What are the nasal cavity and sinuses?
 How common is sinus cancer?
 Where do sinus cancers occur?
 What is the outlook for patients with sinus cancers?
 What types of malignant tumors (cancers) occur in the nose and sinuses?
 What types of benign tumors occur in the nose and sinuses?
 What are the risk factors for sinonasal cancer?
 What causes sinus or nasal cancer?
 Can sinonasal cancer be prevented?
 Can sinus or nasal cancer be detected early?
 What symptoms will sinus or nose cancer cause?
 How is sinus cancer diagnosed?
 How are sinus and nasal tumors treated?
 What type of surgery is performed?
 What is radiation therapy?
 What is chemotherapy?
 What is the latest research findings in sinus and nasal tumors?

What are the nasal cavity and sinuses?

The external nose opens into the nasal cavity or breathing passage. The nasal cavity runs above the hard and soft palate (the roof of your mouth). It connects with the back of the throat in an area called the nasopharynx.

Four paired groups of sinuses surround the nose. The sinuses are hollow cavities that help humidify, warm and filter the air we breathe. The nasal cavity opens into the frontal sinuses beneath the forehead, the maxillary sinuses behind the cheeks, the ethmoid sinuses between the eyes, and the sphenoid sinuses deep behind the nose at the center of the skull.

The nasal cavity and sinuses are made up of a variety of cell types. These include the mucus producing cells and minor salivary gland cells, epithelial cells which make up most of the lining of the nose and sinuses, nerve cells for smell and sensation, and cells that make up blood vessels and lymphatic channels. All of these cell types can develop into benign or malignant tumors.

How common is sinus cancer?

Nasal cavity and sinus cancers are rare. Approximately 2,000 cases occur in the United States each year. These cancers occur more often in men than women, and most patients are in their 50s or 60s.

Where do sinus cancers occur?

Approximately 60 to 70 percent of cancers occur in the maxillary sinus, 20 to 30 percent in the nasal cavity, 10 to 15 percent in the ethmoid sinuses, and fewer than 5 percent in the sphenoid or frontal sinuses.

What is the outlook for patients with sinus cancers?

Survival rates are typically reported for a five-year period. Survival rates vary from 10 percent or less for patients with very advanced sinus cancers to 100 percent for patients with very early cancers that are treated appropriately.

What types of malignant tumors (cancers) occur in the nose and sinuses?

Squamous cell carcinoma is the most common type of nasal/sinus cancer and makes up approximately 70 percent of malignant tumors. It arises from the epithelial cells in the respiratory tract.

Adenocarcinoma makes up approximately 10 to 20 percent of cancers in the sinuses and arises from glandular cells in the sinus lining.

Lymphomas comprise approximately 5 percent of sinonasal cancers and arise from cells in the immune system or lymphatic channels.

Melanomas make up approximately 3 percent of sinus cancers. They develop from cells that contain pigment in the sinus lining and are very aggressive.

Esthesioneuroblastomas arise from nerves that provide sense of smell. These tumors occur at the skull base, where the nerves exit from the brain and enter the roof of the nasal cavity.

Other types of malignant tumors can arise from any of the cells in the sinuses, such as blood vessels, bone, cartilage, muscle and fibrous cells.

What types of benign tumors occur in the nose and sinuses?

Benign tumors can arise from any of the cell types present in the nose or sinuses. Benign tumors do not metastasize or spread to other parts of the body, but they can grow aggressively and cause destruction within the sinus cavity if not treated appropriately.

Osteomas are frequently found and usually do not cause significant symptoms. They occur most frequently in the frontal, ethmoid and maxillary sinuses. If they significantly obstruct a nearby sinus or impinge on other structures in the area, they may need to be removed.

Papillomas are wart-like growths thought to be caused from viral infections, similar to warts on other parts of the body. Three types of papillomas occur in the nose and sinuses. Most are benign, but approximately 10 percent may turn into cancer. Papillomas should always be biopsied to evaluate for risk of cancer. Treatment is typically surgical removal.

What are the risk factors for sinonasal cancer?

Tobacco smoke is a risk factor for nose and sinus cancer, as well as cancer of the mouth, throat, voice box and lungs. Occupational or work exposures that appear to increase the risk of nose and sinus cancer include dusts from wood, textiles and leather. Other inhaled substances linked to sinonasal cancer include glues, formaldehyde, furniture and shoe production solvents, nickel, chromium, mustard gas, rubbing alcohol, and radium. Family history does not seem to be a major risk factor for most sinus cancers.

What causes sinus or nasal cancer?

 While doctors know that certain risk factors may make a person more likely to develop sinonasal cancer, the exact cause of most cancers is unknown. Cancers develop when genes that control cell growth and division become defective. Some people may have inherit certain gene defects or mutations from their parents, however, most mutations probably occur during a patient’s lifetime, rather than being present from birth. These mutations probably occur after exposure to certain risk factors described above, or they may occur for no apparent reason.

Can sinonasal cancer be prevented?

Most people who develop sinus or nasal cancer have no known risk factors, thus there is no way to prevent cancers in these cases. Avoiding known risk factors and exposures is the best way to decrease the chance of developing one of these tumors. The most important avoidable risk factor is tobacco smoke. It is also important to avoid exposures or take protective measures when working near harmful substances as described above.

Can sinus or nasal cancer be detected early?

Most early cancers are relatively small and cause few symptoms, so routine screening is not used. When they do cause symptoms, patients often feel as if they have a routine cold or sinus infection.  The safest way to detect early cancers is to see your doctor if you have prolonged nasal or sinus symptoms described below.

