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What is Nasal Cavity and Paranasal Sinus Cancer?

The Nasal Cavity

The nasal cavity is the space just behind the nose where air passes on its way to the throat.

Paranasal Sinuses

The paranasal sinuses are air-filled areas that surround the nasal cavity. The paranasal sinuses include:

  • Maxillary sinuses in the cheeks
  • Ethmoid sinuses on the bridge of the nose between the eyes
  • Frontal sinuses above the eyes
  • Sphenoid sinuses behind the ethmoids

Types of Paranasal Sinus and Nasal Cavity Cancer:

  • Squamous cell carcinoma
    • This is the most common type of nasal cavity and paranasal sinus cancer. Squamous cells are flat cells that make up the thin surface layer of the structures of the head and neck.
  • Melanoma
    • Melanoma is an invasive, fast-growing cancer that develops from cells called melanocytes that give the skin its color.
  • Sarcoma
    • This is a type of cancer that begins in muscle, connective tissue, or both
  • Inverting papilloma
    • These are benign, wart-like growths. They are not cancer, but they can come back after treatment. In a small group of people, they can develop into cancer.
  • Midline granulomas
    • These are conditions that cause the breakdown of the healthy tissue of the nose, sinuses, and nearby tissues. Many are a type of lymphoma.
  • Adenocarcinoma
    • This is the second most common type of nasal cavity and paranasal sinus cancer. It begins in gland cells.
  • Adenoid cystic cancer
    • This is a rare form of cancer that begins in gland tissues. It most commonly arises in the salivary glands of the head and neck.

Risk Factors & Symptoms

Risk factors for nasal cavity and paranasal sinus cancer include:

  • Being exposed to certain workplace chemicals or dust, such as those found in the following jobs:
  • Furniture-making
  • Sawmill work
  • Woodworking
  • Shoemaking
  • Metal-plating
  • Flour mill or bakery work
  • Being infected with human papillomavirus (HPV)
  • Being male and older than 40 years
  • Smoking

Signs of nasal cavity and paranasal sinus cancer include:

  • Blocked sinuses that do not clear, or sinus pressure
  • Headaches or pain in the sinus areas
  • A runny nose
  • Nosebleeds
  • A lump or sore inside the nose that does not heal
  • A lump on the face or roof of the mouth
  • Numbness or tingling in the face
  • Swelling or other trouble with the eyes, such as double vision or the eyes pointing in different directions
  • Pain in the upper teeth, loose teeth, or dentures that no longer fit well
  • Pain or pressure in the ear
  • Tearing/watering of the eye (due to blockage of the tear duct)

Diagnosis

Staging

If you are diagnosed with paranasal sinus or nasal cavity cancer, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The staging system most often used for nasal cavity and paranasal sinus cancers is the TNM system:

  • - Indicates the size of the primary tumor and which, if any, tissues of the oral cavity or oropharynx it has spread to
  • N - Describes the extent of spread to nearby lymph nodes.
  • M - Indicates whether the cancer has metastasized to other organs of the body. (The most common site of spread is to the lungs. The next most common sites are the liver and bones.)

Numbers or letters appear after T, N, and M to provide details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means "cannot be assessed" because the information is not available.

Cancer stage grouping

Doctors combine the T, N, and M information to say what stage the cancer is.

