Nasal Cavity and Paranasal Sinus Cancer

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What is Nasal Cavity and Paranasal Sinus Cancer ? 

Cancer begins when normal cells in the body change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign or malignant. A benign tumor is not cancerous and usually can be removed without growing back. A malignant tumor is cancerous and can invade and damage the body’s healthy tissues and organs.                     

            The nasal cavity

The paranasal sinuses

Nasal cavity and paranasal sinus cancer is a malignant tumor that begins in the inside of the nose or paranasal cavities around the nose. The nasal cavity is the space just behind the nose where air passes on the way to the throat. The paranasal sinuses are air-filled areas that surround the nasal cavity on the cheeks (maxillary sinuses), above and between the eyes (ethmoid and frontal sinuses), and behind the ethmoids (sphenoid sinuses). The maxillary sinus is the most common location of paranasal sinus cancer.

Nasal cavity and paranasal sinus cancer are among the major types of cancer in the head and neck region, a grouping called head and neck cancer.

Types of nasal cavity and paranasal sinus cancer

The nasal cavity and paranasal sinuses contain several types of tissue, and each contains several types of cells. Different cancers can develop from each kind of cell. The differences are important because they determine how fast-growing the cancer is and the type of treatment needed.

The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue with the following cell types: squamous epithelial cells, minor salivary gland cells, nerve cells, infection- fighting cells, and blood vessel cells. Some tumor types found in these cells and tissues include the following:

Squamous cell carcinoma. This is the most common form of nasal cavity and sinus cancer. Squamous cells are flat cells that make up the thin, surface layer of the structures of the head and neck.

Adenocarcinoma. Beginning in the gland cells, this is the second most common form of nasal cavity and paranasal sinus cancer.

Malignant melanoma. Arising from cells called melanocytes that give the skin its color, this is an aggressive cancer, but it only accounts for about 1% of tumors in this area of the body. Learn more about melanoma.

Inverting papilloma. These are benign, wart-like growths that may develop into squamous cell carcinoma. Approximately 10% to 15% of these can develop into cancer.

Esthesioneuroblastoma. Related to the nerves that control the sense of smell, this type of cancer occurs on the roof of the nasal cavity and involves a structure called the cribriform plate, a bone located deep in the skull between the eyes and the sinuses. This type of cancer looks similar to neuroendocrine cancer, but it is important to figure out which one it is.

Midline granuloma. This refers to a group of several unrelated conditions that cause the breakdown of the normal tissue of the nose, sinuses, and nearby tissues. Some cases are due to immune system problems, and many others are actually a type of lymphoma (a cancer of the lymph system).

Lymphoma. This is a type of cancer that originates from the lymph tissue within the mucosa (lining) of the nasal cavity and paranasal sinuses.

Sarcoma. Sarcoma is a type of cancer that begins in muscle, connective tissue, or bone.

Risk Factors and Prevention

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

Two risk factors greatly increase the risk of nasal cavity and paranasal sinus cancer:

Tobacco use. Use of tobacco (including cigarettes, cigars, pipes, chewing tobacco, and snuff) is the single largest risk factor for head and neck cancer.

Alcohol. Frequent and heavy consumption of alcohol is a risk factor for head and neck cancer.

Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer. Secondhand smoke may also increase a person’s risk of head and neck cancer.

Other factors can raise a person’s risk of developing nasal cavity or paranasal sinus cancer:

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for nasal cavity and paranasal sinus cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. HPV vaccines protect against certain strains of the virus.

Specific inhalants. Breathing in certain substances, most commonly found in the work environment, may increase the risk of nasal cavity and paranasal sinus cancer. These substances include:

Dust from the wood, textiles, or leather industries

Flour dust

Nickel dust

Chromium dust

Mustard gas

Asbestos

Isopropyl (rubbing) alcohol fumes

Radium fumes

Glue fumes

Formaldehyde fumes

Solvent fumes used in furniture and shoe production

Exposure to air pollution. Being exposed to air pollution may increase a person’s risk of nasal cavity and paranasal sinus cancer.

