Paranasal Sinus and Nasal Cavity Cancer

Description

What is cancer of the paranasal sinus and nasal cavity?

Cancer of the paranasal sinus and nasal cavity is a disease in which cancer (malignant) cells are found in the tissues of the paranasal sinuses or nasal cavity. The paranasal sinuses are small hollow spaces around the nose. The sinuses are lined with cells that make mucus, which keeps the nose from drying out; the sinuses are also a space through which the voice can echo to make sounds when a person talks or sings. The nasal cavity is the passageway just behind the nose through which air passes on the way to the throat during breathing. The area inside the nose is called the nasal vestibule.

There are several paranasal sinuses, including the frontal sinuses above the nose, the maxillary sinuses in the upper part of either side of the upper jawbone, the ethmoid sinuses just behind either side of the upper nose, and the sphenoid sinus behind the ethmoid sinus in the center of the skull.

Cancer of the paranasal sinus and nasal cavity most commonly starts in the cells that line the oropharynx. Much less often, cancer of the paranasal sinus and nasal cavity starts in the color-making cells called melanocytes, and is called a melanoma. If the cancer starts in the muscle or connecting tissue, it is called a sarcoma. Another type of cancer that can occur here, but grows more slowly, is called an inverting papilloma. Cancers called midline granulomas may also occur in the paranasal sinuses or nasal cavity, and they cause the tissue around them to break down.

A doctor should be seen for any of the following problems:

• Blocked sinuses that do not clear.

• A sinus infection.

• Nosebleeds.

• A lump or sore that doesn?t heal inside the nose.

• Frequent headaches or sinus pain.

• Swelling or other trouble with the eyes.

• Pain in the upper teeth.

• Dentures that no longer fit well.

If there are symptoms, a doctor will examine the nose using a mirror and lights. The doctor may order a CT scan (a special x-ray that uses a computer) or an MRI scan (an x-ray-like procedure that uses magnetic energy) to make a picture of the inside of parts of the body. A special instrument (called a rhinoscope or a nasoscope) may be put into the nose to see inside. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Sometimes the doctor will need to cut into the sinus to do a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the sinuses, whether the cancer is just in the area where it started or has spread to other tissues (the stage), and the patient?s general state of health.

Stage Explanation

Stages of cancer of the paranasal sinus and nasal cavity

Once cancer of the paranasal sinus and nasal cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. It is important to know the stage of the disease to plan treatment. Staging systems have been established for the most common paranasal sinus cavity cancers.

Stages of cancer of maxillary sinus

The following stages are used for maxillary sinus cancer:

Stage 0

In stage 0, cancer is found in the innermost lining of the maxillary sinus only. Stage 0 cancer is also called carcinoma in situ.

Stage I

In stage I, cancer is found 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 bones at the back of the maxillary sinus or the base of the skull.

Stage III

In stage III, cancer is found in any of the following places:

• Bone at the back of the maxillary sinus.

• Tissues under the skin.

• The eye socket.

• The base of the skull.

• The ethmoid sinuses.

or

Cancer is found in one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller; cancer also is found in any of the following places:

• The maxillary sinus.

• Bones around the maxillary sinus.

• Tissues under the skin.

• The eye socket.

• The base of the skull.

• The ethmoid sinuses.

Stage IV

Stage IV is divided into stages 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 smaller than 6 centimeters; or, cancer has spread to more than one lymph node anywhere in the neck, and all are 6 centimeters or smaller; cancer is also found in any of the following areas:

• The maxillary sinus.

• Bones around the maxillary sinus.

• Tissues under the skin.

• The eye socket.

• The base of the skull.

• The ethmoid sinuses.

or

Cancer is found in one or more lymph nodes in the neck, none larger than 6 centimeters, and in any of the following areas:

• The front of the eye.

• The skin of the cheek.

• The base of the skull.

• Behind the jaw.

• The bone between the eyes.

• The sphenoid or frontal sinuses.

Stage IVB

In stage IVB, cancer has spread to either:

• one or more lymph nodes larger than 6 centimeters; or

• the back of the eye, the brain, the base and middle parts of the skull, nerves in the head, and/or the upper part of the throat behind the nose; cancer may also be found in one or more lymph nodes.

Stage IVC

In stage IVC, cancer has spread to other parts of the body.

Stages of cancer of nasal cavity and ethmoid sinus

The following stages are used for nasal cavity and ethmoid sinus cancer:

Stage 0

In stage 0, cancer is found in the innermost lining of the nasal cavity or ethmoid sinus only. Stage 0 cancer is also called carcinoma in situ.

Stage I

In stage 1, cancer 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) or has spread to a nearby area; cancer may have spread into bone.

Stage III

In stage III, cancer is found in any of the following places:

• The eye socket.

• The maxillary sinus.

• The roof of the mouth.

• The bone between the eyes.

or

Cancer is found in a single lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller; cancer also is found in any of the following places:

• The nasal cavity or ethmoid sinus.

• The eye socket.

• The maxillary sinus.

• The roof of the mouth.

• The bone between the eyes.

Stage IV

Stage IV is divided into stages 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 smaller than 6 centimeters; or, cancer has spread to more than one lymph node anywhere in the neck, and all are 6 centimeters or smaller; cancer is also found in any of the following places:

• The nasal cavity or ethmoid sinus.

• The eye socket.

• The maxillary sinus.

• The roof of the mouth.

• The bone between the eyes.

or

Cancer is found in one or more lymph nodes in the neck, and the lymph nodes are 6 centimeters or smaller; cancer is also found in any of the following areas:

• The front of the eye.

• The skin of the nose or cheek.

• Front parts of the skull.

• The base of the skull.

• The sphenoid or frontal sinuses.

