A National Cancer Institute-designated Comprehensive Cancer Center

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Paranasal Sinus and Nasal Cavity Cancers

Paranasal Sinus and Nasal Cavity Cancers
City of Hope offers a truly comprehensive approach to paranasal sinus and nasal cavity cancers. Our accomplished head and neck surgeons specialize in the complex operations often necessary to eradicate these tumors while preserving vital structures and function. We offer ultra-sophisticated radiotherapy techniques, such as intensely-modulated radiation therapy (IMRT) and Helical TomoTherapy. We also employ the latest chemotherapy protocols and devise promising therapies through our drug development research programs. These combined attributes allow us to provide powerful therapeutic options to patients fighting paranasal sinus and nasal cavity cancers.

Paranasal sinus and nasal cavity cancer patients at City of Hope receive treatment from a coordinated, multidisciplinary team of head and neck surgeons, plastic surgeons, oncologists, neurologists, radiation oncologists, nurses, nutritionists, speech pathologists and other supportive care specialists, ensuring the highest possible standard of care.
 
About Paranasal Sinus and Nasal Cavity Cancers
 

Paranasal sinus and nasal cavity cancers result from an accumulation of malignant cells in the paranasal sinuses - hollow, air-filled spaces in the bones near the nose – and/or the nasal cavity (the tissue comprising the nasal passages leading from the nostrils to the back of the nose into the throat). The paranasal sinuses are divided into four types, which are named after the bones that surround them:
 

 
  • Frontal sinuses - in the lower forehead above the nose
  • Maxillary sinuses - in the cheekbones on either side of the nose
  • Ethmoid sinuses - beside the upper nose, between the eyes
  • Sphenoid sinuses - behind the nose, in the center of the skull

Most cancers of the paranasal sinuses are found in the maxillary sinuses. Like other head and neck cancers, these cancers may originate from a variety of different types of cells. The cellular classification of the cancer is important in determining prognosis and treatment options.
 
Paranasal Sinus and Nasal Cavity Cancer Risk Factors 
 
  • Age over 40
  • Male
  • Smoking
  • Chronic sinusitis
  • Nasal polyps (particularly in cases of inverted papilloma)
  • HPV (human papillomavirus) infection (inverted papilloma)
  • EBV infection (in cases of T cell lymphoma)
  • Asian or South American ancestry (T cell lymphoma)
  • Certain autoimmune diseases (B cell lymphoma)
  • Neurofibromatosis (in sarcomas)
  • Occupational exposure to certain chemicals or dust – such jobs include:
    • Furniture manufacturing
    • Sawmill work
    • Woodworking (carpentry)
    • Shoemaking
    • Leather tanning
    • Metal plating
    • Flour mill or bakery work
    • Welding/soldering

       
  • Suspect substances include
    • Nickel compounds
    • Chromium compounds
    • Lacquers
    • Mineral oils
    • Wood dust
 
Paranasal Sinus and Nasal Cavity Cancer Symptoms
 
Paranasal sinus and nasal cavity cancer often have no symptoms until the tumor encroaches on other structures in the head and neck. When present, symptoms may include the following:
 
  • Blocked sinuses that do not clear, or sinus pressure
  • Headaches or pain in the sinus areas
  • Runny nose
  • Nosebleeds
  • Lump or sore inside the nose that does not heal
  • 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
 

Diagnosis

A variety of methods is used to diagnose paranasal sinus and nasal cavity cancer. They include:

  • Physical exam and history: An exam of the body to check general signs of health. The head, neck, mouth and throat will be checked for signs of disease such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
    After a physical exam that reveals cause for suspicion of paranasal sinus and nasal cavity cancer, imaging tests may be ordered to determine the extent of spread of the tumor, if any. Standard imaging tests include:
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear MRI, or NMRI.
  • CT scan (computed tomography scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. Contrast medium (a dye injected into a vein or swallowed to help the organs or tissues show up more clearly) is generally not used when imaging the sinonasal area. This procedure is also called computed tomography computerized tomography, or computerized axial tomography.
     
Note: MRI and CT scans are preferred over conventional radiography (X-ray).
 
