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Paranasal Sinus Cancer
The paranasal sinuses are small hollow spaces around the nose. The sinuses are lined with cells that make mucus, a substance that keeps the nose from drying out. The maxillary sinuses are air-filled bony cavities that are located above the teeth, and below the eyes. The ethmoid sinuses are located in the space between the eye sockets and above the nose. 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 pairs of sinuses and cancer can develop in any of them. You have
- Maxillary sinuses behind your cheeks, below your eyes and on either side of your nose
- Frontal sinuses at the very top of your nose close to the eyebrows
- Ethmoid sinuses above the nose and between the eyes
- Sphenoid sinuses behind the ethmoid sinuses, above the nasopharynx and between your eyes
Nose problems
Nasal and paranasal cancers may cause
- Blockages causing stuffiness in one side of your nose that will not go away
- Nosebleeds
- Decreased sense of smell
- Mucus coming from the nose
- Mucus draining into the back of your nose and throat
Eye problems
People with nose and paranasal sinus cancer may notice
- Bulging of one eye
- Complete or partial loss of sight
- Double vision
- Pain above or below the eye
- A watery eye with tears running down the cheek
There are other symptoms you may have including
- A lump or growth anywhere on the face, nose or roof of the mouth that does not go away
- Pain or numbness in parts of your face, particularly the upper cheek, that doesn’t go away
- Loose teeth
- Difficulty opening your mouth
- Enlarged lymph nodes in your neck
- Pain or pressure in one of your ears
Diagnosis
X-rays of the sinuses: These x-ray images may tell if the sinuses are not filled by air as they should be. This would suggest that something is wrong, although it may not be a tumor. Most of the time, an abnormal sinus x-ray means there is an infection. If treatment for infection doesn't work, then other more specialized x-ray tests may be done.
Chest x-ray: This test may be done to determine whether nasal cavity or paranasal sinus cancer has spread to the lungs, which is the most common site of spread other than lymph nodes.
Computed tomography scan: The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then processes these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.
This test is very useful in identifying cancers of the nasal cavity and paranasal sinuses. Often after the first set of pictures is taken, you will receive an intravenous injection of a "dye" or radiocontrast agent that helps better outline structures in your body. A second set of pictures is then taken. Some people get a flushed feeling or are allergic to the dye and get hives or, rarely, more serious reactions like difficulty in breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays, and you need to lie quietly on a table while they are being done. But just like other computerized devices, they are getting faster, and your stay might be pleasantly short. Also, you might feel a bit confined by the machine you lie within when the pictures are being taken.
Magnetic resonance imaging (MRI): Magnetic resonance imaging scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected just as with CT scans. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. Because they are better than CT in distinguishing fluid from tumor, sometimes they can tell a benign tumor from a malignant one.
MRI scans take longer than CT scans, often up to an hour. Also, you are placed inside a tube, which is confining and can upset people with claustrophobia or fear of enclosed spaces. The machine gives off a thumping noise, and some facilities provide headphones with music to block out the noise. However the benefits of the test outweigh any discomfort.
Both tests are helpful in identifying cancers of the nasal cavities and paranasal sinuses and their characteristics. While the CT scan can tell if the cancer is growing into bone, the MRI is better at evaluating the kind and size of the cancer. Both can tell if it has spread to lymph nodes in the neck.
BiopsyBiopsies of the tumor will be needed to determine what type and grade (how aggressive) cancer you have and to plan the most effective treatment for you. These may be done in the ENT doctor's office or clinic or in the operating room if the tumor is in an area that is inaccessible while you are awake. Several types of biopsies are used to diagnose nasal cavity or paranasal sinus cancer.
Page TopTypes of Paranasal Sinus Cancer
Squamous cell cancers
Malignant nasal and paranasal sinus tumours are cancers. In time, they can grow deep into the surrounding tissue and spread to other parts of the body. More than 6 out of 10 nasal cavity and paranasal sinus cancers (60%) are squamous cell carcinomas. Squamous cells are the flat, skin like cells that cover the lining of the mouth, nose, larynx, thyroid and throat. Carcinoma just means cancer. So squamous cell carcinoma is cancer that starts in these cells.
Other types of paranasal sinus cancer
Squamous cell cancer is by far the commonest, but not the only type of cancer that can develop in the nose and nasal sinuses. Cancers in these places could be
- Adenocarcinomas and adenoid cystic cancer
- Lymphomas
- Plasmacytomas
- Melanomas
- Neuroendocrine carcinomas and olfactory neuroblastomas (previously called ‘esthesioneuroblastomas’)
- Sarcomas
The nasal and ethmoid sinuses are the most common site for adenocarcinoma of the head and neck. Adenocarcinoma starts in the gland cells (adenomatous cells) that are scattered around the surface tissues inside the nose. These cells produce mucus (phlegm).
Lymphomas are cancers that start in the lymph nodes. There are many lymph nodes in the neck and painless swelling of a lymph node is the most common symptom of lymphoma.
Plasmacytomas are tumours made up of plasma cells, and are closely related to myeloma.
Melanomas develop from the pigment producing cells that give the skin its colour. Melanomas of the head and neck can occur anywhere on the skin or inside the nose or mouth (oral cavity).
Olfactory neuroblastomas and neuroendocrine carcinomas are very rare tumours found in the nose (nasal cavity).
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Risk Factors
Cancers of the nasal cavity and paranasal sinuses are rare. People often worry that they are at a higher risk of cancer because someone in their family has it. This may be true of some types of cancers, but is not true for nasal cavity and paranasal sinus cancers.
Smoking
Smoking tobacco (cigarettes, cigars and pipes) increases your risk of nasal cavity cancer. If you smoke regularly you are at a higher than average risk of developing this type of cancer.
Cigarettes contain nitrosamines and other chemicals that cause cancer. When you smoke, the smoke may pass through your nasal cavity on its way to your lungs. Your risk increases the longer you smoke. If you smoke a lot, you increase your risk even more. If you give up smoking, your risk gradually falls.
Exposure to some chemicals
Through your job, you could be exposed to harmful chemicals that can increase the risk of nasal cavity and paranasal sinus cancers. If you have been regularly exposed to wood dust over some years, you may be at increased risk. Other substances that have been linked to these types of cancers include
- Glues
- Formaldehyde - an industrial chemical used to make other chemicals, building materials, and household products
- Solvents used in furniture and shoe production
- Nickel
- Chromium dust
- Wood dust
Passive smoking
Although smokers are at increased risk of developing nasal and paranasal sinus cancer, as yet there is limited evidence that passive smoking increases the risk of getting these cancers.
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Treatment
There is always research going on in the area of nasal cavity and paranasal sinus cancers. Scientists are looking for causes and ways to prevent nasal cavity and paranasal sinus cancers. Research on better treatment for nasal cavity and paranasal sinus cancer is now being done at many medical centers, university hospitals, and other institutions across the nation.
Clinical trials currently in progress are studying ways to make radiation therapy more effective by using radiosensitizers. These drugs make cancer cells more sensitive to radiation therapy. Other studies are testing radioprotective agents. These drugs protect normal cells from damage by radiation and thereby reduce side effects of radiation therapy. Reducing side effects improves patients’ quality of life as well as helping them tolerate higher radiation doses that can kill more cancer cells. Researchers are also testing new methods of aiming radiation therapy more accurately, known as conformal therapy, and are testing how differences in fractionation (how often radiation treatments are given) affect the effectiveness of the treatments.
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