Staging of Maxillary Sinus Cancer

  • Stage 0 (Carcinoma in-situ) -Abnormal, but non-invasive cells found in top layer of tissue.
  • Stage I - The tumor is confined to the membrane of the maxillary sinus. Tumor has not caused any bone erosion/destruction.
  • Stage II - The tumor is confined to the maxillary sinus and has caused bone erosion/destruction. It may have spread to the roof of the mouth and/or the middle nasal passage.
  • Stage III - The tumor has grown through the bone of the sinus wall, into the eye socket, the ethmoid sinus (in front of maxillary sinus), or into deep layers of skin. Cancer has not spread to any lymph nodes.
    • OR the tumor may be any size and may or may not have spread to the previously mentioned areas. Cancer has spread to 1 lymph node on the same side of the neck that is 3 cm or less in diameter. The tumor has spread to the front of the eye socket, the skin of the cheek, the nose bone, or the sphenoid/frontal sinus. May or may not have spread to one lymph node that is 3 cm or less in diameter.
    • OR the tumor may be any size and may have spread to any previously mentioned areas. Cancer has spread to:
      • 1 lymph node on the same side of the neck, which is greater than 3 cm but no greater than 6 cm, or
      • Multiple lymph nodes on the same side of the neck, none of which are greater than 6 cm, or
      • Lymph nodes on opposite side or both sides of the neck, none of which are greater than 6 cm.
  • Stage IV is divided into Stage IVA, IVB and IVC as follows:
    • Stage IVB:
      • Tumor has spread to the brain, meninges, cranial nerves, eye, nasopharynx, etc. May or may not have spread to the lymph nodes.
      • OR tumor may be any size and may have spread to any of the previously mentioned areas. Cancer has spread to a single lymph node that is greater than 6 cm in diameter.
    • Stage IVC: Cancer has spread to distant organs or parts of the body.

Staging of Nasal Cavity & Ethmoid Sinus Cancer

  • Stage 0 (Carcinoma in-situ) - Abnormal, but non-invasive cells found in top layer of tissue.
  • Stage I - Tumor confined to the one area where it began (i.e. the specific section of the nasal cavity or the specific ethmoid sinus). Tumor may or may not have spread to the bone.
  • Stage II - More extensive involvement of one or two areas in the nasal cavity / ethmoid sinus, may or may not have invaded the bone.
  • Stage III – The tumor has spread to the maxillary sinus, the wall of the eye socket, the hard palate, or the cribiform plate (the structure between the nasal cavity and the bones surrounding the front of the brain).
    • OR Cancer has spread to 1 lymph node on the same side that is 3 cm or less in diameter. Tumor may be any size and may have spread to any of these areas.
  • Stage IV is divided into stage IVA, IVB and IVC as follows:
    • Stage IVA: Moderately advanced local disease
      • Tumor has spread to the front of the eye socket, the skin of the nose or cheek, the front of the skull base, the pterygoid plates, or the sphenoid/frontal sinus. May or may not have spread to one lymph node that is 3 cm or less in diameter.
      • OR Tumor may be any size and may have spread to any previously mentioned areas. Cancer has also spread to:
        • 1 lymph node on the same side of the neck, which is greater than 3 cm but no greater than 6 cm, or
        • multiple lymph nodes on the same side of the neck, none of which are greater than 6 cm, or
        • lymph nodes on opposite side or both sides of the neck, none of which are greater than 6 cm.
    • Stage IVB: Very advanced local disease
      • Tumor has spread to the brain, eye, meninges, cranial nerves other than the nasopharynx. Tumor may or may not have spread to the lymph nodes.
      • OR tumor may be any size and may have spread to any of the previously mentioned areas. Cancer has spread to a single lymph node that is greater than 6 cm in diameter.
  • Stage IVC: Cancer has spread to distant organs or parts of the body. 

Surgery

Endoscopic surgery: uses a narrow instrument called an endoscope, which can often be used to remove tumors from the nose and sinuses without making any cuts to the face.

Open surgery: For some large tumors and those that cannot be removed with an endoscope, the doctor may need to make a cut in the face to most safely remove your cancer. The doctor will try to keep all surgical cuts in the area of natural shadow lines or skin creases to hide them.

If you have a tumor that extends to the roof of the mouth, the surgery to remove the tumor may create a hole from the mouth to the nose and/or sinuses. A specialist called a maxillofacial prosthodontist can develop a dental appliance called an obturator, which seals the hole. It acts like an upper denture to replace any missing teeth in the area.

In cases where the tumor extends through the skull base, or the narrow sheet of bone that separates the nasal cavity from the space containing the brain, your surgeon may work with a neurosurgeon to help most safely remove the tumor.

Click Here for Additional Treatments for Nasal Cavity and Paranasal Sinus Cancer