Nasal and Paranasal Sinus Cancer
Nasal and paranasal sinus cancers are rare and affect the nasal cavity (which runs along the palate and connects to the throat) and the paranasal sinuses (small cavities or tunnels around the nasal cavity). The nasal cavity and paranasal sinuses are lined by a layer of mucous-producing tissue called mucosa. The mucosa has many types of cells, which can become cancerous and result in the following types of cancer:
- squamous cell carcinoma (the most common type of nasal and paranasal sinus cancer)
- adenocarcinoma (the second most common type)
- malignant lymphoma (from lymph or immune system cells)
- malignant melanoma (an aggressive cancer of pigment or skin color-containing cells)
- papillomas (benign growths that have a small chance of developing into squamous cell carcinomas)
- esthesioneuroblastomas (occur at the roof of the nasal cavity)
- midline granuloma (which can destroy normal tissues of the nose, sinuses, and nearby tissues)
- tumors of bone, muscle, cartilage, and fibrous cells
The Cancer Center's Division of Head and Neck Oncology comprises board-certified otolaryngologists who are highly skilled in the diagnosis, treatment, and management of all types of cancers that affect the head and neck. Our co-chief of the Division of Head and Neck Oncology, Christopher M. Shaari, M.D., is one of only a handful of otolaryngologists (head and neck surgeons) in the tri-state area to have completed a fellowship in head and neck microvascular reconstructive surgery. This is used to restore function in patients who have undergone extensive surgical treatments for head and neck cancers. An important goal of surgical treatment for head and neck cancers is to restore as much of the patient's functioning (speech, swallowing, etc.) as possible after surgery. To achieve this, microvascular reconstructive techniques - such as those practiced by Dr. Shaari - may be used. During surgery, Dr. Shaari or another otolaryngologist and a plastic/reconstructive surgeon work together to transplant tissue from a patient's arms or legs to where a cancerous tumor has been removed. The blood vessels of this tissue are connected in the neck to restore functioning to the tissues in the treatment area.
Nasal and paranasal sinus cancer primarily affects adults in their 50s and 60s and afflicts nearly twice as many men as women. The cancer typically grows or spreads locally and may then spread to the lymph nodes. The greatest risk factor for all head and neck cancers is smoking.
Surgery is the primary treatment for nasal and paranasal sinus cancers. Surgery may be combined with three-dimensional conformal radiation therapy or chemotherapy.
The goal of surgery is to remove the tumor and surrounding tissue while keeping appearance and functions (breathing, chewing, speech, and swallowing) as normal as possible. Treatment may include removing the eye because of its close proximity to the treatment area or if the cancer has spread there.
For patients with nasal cancer, part or all of the nose may have to be removed. It may be rebuilt with surrounding tissue or a cosmetic prosthesis. For paranasal sinus cancer, several types of surgery are used depending on the tumor's size, type, location, and involvement with other structures. Endoscopic surgical techniques, which are less destructive, may be used to treat small tumors or as a palliative treatment to ease pain, bleeding, and other difficulties caused by tumors too large to be removed completely. A neck dissection (removal of lymph glands in the neck) may be part of the treatment plan if cancer has spread to these glands.
Surgery is often combined with three-dimensional conformal radiation therapy to shrink the tumor before surgery or to destroy any remaining cancerous cells after surgery. Three-dimensional conformal radiation therapy may also be used as the primary treatment for patients whose tumor cannot be removed completely or for those who cannot tolerate surgery. It may also be used as a palliative treatment. High-dose-rate brachytherapy, involving the insertion of small rice-like tubes of radiation into the tumor, may be used in combination with three-dimensional conformal radiation therapy.
Chemotherapy may be used to treat patients whose cancer has metastasized to distant organs. It may also be used as an adjuvant (addition) to three-dimensional conformal radiation therapy.