Surgery For Nasal Cavity And Sinus Cancers
For most people with nasal cavity or sinus tumors, surgery will be part of treatment. At Memorial Sloan Kettering, our surgeons often take a minimally invasive approach.
During minimally invasive surgery, an endoscope is inserted through the nasal passage for a magnified view of the tumor. Because the view is so clear, the surgeon is better able to remove all of the tumor while preserving healthy tissue. The risk of complications with this technique is very low. The surgery leaves no visible scar.
We may recommend a traditional open surgery instead. This type of operation requires one or more incisions. The precise location and size of the tumor help determine which of these surgeries is the right choice for you.
Learn more about other specific types of surgery that may be used to treat nasal cavity and sinus cancers.
Types Of Sinus Cancer Nasal Cancer And Skull
Many different types of cancers can be found within the sinus cavities, nasal passageway and skull base. These cancers include:
- Squamous carcinoma, occurring in the maxillary sinus.
- Salivary gland cancers, occurring in the sinonasal cavity. These cancers include adenocarcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.
- Ethesioneuroblastoma, a common cancer of the nasal cavity. This cancer arises from the olfactory nerves in the roof of the ethmoid sinuses and has an extremely good prognosis.
- Sarcomas tumors arising from soft tissue, cartilage, and bone occurring in the nasal cavity and skull base. Their prognoses vary considerably. Low grade tumors have an excellent prognosis while the outcome for high grade lesions is not as good.
- Melanoma, occurring in the nasal cavity mucosa, similar to the melanomas that occur on the skin. This is an aggressive tumor even in the face of treatment. Skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma, whether locally aggressive or recurrent, can invade the skull base.
- Lymphomas, occurring in the sinonasal cavity.
Diagnosing Nasal And Sinus Cancer
Tests you may have to help diagnose nasal and sinus cancer include:
- a nasal endoscopy where a long, thin, flexible tube with a camera and light at the end is inserted into your nose to examine the area this can be uncomfortable, so before the procedure you’ll be asked whether you’d like anaesthetic sprayed on the back of your throat
- a biopsy where a small sample of tissue is removed and examined this may be done during an endoscopy
- a fine needle aspiration where fluid and cells are taken from a lymph node using a needle to see if the cancer has spread
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When Should You See A Doctor
Its a good idea to see your doctor if you develop any potential symptoms of sinus cancer that have no obvious cause, even if theyre unlikely to be caused by cancer.
Catching cancer in the early stages gives you the best chance of successfully treating it.
Getting a sinus cancer diagnosis starts by visiting a primary healthcare professional. If they suspect cancer, theyll refer you to an ear, nose, and throat doctor for further tests.
These tests may include:
- Endoscopy. An endoscope is a long and thin tube with a camera and light thats inserted into your nose to allow your doctor to examine your sinuses. The ENT doctor may apply a numbing spray to your nose before starting the procedure.
- Biopsy. A biopsy involves removing a small amount of tissue for lab analysis. A biopsy may be taken during an endoscopy.
- Fine-needle aspiration. A fine-needle aspiration involves using a very thin needle to remove a small amount of fluid from a lymph node to see if cancer has spread to it.
- Imaging. Your doctor may order various types of imaging to examine how far a tumor has grown. Imaging techniques that may be used include:
How Is Sinus Cancer Treated
Treatment for sinus cancer depends on factors like the size and location of the tumor within the sinus, its stage, your overall health, and the type of cancer. Treatment options include:
- Surgery. The tumor may be removed surgically through a procedure called endoscopic microsurgery. During this procedure, the cancer is removed through your nose with an endoscope.
- Radiation therapy. Radiation therapy may be used to shrink a tumor before surgery or to kill remaining cells after surgery.
- Chemotherapy. Chemotherapy is a chemical drug therapy used to kill cancer cells. It may be used with radiation therapy to treat some types of sinus cancers, such as
These numbers can give you an estimate of what to expect, but your doctor can give you the most accurate outlook.
Many factors can influence how well you respond to treatment including your age and overall health. Ethnicity and race may also influence outlook.
In a 2021 study , researchers found that compared to white people, Black people, American Indian, and Alaska Natives had higher death rates from sinus cancer. They also found that Hispanics were more likely to be diagnosed with advanced cancer.
Its likely that multiple factors contributed to these differences including socioeconomic status and access to healthcare. Its important to note that the stress of enduring racism, discrimination, and racist systems may play a part in these inequities in healthcare.
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How Do I Know If I Have It
If youâre experiencing a combination of symptoms that donât go away over time, see your doctor. Theyâll do a physical exam. Theyâll ask about your symptoms, medical history, and any related risk factors. If they suspect sinus and nasal cavity cancer, theyâll send you to a specialist for more tests.