Stage IVB

In stage IVB, cancer is found in any of the following areas:

• The back of the eye.

• The brain.

• The middle parts of the skull.

• Nerves in the head.

• The upper part of the throat behind the nose.

• The base of the skull.

Cancer may also be found in one or more lymph nodes.

or

Cancer is found in a lymph node that is larger than 6 centimeters.

Stage IVC

In stage IVC, cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the paranasal sinuses or nasal cavity or in another part of the body.

Treatment Option Overview

How cancer of the paranasal sinus and nasal cavity is treated

There are treatments for all patients with cancer of the paranasal sinus and nasal cavity. Three kinds of treatment are used:

• Surgery (taking out the cancer).

• Radiation therapy (using high-dosex-rays or other high-energy rays to kill cancer cells).

• Chemotherapy (using drugs to kill cancer cells).

Surgery is commonly used to remove cancers of the paranasal sinus or nasal cavity. Depending on where the cancer is and how far it has spread, a doctor may need to cut out bone or tissue around the cancer. If cancer has spread to lymph nodes in the neck, the lymph nodes may be removed (lymph node dissection).

Radiation therapy is also a common treatment of cancer of the paranasal sinus and nasal cavity. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors.Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Because the paranasal sinuses and nasal cavity help in talking and breathing, and are close to the face, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help in recovery from treatment. Patients may need plastic surgery if a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out.

Treatment by stage

Treatment of cancer of the paranasal sinus and nasal cavity depends on where the cancer is, the stage of the disease, and the patient?s age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with cancer of the paranasal sinus and nasal cavity. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy may be given after surgery.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Radiation therapy, if the cancer cannot be removed with surgery.

2. Surgery followed by radiation therapy.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and will probably be radiation therapy with or without chemotherapy. (Refer to the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may be surgery, radiation therapy, or both.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, a combination of surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy.

Stage II Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy is given before or after surgery.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. External-beam radiation therapy.

2. Surgery followed by radiation therapy.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and will probably be radiation therapy with or without chemotherapy. (Refer to the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may be one of the following:

1. Surgery and/or radiation therapy.

2. Radiation with or without chemotherapy.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, a combination of surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy.

Stage III Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment may be one of the following:

1. Surgery to remove the cancer. Radiation therapy is given before or after surgery.

2. A clinical trial of a special type of radiation therapy given before or after surgery.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Surgery followed by radiation therapy.

2. A clinical trial of chemotherapy before surgery or radiation therapy.

3. A clinical trial of chemotherapy after surgery or after a combination of treatments.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and will probably be radiation therapy with or without chemotherapy. (Refer to the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may be one of the following:

1. Surgery.

2. Radiation therapy with or without chemotherapy.

3. Surgery plus radiation therapy.

4. A clinical trial of chemotherapy before surgery or radiation therapy.

5. A clinical trial of chemotherapy after surgery or after a combination of treatments.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. Radiation therapy may be given if the cancer cannot be removed with surgery. For certain types of sarcoma, a combination of surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. External-beam and/or internal radiation therapy.

2. Surgery if the cancer comes back following treatment.

3. A clinical trial of chemotherapy before surgery or radiation therapy.

4. A clinical trial of chemotherapy after surgery or after a combination of treatments.

Stage IV Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be one of the following:

1. Radiation therapy.

2. A clinical trial of chemotherapy before surgery or radiation therapy.

3. A clinical trial of radiation therapy.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Surgery followed by radiation therapy.

2. Radiation therapy followed by surgery.

3. Chemotherapy and radiation therapy given at the same time.

4. A clinical trial of chemotherapy before surgery or radiation therapy.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and may be one of the following:

1. Radiation therapy with or without chemotherapy.

2. A clinical trial of chemotherapy before surgery or radiation therapy.

(Refer to the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may be one of the following:

1. Surgery.

2. Radiation therapy with or without chemotherapy.

3. Surgery plus radiation therapy.

4. A clinical trial of chemotherapy before surgery or radiation therapy.

If the cancer is an inverting papilloma, treatment may be one of the following:

1. Surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

2. A clinical trial of chemotherapy before surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment may be one of the following:

1. Surgery.

2. Radiation therapy.

3. Chemotherapy.

4. A clinical trial of chemotherapy before surgery or radiation therapy.

If the cancer is a midline granuloma, treatment may be one of the following:

1. Radiation therapy.

2. A clinical trial of chemotherapy before surgery or radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. External-beam and/or internal radiation therapy.

2. Surgery if the cancer comes back following treatment.

3. A clinical trial of chemotherapy before surgery or radiation therapy.

Recurrent Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer, where the cancer is found, and the type of treatment the patient received before.

If cancer is in the maxillary sinus, treatment will probably be one of the following:

1. Radiation therapy alone or after extensive surgery (if limited surgery was done for the original cancer).

2. Surgery (if radiation therapy was given for the original cancer).

3. Chemotherapy.Clinical trials are testing new chemotherapy drugs.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Radiation therapy alone or after extensive surgery (if limited surgery was done for the original cancer).

2. Surgery (if radiation therapy was given for the original cancer).

3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. Chemotherapy is given if radiation therapy does not work.

If cancer is in the nasal cavity, treatment may be one of the following:

1. Radiation therapy alone or after extensive surgery (if limited surgery was done for the original cancer).

2. Surgery (if radiation therapy was given for the original cancer).

3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment may be surgery or chemotherapy.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. Surgery (if radiation therapy was given for the original cancer).

2. Radiation therapy alone or after extensive surgery (if limited surgery was done for the original cancer).

3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

Changes to This Summary (07/19/2005)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary and links to the NCI Dictionary of Cancer Terms were added.

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