Nasal Cavity and Paranasal Sinus Cancer
Treatment Center
The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health treats nasal cavity and paranasal sinus cancer through a multidisciplinary team approach incorporating the skills of board-certified neurologists, neurosurgeons, neuropathologists, neuro-oncologists, otolaryngologists, and others to deliver the highest-quality care to our patients. Our neurosurgeons are highly skilled in minimally invasive surgical treatment, as well as complicated reconstructive surgeries designed to restore the patient’s ability to eat and speak. With state-of-the-art technology, our physicians are able to deliver the very best treatment for optimal outcomes of nasal and paranasal tumors.
What Are Nasal and Paranasal Cancers?
To understand this type of cancer, it’s 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 it’s very important to find a treatment team familiar with it and able to perform complex tumor removal operations.
Symptoms of Nasal and Paranasal Tumors
Symptoms usually only occur on one side and include:
- Progressively worse nasal congestion or blockage
- Pain near the eye
- Post-nasal drip
- Nosebleeds
- Pus draining from the nose
- Diminished or loss of sense of smell
- Numbness of the teeth
- Constantly watery eyes
- Bulging eye
- Pain or pressure in one ear
- Hearing loss
- Headache
- Enlarged lymph nodes in the neck
What Causes Nasal and Paranasal Cancer?
As is the case with many types of cancer, the cause of nasal cavity or paranasal sinus cancer is largely unknown. Researchers have identified some risk factors, such as toxic chemical exposure that may damage the DNA of the cells lining the inside of the nose and sinuses. Another possible cause of cancer is inheriting DNA mutations from a parent, or acquiring a DNA mutation from radiation exposure.
Diagnosis of Nasal and Paranasal Tumors
Most cancers of the nasal and paranasal sinuses aren’t found until they have grown to a certain size and begin to produce unpleasant symptoms. Currently, there is no early screening test to find these types of tumors.
To come to a diagnosis, a physical exam is necessary to check the parts of the nose and/or sinuses causing problems. Your doctor will check for numbness, pain, or signs of swelling or firmness of the face and lymph nodes in the neck. Your doctor may examine your nasal cavity to see inside your nasal passages. If your doctor thinks you could have a tumor in the nasal cavity or paranasal sinuses, they will likely refer you to an otolaryngologist (a physician who specializes in conditions affecting the ear, nose, and throat, also called an ENT).
Usually, these tumors are diagnosed after taking imaging tests, such as MRI and CT scans. These imaging tests create pictures of the inside of the body to help look for a tumor if your doctor suspects one, and to see if the tumor is operable without too much risk of permanent nerve damage. These imaging tests can also help your doctor see if the tumor has spread or if it has come back after treatment.
In order to make a definitive diagnosis, a tissue sample must be taken and examined under a microscope by a neuropathologist (biopsy). If cancer is found, the neuropathologist who examines the tissue sample will be able to discern the type and aggressiveness of the cancer. This information helps the patient’s medical team devise the best treatment.
Staging of Nasal and Paranasal Tumors
Part of the diagnosis process is staging. This indicates how advanced and aggressive the cancer is, and it helps your medical team come up with the best treatment plan for you. Cancer stages go from 1 to 4, with 1 being the earliest stage and 4 being the most advanced. In stage 1, the tumor is contained in the nasal cavity or paranasal sinus and has not spread. In stage 2, the tumor has spread regionally, and in stage 3, the tumor has spread to the bone or eye socket and possibly the lymph nodes. In the final stage, the tumor has spread further and may have a larger presence in the lymph nodes of the neck.
Treatment of Nasal and Paranasal Tumors
For most sinus cancers, surgery is the first-line treatment, if the size and location of the tumor permit. Because nasal cavity and paranasal sinus tumors are located near the brain, eyes, major blood vessels, and nerves that control vision, it’s important to use the least invasive approach possible to remove the tumor. The goal of surgery is to remove the entire tumor while keeping the patient’s appearance and functions as normal as possible.
Radiation and chemotherapy are also usually necessary as secondary treatment. A radiation oncologist carefully plans and delivers radiation to kill cancer cells while sparing the adjacent healthy tissue, and chemotherapy uses cancer-killing drugs. Both radiation and chemotherapy may be used in combination to shrink the tumor either before surgery, to make the tumor easier to remove, or after surgery if the tumor is inoperable.
Prognosis for Nasal and Paranasal Tumors
The average survival rates for nasal cavity and paranasal sinus cancers won’t tell you how long you will live, but can give you a better understanding of how successful your treatment is likely to be. The 5-year relative survival rate, per the American Cancer Society, is about 80% for those who only have a localized tumor (a tumor that has not spread outside of the nasal cavity or paranasal sinus). For those whose cancer has spread beyond the original site, the 5-year survival rate is about 44-50%.
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