What symptoms will sinus or nose cancer cause?

• Persistent nasal congestion and stuffiness, particularly on one side
• Pain in the forehead, cheek, nose, around the eyes or in the ear
• Persistent nasal drainage in the back of the throat
• Frequent or persistent nose bleeds
• Loss of sense of smell or taste
• Numbness or pain in the face or teeth
• Growth in the face, nose, palate or neck
• Tearing of the eye
• Trouble opening the mouth
• Double vision or blurry vision
• Trouble hearing or recurrent ear infections

If you have any of these symptoms, you should see your doctor for evaluation. While many of these symptoms are caused by common non-cancerous conditions, early detection is critical if a tumor is present.

How is sinus cancer diagnosed?

Your doctor will ask you several questions about the history of your condition and your symptoms. He or she will then perform a thorough head and neck examination, paying particular attention to the nasal cavity, face, throat and neck. A small fiberoptic telescope (link) may be used to perform an examination of the nasal and sinus areas. This procedure is painless and done often for patients with nose or sinus problems.

If your doctor suspects a possible sinonasal tumor, he or she may order a CT scan. This procedure uses x-ray to take pictures of your sinuses and neck. Intravenous contrast (dye) may also be used to study the area of interest. (link to CT site). Another type of imaging study that may be ordered is an MRI. This study uses magnets rather than X-rays to take pictures of the sinuses and neck. It is especially useful in evaluating tumors that may involve the eye, brain or nerves. Other types of imaging studies are used in special circumstances and may include PET scans and angiography.

Biopsies are required in the evaluation of all sinus or nasal masses. During this procedure, your surgeon will remove a small piece of tissue, typically about the size of a pencil eraser or two. This may be done in the clinic using some local anesthetic, or in the operating room, depending upon the location and type of mass. Often times, this can be done using small fiberoptic endoscopes without an incision (link to endoscopy picture). Once the biopsy is obtained, a pathologist will examine the tissue under a microscope to determine exactly what type of tumor is present. This step is critical in determining the proper treatment for any patient with a nasal mass.

How are sinus and nasal tumors treated?

Proper treatment depends upon the type and location of the specific tumor. Current treatments include surgery, radiation and chemotherapy. All sinus tumor cases are reviewed at our Tumor Board, where individual cases are reviewed in detail and discussed by specialists from ear, nose, and throat surgery, plastic surgery, radiation oncology, hematology oncology, radiology, pathology, prosthetics/reconstruction, speech pathology, and oral surgery. A comprehensive, multi-disciplinary treatment plan is developed and presented to each patient.

What type of surgery is performed?

The specific surgical approach depends upon the type and location of the tumor.

Benign tumors or smaller malignancies may be removed using an endoscopic, minimally-invasive approach. This approach uses fiberoptic telescopes to work through the nose. It is generally less destructive than traditional open approaches through external incisions, but long-term results using this approach are not yet available for many types of tumors.

Tumors that extend far into the cheek, eye, brain, nerves, or other vital structures will often require an open surgical approach. Many of these approaches can be performed through incisions hid under the lip, within the nose, or in the hairline, so that there are no visible scars. More extensive tumors may require incisions through the skin along the side of the nose or around the eye in order to completely excise these advanced cancers. Often times, ENT surgeons work with neurosurgeons, plastic surgeons and oral surgeons to excise sinus tumors and reconstruct the nose, sinuses and face in the best manner possible for each patient.

Cancers that have spread to the lymph nodes in the neck may need to be removed by performing a neck dissection. Glands with known or suspected metastatic cancer are removed through a skin incision. Additionally, neck surgery may be needed if extensive reconstruction is required after removal of large sinus tumors.

What is radiation therapy?

Radiation therapy often is used for treatment of sinus cancers. Most commonly, external beams of radiation are focused at the center of the cancer. Treatment lasts just a few minutes and is usually given five days a week for several weeks. Radiation therapy can be used alone to cure small tumors or in patients whose health is too poor to undergo surgery. Additionally, radiation may be given after surgery to kill small cancer cells that cannot be seen with the naked eye or before surgery to shrink the tumor and make surgery easier. Side effects of radiation include dry mouth and nose, skin inflammation, fatigue, tooth decay, and visual loss. These side effects should be discussed with your radiation oncologist.

What is chemotherapy?

Chemotherapy uses a variety of anti-cancer drugs given by mouth or through the vein and is the only treatment approach that reaches all areas of the body. Therefore, it may be used if the cancer has spread to the lungs, liver or bones. Additionally, chemotherapy often is used in addition to radiation or surgical therapy to make treatments more effective. Side effects of chemotherapy include a low blood cell count, which may make patients more susceptible to infections or bleeding problems. Other temporary side effects include fatigue, nausea, vomiting and loss of appetite.

What is the latest research findings in sinus and nasal tumors?

Ongoing research is conducted and reported in the area of sinus and nasal tumors. Many research trials focus on unlocking the genetic abnormalities that permit cancers to develop. Research also looks for therapies to reverse or correct these abnormalities. Other trials examine the effectiveness of new chemotherapeutic agents and alternative radiation treatments. The Hollings Cancer Center also actively researches the role of the immune system in eradicating both benign and malignant tumors of the sinuses, an approach that investigates the ability of the body’s natural immune system to attack the tumor. If effective, this approach avoids many unfavorable side effects of surgery, radiation and chemotherapy.