Gender. Nasal cavity and paranasal sinus cancer occurs twice as often in men than women.

Age. This type of cancer is most commonly found in people between the ages of 45 and 85.

Prevention : Although some risk factors for nasal cavity and paranasal sinus cancer cannot be changed, such as a person’s age, several can be avoided by making lifestyle changes. Stopping the use of all tobacco products is the most important thing a person can do, even for people who have been smoking for many years.

Also, avoiding exposure to substances that have been known to increase the risks of cancer or wearing a protective facemask to reduce breathing in potentially harmful substances may help reduce this risk. Workplace exposure and industrial-related hazards can be reduced by appropriate air filtering, and workers in these areas need to be aware of their potential risk of exposure.

Symptoms and Signs : People with nasal cavity and paranasal sinus cancer may experience the following symptoms or signs. Sometimes, people with nasal cavity and paranasal sinus cancer do not show any of these symptoms. In fact, this type of cancer is usually diagnosed in its later stages because early cancer typically does not cause any symptoms. Nasal cavity or paranasal sinus cancer is often discovered when a person is being treated for seemingly benign, inflammatory disease of the sinuses, such as sinusitis. However, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

Nasal obstruction or persistent nasal congestion and stuffiness, which is often called sinus congestion 

Chronic sinus infections that do not respond to antibiotic treatment

Frequent headaches or pain in the sinus region

Pain or swelling in the face, eyes, or ears

Persistent tearing of the eyes

Bulging of one of the eyes or vision loss

Decreased sense of smell

Pain or numbness in the teeth

Loosening of teeth

A lump on the face, nose, or inside the mouth

Frequent runny nose

Frequent nosebleeds

Difficulty opening the mouth

A lump or sore inside the nose that does not heal

Fatigue

Unexplained weight loss

A lump in the neck 

A person who notices any of these warning signs should talk with a doctor and/or dentist right away and ask for a detailed physical examination, particularly if the symptoms continue for several weeks. Nasal cavity and paranasal sinus cancer has a much better chance of being treated successfully when it is found early.

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

Because many of these symptoms can be caused by other, noncancerous health conditions, it is always important to receive regular health and dental screenings; this is particularly important for people who routinely drink alcohol or who currently use tobacco products or have used them in the past. In fact, people who use alcohol and tobacco should receive a general physical examination at least once a year even if they do not have any symptoms. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using one or more of the diagnostic procedures mentioned in the Diagnosis section.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

Diagnosis : Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Severity of symptoms

Previous test results

To make the diagnosis, a complete medical history and physical examination are necessary. Signs of nasal cavity and paranasal sinus cancer are often very similar to symptoms of chronic or allergic sinusitis. The physical examination is important, and doctors may perform one or more of the tests listed below to reach a diagnosis. There are no specific blood or urine tests that can be performed to help make an early diagnosis of this type of cancer.

The following tests may be used to diagnose nasal cavity and paranasal sinus cancer:

Physical examination. The doctor feels for any lumps on the neck, lips, gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and/or mirror for a clearer view.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth or nose to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or nasopharyngoscopy (nasal cavity, nasopharynx).

In some cases, the diagnosis of paranasal sinus cancer will be made during an endoscopic surgery for what is believed to be benign chronic sinusitis. During the endoscopic sinus surgery, it is important for the surgeon to obtain a biopsy sample of normal-looking tissues and confirm the diagnosis in a procedure called a frozen section examination before completing the endoscopic surgery for benign chronic sinusitis. 

