Tumors of the nose and paranasal sinuses

Introduction and Frequency

​"Paranasal" means near the nose. The paranasal sinuses are hollow, air-filled spaces in the bones around the nose. They are lined with cells that produce mucus, which prevents the inside of the nose from drying out during breathing. There are several parasinuses, named after the bones that surround them:

* Frontal sinuses are in the lower part of the forehead above the nose

* Maxillary sinuses are located in the cheekbones on either side of the nose

* Ethmoid sinuses are next to the upper nose, between the eyes

* Sphenoid sinus is behind the nose, in the center of the skull

The nose opens into the nasal cavity, which is divided into two nasal passages through which air passes during breathing. The nasal cavity is located above the bone that forms the roof of the mouth and connects to the pharynx at the back. Together, the paranasal sinuses and the nasal cavity filter, warm, and moisten the air before it enters the lungs. Cancer of the paranasal sinuses and nasal cavity is a subtype of malignant tumors of the head and neck. Different types of cells in the paranasal sinuses and nasal cavity can become malignant, with the most common type being squamous cell carcinoma. This type of cancer develops in the thin, flat cells that line the inside of the paranasal sinuses and nasal cavity. Other types of cancer in this area include:

* Adenocarcinomas: tumors of the glandular epithelium

* Melanomas: begin in cells called melanocytes, the cells that give the skin its natural color

* Sarcomas: cancers that begin in muscle or connective tissue

* Inverted papillomas: benign tumors that develop inside the nose, a small number of which can become malignant

​Risk factors

​Risk factors for cancer of the paranasal sinuses and nasal cavity include the following:

* Exposure to certain chemicals or dust in the workplace (some risky occupations include furniture making, working in a sawmill, woodworking (carpentry), shoemaking, metalworking, working in a mill or bakery)

* Infection with the human papillomavirus (HPV)

* Male gender, age over 40

* Smoking

You can read more about risk factors for developing cancer in a separate article.

Signs and symptoms

The first symptoms of the disease are often non-specific, i.e. they can be caused by both cancer of the paranasal sinuses and nasal cavity, and other (benign) conditions / diseases. Also, some patients do not have any symptoms in the early stages of the disease, but only appear after some time as the tumor mass increases. You should definitely contact your doctor if you have noticed any of the following:

* Blocked sinuses that do not clear or pressure in the sinus area

* Headaches or pain in the sinus area

* Runny nose

* Nosebleeds

* A lump or sore in the nose that does not heal

* Numbness or tingling in the face

* Swelling or other eye problems, such as double vision or eyes looking in different directions

* Pain in the upper teeth, loose teeth or dentures that no longer fit well

* Pain or pressure in the ear

Figure 1. Illustration of the human sphenoid sinuses. Each location has its own specifics. (source: depositphotos.com)

Diagnosis

​The basis is a detailed examination of the patient and a thorough medical history. The examination of the patient is important to check for any signs of disease, such as lumps, enlarged lymph nodes, or anything else that seems unusual. A general examination of the nose, face, and neck is usually performed. If a suspicious lesion is found, a biopsy may be needed. This involves removing cells or tissue so that a pathologist can examine them under a microscope to check for signs of cancer. The exact type of biopsy needed will be determined by your doctor. Nasoscopy is an endoscopic procedure that uses direct examination to look for abnormal areas inside the nose. A nasoscope is a thin, tube-like instrument with a light and a viewing lens. A special tool on the nasoscope can be used to take tissue samples.

Once cancer of the paranasal sinuses and nasal cavity is diagnosed, tests are done to find out if the cancer cells have spread within the paranasal sinuses and nasal cavity or to other parts of the body. The most common radiological examinations are CT, MRI, PET/CT, and others. You can read more about the diagnosis of malignant diseases in general in a separate article.

Prognosis and stage of the disease

The prognosis and treatment options depend on where the tumor is located in the paranasal sinus or nasal cavity, whether it has spread to distant organs, the size of the tumor, the type of cancer, the patient's age and general health, and whether the cancer was diagnosed for the first time or has recurred (recurred). Cancer of the paranasal sinuses and nasal cavity is often in an advanced stage at diagnosis and is difficult to cure. After treatment is completed, frequent and careful lifelong monitoring is important because there is an increased risk of developing another type of head or neck cancer. The disease can be divided into 4 stages, according to the division of other tumor sites. The fourth stage indicates locoregionally very advanced disease or the presence of metastases. The higher the stage, the more advanced the disease and the worse the prognosis and treatment options.

​Treatment

​There are different types of treatment available to patients with cancer of the paranasal sinuses and nasal cavity. Some treatments are standard (the treatments currently used), and some are being tested in clinical trials. Given the complexity of this disease, the treatment of patients with cancer of the paranasal sinuses and nasal cavity should be planned by a team of doctors who have expertise in treating head and neck cancers. Patients with this disease may need special help adjusting to breathing problems or other side effects of the cancer and its treatment. If the surgery removes a large amount of tissue or bone around the paranasal sinuses or nasal cavity, plastic surgery may be needed to correct the defect. The treatment team may include the following specialists:

* Oncologist

* Neurologist

* Oral or head and neck surgeon

* Plastic surgeon

* Dentist

* Nutritionist

* Speech therapist

* Physical medicine and rehabilitation specialist

Three types of standard treatment are used - surgery (surgery), radiotherapy (radiation) and chemotherapy. The specific treatment for an individual patient depends on the type of tumor, the general condition of the patient and the stage of the disease. Since paranasal sinus and nasal tumors are a group of diseases, each disease / location has its own specificities. For example, the main form of treatment for early stage maxillary sinus cancer is surgery, while for tumors of the ethmoid or sphenoid sinus it is radiotherapy. In general, it can be said that for localized disease, surgery and radiotherapy are more commonly used (and for some patients, chemotherapy), while for very advanced disease, treatment should be systemic and chemotherapy plays a greater role. Most patients will need a combination of several forms of treatment to achieve optimal results.

Treatment at onkologija.net: We treat our patients according to American and Western European guidelines, and we additionally enable genetic testing for the application of personalized targeted therapy. Contact us for more details.

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