They might also order a number of imaging tests to help locate your tumor. These include X-rays, CT scans, and MRIs. These can also help determine if the cancer has spread.
Once your doctor locates your tumor, theyâll do a biopsy. That means heâll remove a small tissue sample from the tumor and send it to a lab for testing. If you do have cancer, a biopsy can help identify what type and how aggressive it is. Once your doctor knows these things, heâll be able to decide on the proper treatment plan.
How Is Nasal And Sinus Cancer Diagnosed
Nasal and sinus cancers are diagnosed in the following manner:
- Physical exam: Your doctor will look you over for evidence of a cancerous growth. He or she will document your symptoms and ask questions about your medical history.
- Medical imaging: CT scans and magnetic resonance imaging scans can help locate cancerous masses in the nasal passages or sinus cavities.
- Endoscopy: An endoscope is a tiny camera with a light that a physician inserts into your nasal or sinus cavities by means of a long flexible tube. He or she uses this camera to inspect for evidence of a medical condition. Though not a surgical procedure, endoscopy typically requires some type of anesthesia.
- Biopsy: To verify a diagnosis of cancer, your physician may conduct a biopsy. He or she will collect a tissue sample, either by incision or needle insertion, or as part of a surgical procedure. This sample will be analyzed for evidence of disease.
If youve developed a sinus or nasal cancer, your physician or oncologist will assess its stage of development. He or she will determine the size and disposition of your tumors, and the overall prevalence of cancer within your body. Cancer stages are generally rated from 0 to 4, with stage 4 being the most advanced version of the disease.
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What Are Nasal And Paranasal Cancers
To understand this type of cancer, its helpful to know about the anatomy of the nasal cavity and paranasal sinuses. There are multiple sinuses, including the maxillary, frontal, sphenoid, and ethmoid sinuses, any of which can have cancerous tumors. The sinuses are air-filled pockets found throughout the head, including in the forehead, the upper cheeks, between the nose and eyes, and in the center of the skull. The purpose of the nasal cavity and paranasal sinuses is to filter, warm, and moisten the air you breathe. They also give your voice resonance, lighten the weight of the skull, and provide a bony framework for the eyes.
Nasal cavity and paranasal sinus cancers are tumors found inside the nose or the small, hollow spaces around the nose. These tumors begin in the cells lining the membranes, bones, or nerves lining the area. This type of cancer is rare, so its very important to find a treatment team familiar with it and able to perform complex tumor removal operations.
Outlook For Nasal And Sinus Cancer
There are many different types of cancer that can affect the nasal cavity and sinuses.
The outlook varies, depending on the specific type of nasal and sinus cancer you have, its exact location, how far it’s spread before being diagnosed and treated, and your overall level of health and fitness.
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Who’s At Risk Of Nasal And Sinus Cancer
Several factors are known to increase the risk of developing nasal and sinus cancer, including:
- your gender men are more likely to develop nasal and sinus cancer than women
- prolonged exposure to certain substances through your work, including wood dust, leather dust, nickel, chromium and formaldehyde
- smoking the more you smoke, the higher your risk of developing several types of cancer, including nasal and sinus cancer
- human papilloma virus a group of viruses that affect the skin and moist membranes, such as the mouth and throat
The Health and Safety Executive has produced a report on the risk of occupational nasal and sinus cancer in Great Britain .
Treatment Of Nasal Cavity And Sinus Cancers
The goals for the treatment of nasal cavity or sinus cancer are to:
- cure the cancer
- preserve your appearance
- preserve normal function
The extent and depth of the cancer guides your plan of care. Surgery is the most common treatment for nasal cavity and sinus cancers. Often surgery is the only treatment needed for noncancerous tumors and early-stage cancers.
If the disease is more advanced, radiation, chemotherapy, or both may be used to shrink the tumor. This can be done before or after surgery to reduce the risk of the cancer coming back. A type of radiation treatment called proton therapy has been shown to be particularly effective for nasal cavity and sinus tumors. Memorial Sloan Kettering is one of only a limited number of cancer centers nationwide that offer proton therapy.
Like other types of radiation therapy, proton therapy kills cancer cells by damaging their DNA. However, proton therapy may cause fewer side effects than other types of radiation therapy. Thats because protons deliver the radiation directly to the tumor.
This is an important benefit because the optic nerves and brain stem are very near the nasal cavity and sinuses. Proton therapy is less likely to damage the surrounding healthy tissue of the eyes, the optic nerves, and the brain.
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Stages Of Maxillary Sinus Cancer
A doctor will conduct tests to determine the stage of maxillary sinus cancer, which is then used develop an appropriate treatment plan. The following stages are used for maxillary sinus cancer:
Cancer is found in the innermost lining of the maxillary sinus only. Stage 0 cancer is also called carcinoma in situ.