X-ray. An x-ray is a picture of the inside of the body. An x-ray can show if the sinuses are filled with something other than air. If so, it is usually not cancer but, instead, an infection that is treatable. If treatment doesn’t work to clear the sinuses, then other more specialized x-ray tests may be done to identify the blockage. Signs of cancer on an x-ray may be followed up with a computed tomography (CT) scan.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. CT scans are very useful in identifying cancer of the nasal cavity and paranasal sinus.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the eye in its socket and the part of the brain near the sinuses. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Bone scan. This test may be done to see if cancer has spread to the bones. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

Staging with Illustrations : Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer: 

How large is the primary tumor, and where is it located? (Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized to other parts of the body? (Metastasis, M)

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: No evidence of a tumor is found.

Tis: A stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in one layer of tissue.

Tumors of the paranasal sinuses are also evaluated by their exact location.

Primary tumor (T) in the maxillary sinus

T1: The tumor is limited to the inside of the sinus and does not erode or invade bone.

T2: The tumor erodes or invades bone surrounding the sinuses.

T3: The tumor invades the surrounding bone, the skin of the cheek, or the other sinuses.

T4a: The tumor invades the bone surrounding the eye, the skin of the cheek, or the bones in the back of the throat.

T4b: The tumor invades any of the following: the back of the eye, the brain area, or the bones of the skull, other than those behind the nose or the back of the head.

Primary tumor (T) in the nasal cavity and ethmoid sinus

T1: The tumor is limited to the inside of the sinus with no involvement with the bone.

T2: The tumor extends into the nasal cavity.

T3: The tumor extends into the maxillary sinus or to the bone surrounding the eye.

T4a: The tumor has spread throughout the facial bones or into the base of the skull.

T4b: The tumor invades any of the following: the back of the eye, the brain area, or the back of the head.

Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Since there are many nodes in the head and neck area, careful assessment of lymph nodes is an important part of staging.

NX: The regional lymph nodes cannot be evaluated.

N0: There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found is 3 centimeters (cm) or smaller.

N2: This describes any of these conditions:

N2a: The cancer has spread to a single lymph node on the same side as the primary tumor, and it is larger than 3 cm but not larger than 6 cm.

N2b: The cancer has spread to more than one lymph node on the same side as the primary tumor, but none measure larger than 6 cm.

N2c: The cancer has spread to more than one lymph node on either side of the body, but none measure larger than 6 cm.

N3: The cancer is found in at least one nearby lymph node and is larger than 6 cm.

Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Distant metastasis cannot be evaluated.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part(s) of the body.

Cancer stage grouping 

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: This is a very early cancer (Tis) with no spread to lymph nodes (N0) or distant metastasis (M0).

Stage I: This is a noninvasive cancer (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0).

Stage II: This is an invasive cancer (T2) that has not spread to lymph nodes (N0) or to distant parts of the body (M0).

Stage III: This includes invasive cancer (T3) with no spread to regional lymph nodes (N0) or metastasis (M0), as well as invasive cancer (T1, T2, T3) that has spread to regional lymph nodes (N1) but shows no sign of metastasis (M0).

Stage IVA: This is an invasive cancer (T4a) that either has no lymph node involvement (N0) or has spread to only one same-sided lymph node (N1) but with no metastasis (M0). It is also used for any cancer (any T) with more significant nodal involvement (N2) but with no metastasis (M0).

Stage IVB: This is an invasive cancer (any T) that has spread to lymph nodes (any N) but has no metastasis (M0). It is also used for any cancer (any T) that is found in lymph nodes and is larger than 6 cm (N3) but has no metastasis (M0).

Stage IVC: This refers to any tumor (any T, any N) when there is evidence of distant spread (M1).

Tumor grade. Doctors also describe a primary tumor by its grade (G), which is determined by using a microscope to examine tissue from a tumor. The doctor compares the tumor tissue with normal tissue. Normal tissue contains many different types of cells grouped together, which is called differentiated. Tissue from tumors usually has cells that look more alike, called poorly differentiated. Generally, the more differentiated the tissue (the lower the grade), the better the prognosis.

GX: The grade cannot be evaluated.

G1: The cells look more like normal tissue (well differentiated).

G2: The cells are only moderately differentiated.

G3: The cells don’t resemble normal tissue (poorly differentiated).

Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.  

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