  • Bone scan: A procedure to check if there are rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
 
After identifying the primary site or sites of the tumor, the following may be performed:

 

  • Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted into the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples for biopsy .
  • Biopsy: The removal of suspect tissue for analysis. A pathologist views the tissue under a microscope to look for cancer cells. This test is necessary to establish three things:
     
  1. whether the tumor is benign or malignant
  2. what type of cell the tumor originated from
  3. what grade, or level of differentiation, the tumor cells display
 

Staging - Maxillary Sinus Cancer

Staging is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and predicting your chance for cure and long-term survival.
 
Staging is based on the results of the physical exam, nasoscopy, biopsy , the physician’s impression during or after surgery to remove the tumor (presence or absence of invasion of the tumor to other organs), and imaging tests (CT, MRI, bone scan).
 
Maxillary sinus cancer uses the following staging scheme:
 
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
 
Stage I
In stage I, cancer has formed in the mucous membranes of the maxillary sinus.
 
Stage II
In stage II, cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.Stage III In stage III, cancer has spread to any of the following:
  • Bone at the back of the maxillary sinus
  • Tissues under the skin
  • Eye socket
  • Base of the skull
  • Ethmoid sinuses
or

Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is3 centimeters or smaller. Cancer has also spread to any of the following:
  • Lining of the maxillary sinus
  • Bones around the maxillary sinus, including the roof of the mouth and the nose Tissues under the skin
  • Eye socket
  • Base of the skull
  • Ethmoid sinuses

Stage IV
Stage IV is divided into stage IVA, IVB and IVC.

Stage IVA
In stage IVA, cancer 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 not larger than 6 centimeters

More than one lymph node anywhere in the neck, and they are all 6 centimeters or smaller and cancer has spread to any of the following:
  • Lining of the maxillary sinus
  • Bones around the maxillary sinus, including the roof of the mouth and the nose Tissues under the skin
  • Eye socket
  • Base of the skull.
  • Ethmoid sinuses.
or

Cancer has spread to any of the following:
  • Front of the eye
  • Skin of the cheek
  • Base of the skull
  • Behind the jaw
  • Bone between the eyes
  • Sphenoid or frontal sinuses

and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
 
Stage IVB
In stage IVB, cancer has spread to any of the following:
 
  • Back of the eye Brain Middle parts of the skull
  • Nerves in the head that go to the brain
  • Upper part of the throat behind the nose
  • Base of the skull and cancer may be found in one or more lymph nodes of any size, anywhere in the neck.
or

Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.
 
Stage IVC
In stage IVC, cancer may be anywhere in or near the maxillary sinus may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus such as the lungs.
 
 

Staging - Nasal Cavity and Ethmoid Sinus Cancer

Nasal cavity and ethmoid sinus cancer uses the following staging scheme:
 
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
 
 
Stage I
In stage I, cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.
 
Stage II
In stage II, cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.
 
Stage III
In stage III, cancer has spread to any of the following:
 
  • Eye socket
  • Maxillary sinus
  • Roof of the mouth
  • Bone between the eyes
 
or

Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:
 
  • Nasal cavity
  • Ethmoid sinus
  • Eye socket
  • Maxillary sinus
  • Roof of the mouth
  • Bone between the eyes
 
Stage IV
Stage IV is divided into stage IVA, IVB and IVC.
 
Stage IVA
In stage IVA, cancer 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 not larger than 6 centimeters

More than one lymph node anywhere in the neck, and they are all 6 centimeters or smaller and cancer has spread to any of the following:
 
  • Nasal cavity
  • Ethmoid sinus
  • Eye socket
  • Maxillary sinus
  • Roof of the mouth
  • Bone between the eyes
 
or
 
Cancer has spread to any of the following:
 
  • Front of the eye
  • Skin of the nose or cheek
  • Front parts of the skull
  • Base of the skull
  • Sphenoid or frontal sinuses
 
and cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
 
Stage IVB
In stage IVB, cancer has spread to any of the following:
 
 
  • Back of the eye
  • Brain
  • Middle parts of the skull
  • Nerves in the head that go to the brain
  • Upper part of the throat behind the nose
  • Base of the skull
 
and cancer may be found in one or more lymph nodes of any size, anywhere in the neck

or

Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.
 
Stage IVC
In stage IVC, cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus such as the lungs.
  • Sphenoid and frontal sinuses
  • There is no standard staging system for cancer of the sphenoid and frontal sinuses.
 

