Nasal Cavity and Paranasal Sinus Cancer

Treatment Options

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. 

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For nasal cavity or paranasal sinus cancer, the team may include medical and radiation oncologists (doctors who specialize in treating people with cancer), surgeons, otolaryngologists (ear, nose, and throat doctors), dentists, maxillofacial prosthodontists (specialists who perform restorative surgery in the head and neck areas), physical therapists, speech pathologists, psychiatrists, nurses, dietitians, and social workers. A neurosurgeon (a doctor who specializes in surgery on the brain and spinal cord) should be a part of this team when a tumor in the skull or facial area needs to be removed.                                                                                             

Nasal cavity and paranasal sinus cancer can often be cured, especially if found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, eats, and breathes.

Descriptions of the most common treatment options for nasal cavity and paranasal sinus cancer are listed below. The three main treatment options are surgery, radiation therapy, and chemotherapy. One of these treatments, or a combination of them, may be used. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. 

Surgery

Surgery is frequently used to remove cancer of the paranasal sinus and nasal cavity. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove all of the tumor and leave negative margins (no trace of cancer in the healthy tissue). However, it’s usually not possible to completely remove the entire cancer with an operation so additional treatments may be necessary. This may include more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected.

Common types of surgery for this type of cancer include:

Excision. During an excision, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin).

Maxillectomy. This is a surgery that removes part or all of the hard palate, which is the bony roof of the mouth. Prostheses (artificial devices), or more recently, the use of flaps of soft tissue with and without bone can be placed to fill gaps from this operation. A maxillectomy is sometimes recommended to treat paranasal sinus cancer, and occasionally it is possible to save the eye on the side of the cancer.

Craniofacial resection/skull base surgery. This is an extensive surgery often recommended for paranasal sinus cancer that removes additional tissue beyond that needed in a maxillectomy. It requires the close cooperation of the health care team, particularly between a neurosurgeon and a head and neck surgeon.

Endoscopic sinus surgery. This relatively new approach is less destructive to normal tissue than traditional operations and can occasionally be used for nasal cavity and paranasal sinus tumors, especially if they are benign. The surgeon makes a small incision to remove the tumor using a thin, telescope-like tube inserted into the nasal cavity or sinus. As mentioned in the Diagnosis section, endoscopic sinus surgery is often used for chronic sinusitis, and cancer may be discovered during such surgery.

Neck dissection. This is the surgical removal of lymph nodes in the neck area. If the doctor suspects the cancer has spread, a neck dissection may be performed, often at the same time as another surgery. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. The side effects are caused by injury to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away in a few months. Weakness will be permanent if a nerve is removed as part of a dissection.

Reconstructive (plastic) surgery. If surgery requires removing large or specific areas of tissue, reconstructive surgery may be recommended. If the eye is removed, a specialist called a prosthodontist can provide a prosthesis (an artificial replacement). More often, when the maxilla (upper jaw) is removed, a prosthodontist may play a large role in the rehabilitation process.

In general, surgery often includes risks because the eyes, mouth, brain, and important nerves and blood vessels are nearby. Surgery often causes swelling of the face, mouth, and throat, making it difficult to breathe; sometimes a tracheostomy (hole in the windpipe) may be necessary to make breathing easier for some period of time after surgery. It is important to talk with your surgeon(s) about what side effects to expect before having the surgery.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

For this type of cancer, radiation therapy is most often used in combination with surgery, given either before or after the operation. It may also be given along with chemotherapy (see below). For some types of tumors in the nasal cavity and paranasal sinus, radiation therapy may also be the main treatment. It can also be an option if a person cannot have surgery or decides not to have surgery.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. Specific types of external radiation therapy include intensity-modulated radiation therapy (IMRT) and proton therapy (also called proton beam therapy). Intensity-modulated radiation therapy allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects. Proton therapy uses protons, rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used in nasal cavity and paranasal sinus cancer when the tumor is located close to the eye or central nervous system (brain and spinal cord). 