Cancer is found in the mucous membranes of the maxillary sinus.
Cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bones at the back of the maxillary sinus or the base of the skull.
Cancer is found in any of the following places:
- Bone at the back of the maxillary sinus
- Tissues under the skin
- The base of the skull
- The ethmoid sinuses
Cancer is found in one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller cancer also is found in any of the following places:
- The maxillary sinus
- Bones around the maxillary sinus
- Tissues under the skin
- The base of the skull
- The ethmoid sinuses
Stage IV is divided into stages IVA, IVB, and IVC.
Stage IVACancer has spread to either one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but smaller than 6 centimeters or, cancer has spread to more than one lymph node anywhere in the neck, and all are 6 centimeters or smaller cancer is also found in any of the following areas:
Stage IVBCancer has spread to either:
What Are The Symptoms
There are often no signs of sinus and nasal cavity cancer in the early stages. They tend to develop as your tumor grows. When they do appear, symptoms can look a lot like those of many other sinus-related issues. But the difference with sinus and nasal cavity cancer is that the symptoms donât go away in time. They include:
- Ongoing congestion that gets worse
- Sinus blockage or pressure
- Ear pain or pressure
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Treatment Of Stage Ii Paranasal Sinus And Nasal Cavity Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- If cancer is in the maxillary sinus, treatment is usually high-dose radiationtherapy before or after surgery.
- If cancer is in the ethmoid sinus, treatment is usually radiation therapy and/or surgery.
- If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. for more information.)
- If cancer is in the nasal cavity, treatment is usually surgery and/or radiation therapy.
- For inverting papillomas, treatment is usually surgery with or without radiation therapy.
- For melanomas and sarcomas, treatment is usually surgery with or without radiation therapy and chemotherapy.
- For midline granulomas, treatment is usually radiation therapy.
- If cancer is in the nasal vestibule, treatment is usually surgery or radiation therapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Nasal Cavity And Paranasal Sinus Cancer: Symptoms And Signs
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People with nasal cavity or paranasal sinus cancer may experience the following symptoms or signs. A symptom is something that only the person experiencing it can identify and describe, such as fatigue, nausea, or pain. A sign is something that other people can identify and measure, such as a fever, rash, or an elevated pulse. Together, signs and symptoms can help describe a medical problem. Sometimes, people with nasal cavity or paranasal sinus cancer do not have any of the signs and symptoms described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer.
Nasal obstruction or persistent nasal congestion and stuffiness, which is often called sinus congestion
Chronic sinus infections that do not go away with antibiotic treatment
Frequent headaches or pain in the sinus region
Pain or swelling in the face, eyes, or ears
Persistent tearing of the eyes
Bulging of 1 of the eyes or loss of vision
Unexplained weight loss
A lump in the neck
These types of cancer are usually diagnosed in their later stages because early-stage cancer typically does not cause any symptoms. Nasal cavity or paranasal sinus cancer is often discovered when a person is being treated for seemingly benign, inflammatory disease of the sinuses, such as sinusitis.
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Nasal Cavity And Paranasal Sinus Cancer Stages
After someone is diagnosed with a nasal cavity or paranasal sinus cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer’s stage when talking about survival statistics.
The earliest stage of nasal cavity and paranasal sinus cancers is stage 0, also known as carcinoma in situ . The other stages range from I through IV . Some stages are split further, using capital letters . As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each persons cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How Is Sinus/nasal Cancer Diagnosed
Our team of cancer doctors is experienced in diagnosing and treating sinus and nasal cavity cancer at all stages, including advanced stages. Some of the diagnostic tests your doctor may perform to test for sinus/nasal cancer include:
- Physical examination: If your doctor suspects you have nasal or sinus cancer, he or she will perform a physical examination, feeling for lumps in the face, throat and neck areas. To confirm an initial cancer diagnosis or to determine whether the cancer has spread, you may be asked to undergo further testing.
- Imaging tests: Imaging tests, such as MRIs, CT scans and PET scans, are used to produce detailed pictures of the inside of your head or neck. These methods of diagnostic testing can determine the size of tumors and whether they have grown, shrunk or spread.
- Biopsy: During a biopsy, your doctor will remove a small sample of tissue to detect whether it contains cancerous cells . The tissue will be removed using a thin needle or during a surgical procedure and will be further examined beneath a microscope.
- Blood tests: Your doctor may order blood work to look for certain indicators of nasal/sinus cancer or monitor how your treatment is progressing.
- Endoscopy: This procedure will allow your doctor to examine the inside of your mouth area. During an endoscopy, your doctor will insert a small scope into your nose or mouth to examine the hard-to-see areas of your head and neck.
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