Treatment Options

Department of Surgery
First-line treatment for most types of paranasal sinus and nasal cavity cancer is surgery. The surgeon will remove the cancer and possibly some surrounding tissue. Because there is often local invasion (spread to nearby structures) at diagnosis, a wide excision technique is utilized so as to remove as much of the tumor as possible. If a significant amount of tissue needs to be removed, plastic surgery may be required. In the event that the tumor is small and localized to the nasal cavity, an endoscopic approach known as FESS (functional endoscopic sinus surgery) may be used. This is often done with excision of inverted papillomas.
 
Radiotherapy
Because many types of paranasal sinus and nasal cavity cancers are advanced at diagnosis and/or prone to recurrence and metastasis, postoperative radiation therapy is often recommended to improve clinical outcomes. This is especially important in cases of higher-grade or larger tumors, unclean surgical margins (after surgery, the pathology report shows tumor cells extending right up to the margin of the excised area), or evidence of local invasion or metastasis.
 
Radiotherapy may be used by itself or in combination with chemotherapy in cases where the tumor may be too large to be removed surgically, where surgery would be too disfiguring or if the tumor is unresectable (inoperable) for other reasons. Radiotherapy is also used as the primary treatment modality in cases of where the tumor is in the sphenoid sinus, and in lymphoma (formerly known as midline granuloma). Radiotherapy may also be useful as palliative treatment, i.e., to reduce symptoms such as pain and obstruction. Preoperative radiation may sometimes be employed in order to make the tumor more readily operable.

City of Hope’s  Radiation Oncology was the first in the western United States to offer the helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
 
Two types of technology are integrated – spiral CT scan ning and intensity modulated radiation therapy, or IMRT – thus producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.
 
Chemotherapy
Chemotherapy is sometimes used with radiation in paranasal sinus and nasal cavity cancers in cases where the disease is metastatic, unresectable and/or recurrent. Cancers occurring in the ethmoid and sphenoid sinuses are more likely to be treated with chemotherapy and radiation than cancers occurring in the maxillary sinus (except in maxillary sinus cancers with a late-stage or high-grade designation).
 
Chemotherapy regimens vary depending on the particular cell type in question. Sometimes, in order to use high-dose chemotherapy regimens (so as destroy the maximum number of tumor cells), autologous peripheral bloodstem cell transplantationis performed. This enables a “rescue” of the blood and bone marrow, which are hard hit by the intensive chemotherapy.
 
Clinical Trials
City of Hope has several clinical trials involving therapies for advanced solid tumors of the head and neck. Some of these may apply to paranasal sinus and nasal cavity cancer.

Follow-up
Because paranasal sinus and nasal cavity cancers can recur, patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include thorough head and neck palpation as well as multiple imaging modalities, e.g., CT, MRI and bone scans.

 

 

Resources

All of our patients also have access to the  Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
 
SPOHNC (Support for People with Oral and Head and Neck Cancer)
P.O. Box 53
Locust Valley, NY 11560-0053
Phone: 800-377-0928
Fax: 516-671-8794
www.spohnc.org
SPOHNC is a patient-directed self-help organization dedicated to meeting the needs of oral and head and neck cancer patients. Founded in 1991 by an oral cancer survivor, SPOHNC addresses the broad emotional, physical and humanistic needs of this population.
 
Yul Brynner Head and Neck Cancer Foundation
135 Rutledge Ave. MSC 550
Charleston, SC 29425-5500
Phone: 843-792-6624
Fax: 843-792-0546
www.headandneck.org
www.yulbrynnerfoundation.org
Founded by the late actor Yul Brynner, a victim of smoking-induced head and neck cancer, this organization ‘s mission is to provide support to head and neck cancer patients throughout the year, to educate children and adults in the disease process, treatment and prevention of head and neck cancer, and to support ongoing research in head and neck oncology.
 
American Cancer Society
Phone: 800-ACS-2345
For TYY: 866-228-4327
www.cancer.org
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
National Comprehensive Cancer Network (NCCN)
Phone: 888-909- NCCN (6226)
www.nccn.org
The National Comprehensive Cancer Network (NCCN), an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute (NCI)
Phone: 800-4-CANCER
www.cancer.gov
The NCI, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
U.S. Dept. of Health and Human Services
 
National Institutes of Health (NIH)
Phone: 301-496-4000
For TYY: 301-402-9612
www.nih.gov
The NIH is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. Comprising 27 separate institutes and centers, it is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health and Human Services.
 

Paranasal Sinus and Nasal Cavity Cancers Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
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