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the cancer site. The implant is left in place for several days while the person stays in the hospital.

Before beginning any type of radiation therapy for this type of cancer, people should receive a thorough examination from an oncologic dentist (a dentist experienced in treating people with head and neck cancer). Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning cancer treatment.

After radiation therapy for nasal cavity or paranasal sinus cancer, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent dental caries (cavities). 

In addition, radiation therapy to the head and neck may cause redness or skin irritation in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and/or sore throat. Other side effects may include pain or difficulty swallowing; loss of appetite, due to a change in sense of taste; hearing loss, due to buildup of fluid in the middle ear; and buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal. Radiation therapy may also cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down, causing people to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly. There are numerous studies underway to find ways to reduce or better relieve the side effects of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

The use of chemotherapy before or after surgery and/or radiation therapy or in combination with radiation therapy (called concurrent chemoradiotherapy) is frequently recommended for this type of cancer. This treatment is still in an investigative phase and should be done as part of a clinical trial.

For nasal cavity and paranasal sinus cavity cancer, chemotherapy may also be used to treat advanced cancer or to treat symptoms. Some chemotherapy is available in clinical trials that may treat cancer at an earlier stage.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

Palliative/supportive care 

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem, so it is addressed as quickly as possible. 

Recurrent nasal cavity and paranasal sinus cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. 

Metastatic nasal cavity and paranasal sinus cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. 

Your health care team may recommend a treatment plan that consists of chemotherapy or a combination of surgery, radiation therapy, and chemotherapy. Supportive care will also be important to help relieve symptoms and side effects.

For many patients, a diagnosis of metastatic cancer can be very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Palliative care given toward the end of a person’s life is called hospice care. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. 

Clinical Trials

Doctors and scientists are always looking for better ways to treat patients with nasal cavity and paranasal sinus cancer. To make scientific advances, doctors create research studies involving people, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating nasal cavity and paranasal sinus cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with nasal cavity and paranasal sinus cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. 

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Coping with Side Effects

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for nasal cavity or paranasal sinus cancer are described in detail within the Treatmentsection. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with nasal cavity or paranasal sinus cancer. 

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. 

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. 

After Treatment

After treatment for nasal cavity or paranasal sinus cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

If the cancer recurs, it most commonly happens in the first two or three years after diagnosis, so follow-up visits will be more frequent during the first two or three years. Diagnostic examinations, such as CT scans, may be needed to watch for any signs of recurrences or monitor how well the current treatment is working.

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy and speech therapy to regain skills, such as talking and swallowing. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn new ways to eat or to eat foods prepared differently. After surgery, a prosthodontist can help in the restoration and rehabilitation of any oral cavity structures that were removed during surgery.

Rehabilitation of physical changes resulting from a maxillectomy often requires a prosthesis. Prevention of dental decay by fluoride application is very important to avoid loss of existing teeth. Special eye care may also be necessary. When a maxillectomy is done, in many cases, fluid will accumulate in the middle ear on the side of surgery, and a myringotomy (surgery to the eardrum) to drain this fluid may be required. Very frequently, especially after craniofacial resection, people will lose their anosmia (sense of smell), and it is important that these people receive special coping strategies, especially around the house and work area (in case of chemical spills, smoke from a fire, and other situations). If the person has received radiation therapy, he or she should avoid exposing the skin that received treatment to the sun. If radiation therapy included the neck, the person should have his or her thyroid gland checked regularly through blood tests.

People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people cope with these physical and emotional changes and connect them with support services. Support groups may help people cope with changes following treatment.

People recovering from nasal cavity or paranasal sinus cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. 

Latest Research

Doctors are working to learn more about nasal cavity and paranasal sinus cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Combined therapies. Most research for head and neck cancers focuses on combining different types of treatments to improve effectiveness and the patient’s quality of life.

Chemotherapy. As explained in Treatment, there are clinical trials to test new and existing drugs for different stages of this type of cancer.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current nasal cavity and paranasal sinus cancer treatments in order to improve patients’ comfort and quality of life.