cancers is the most effective, although salvage surgery or salvage radiation therapy, as appropriate, may occasionally be successful^[11].

Treatment approaches

Your treatment depends on several factors. These include what type of nasal and paranasal sinus cancer you have, how big it is, whether it has spread (the stage) and the grade. It also depends on your general health^[6].

Most nasal and paranasal tumors are treated with surgery to remove the tumor^[10]. The most common treatments for nasal and paranasal sinus cancer are surgery, radiotherapy and chemotherapy^[8].

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). Most people are referred to a head and neck cancer MDT^[8].

Surgery is a main treatment for nasal cavity cancer. The type of surgery done depends on where the tumour is in the nasal cavity. The surgery usually done is endoscopic surgery. Endoscopic surgery uses a rigid tube with a light and lens on the end (called an endoscope) to remove tumours^[9]. When possible, surgeons use a minimally invasive endoscopic approach to remove nasal cavity and sinus cancers. No incisions are used. Instead, surgeons operate through the nose using tiny instruments^[21].

Radiation therapy may be offered after surgery to destroy any cancer cells that may have been left behind. You may also have radiation therapy before surgery if it is likely that cancer cells will be in the tissue that will be removed by surgery. In some cases, radiation therapy may be offered instead of surgery as the main treatment if the tumour is too hard to remove with surgery^[9].

Chemoradiation is a treatment that gives chemotherapy along with radiation therapy. The chemotherapy drug most often used is cisplatin. It may be given after surgery if there are cancer cells in the tissue around the removed tumour. Chemoradiation may also be offered as the main treatment instead of surgery if the cancer can’t be removed by surgery^[9].

Immunotherapy may be offered for stage 4 nasal cavity cancer^[9].

Because most treatment failures occur within 2 years, patients must be monitored frequently and meticulously during this period. Lifetime follow-up is essential because nearly 33% of these patients develop second primary cancers in the aerodigestive tract^[11].