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Sinus cancer

Top questions about sinus cancer

What you should know about sinus cancer

Sinus cancer is rare, with an estimated 2,000 Americans diagnosed with the disease each year. Most sinus cancer patients are men ages 55 or older. As with other cancers of the head and neck, symptoms of sinus cancer may be misleading, mimicking those of less serious conditions. Sinus cancer also may be confused with certain noncancerous growths, such as nasal polyps or papillomas, which are warts.

Certain lifestyle behaviors and environmental factors, such as smoking and workplace exposure to chemicals, wood, heavy metals and other toxic substances, may increase the risk of sinus cancer.

What is sinus cancer?

Sinus cancer most often occurs in either the nasal cavity—the space just behind the nose, where air passes on its way to the throat—or the paranasal sinuses, the air-filled areas that surround the nasal cavity. These types of cancer are uncommon.

Because squamous cells are the most prevalent cell lining the cavities of the head and neck, the most common type of cancer found in the paranasal sinus and nasal cavity is squamous cell carcinoma.

What are the symptoms of sinus cancer?

Symptoms of sinus cancer vary depending on where the cancer develops and how much it spreads.

Signs may include:

  • A mass in the neck
  • Numbness in one side of the nose, upper lip or cheek
  • Swelling around the eyes
  • Pain behind the nose
  • A lump or sore inside the nose that won’t go away
  • Changes in vision or loss of vision
  • Nasal drainage from one side of the nose
  • Eye tearing
  • Difficulty breathing on one side of the nose due to nasal obstruction
  • Nosebleeds that increase with frequency and amount
  • Lump on the face or roof of the mouth
  • Decreased sense of smell

Sometimes, sinus cancer causes symptoms associated with less serious conditions, such as blocked sinuses and post-nasal drip often caused by a cold.

What are the main types of sinus cancer?

Most cancers of the nasal cavity and paranasal sinuses develop in the nasal cavity or in the maxillary sinuses, located in the cheekbones on either side of the nose. Less commonly, cancer develops in the ethmoid sinuses, located along the upper nose, between the eyes. Staging sinus cancer and designing a treatment plan generally depend on where the cancer originates.

Although the most common type of sinus cancer is squamous cell carcinoma, cancers may develop in other cells in the sinuses. Mucosa cell carcinoma, for example, is cancer that occurs in the mucous membrane. Adenoid cystic cell carcinoma, while rare, affects the minor salivary glands of the paranasal sinuses. Acinic cell carcinoma is cancer that develops in the salivary glands, particularly in the parotid gland, located at the base of each ear. And sinonasal undifferentiated carcinoma, while also rare, develops in the epithelium, or surface tissue, of the nose or sinuses.

What are the biggest risk factors for sinus cancer?

Risk factors for sinus cancer may depend on the location of the cancer and the cancer type. Along with workplace exposure to certain chemicals and substances, risk factors for sinus cancer typically include:

  • Infection with human papillomavirus (HPV) or Epstein-Barr virus (EBV)
  • Smoking
  • Alcohol use
  • Past exposure to high doses of radiation therapy, particularly in the head and neck region

What type of doctor should I see if I think I have sinus cancer?

Making an educated treatment decision for sinus cancer begins with a thorough and accurate diagnosis. If you suspect sinus cancer, request an appointment with a specialist specifically trained in treating diseases of the sinuses, such as a head and neck cancer doctor or otolaryngologist. He or she will likely order diagnostic tests, including a biopsy, to rule out or confirm the disease.

Questions about sinus cancer treatment

Several factors determine how sinus cancer is treated, including the location of the tumor, the stage of the cancer, and the patient’s age, health, individual needs and treatment goals. Treatment also is guided by where the cancer originated and whether it has spread.

How is sinus cancer typically treated?

Most sinus cancers are treated with surgery to remove the tumors. Early-stage sinus cancers are often treated with localized surgical procedures or minimally invasive endoscopic surgery. Sinus cancer that has spread may require open surgeries, such as a full or partial maxillectomy, which removes the front of the hard palate at the roof of the mouth.

Common surgical procedures for sinus cancer include:

  • Excision, or the removal of tumors and some nearby tissue, typically in treating early-stage cancers
  • Endoscopic sinus surgery, or the removal of tumors via a thin tube, or endoscope, inserted into an incision in the sinus or nasal cavity, in treating cancers that haven’t spread
  • Maxillectomy, which removes all or part of the hard palate. In the case of aggressive tumors, the eye may need to be removed, as well.

Surgery also may be combined with other treatments. Radiation therapy may be recommended either before or after a surgical procedure, for example, and may also be used in conjunction with chemotherapy.

What are the potential side effects of sinus cancer treatment?

Sinus cancer treatments may cause various side effects, including fatigue, nausea and vomiting, loss of appetite, mouth and throat pain, mouth sores, diarrhea and constipation.

Also, certain treatments may affect the patient’s physical appearance and ability to perform everyday tasks, such as eating and speaking. To help restore the appearance and functions of facial features affected by cancer or its treatment, reconstructive surgery may be an option. These surgeries typically include microvascular reconstruction, which uses tissues from other parts of the body, such as a rib graft or ear cartilage, to rebuild the upper jaw or other areas, and/or free flaps, in which small blood vessels are sewn together under a microscope to reconstruct the sinuses. Prosthetics to reconstruct the jaw or eye may also be an option.

How long do side effects last?

The length of time sinus cancer patients may experience side effects varies depending on the stage of the disease and the type of treatment received. Most treatment-related side effects go away within a few weeks or months, but some may take longer to subside. Some sinus cancer patients have part or all of their hard palate or teeth removed, for example, which may make it harder to stay nourished.

Can treatment-related side effects be managed?

Supportive care therapies may help sinus cancer patients alleviate certain side effects. Patients who have trouble eating during or after treatment may have a feeding tube inserted. Dietitians also may design a personalized eating regimen to help patients make up for nutritional deficiencies in their diet, and naturopathic providers may suggest supplements or other natural remedies to help prevent or manage side effects like nausea and diarrhea.

An oncology rehabilitation therapist also may use massage, speech or occupational therapy techniques to help patients address issues with speech or breathing.

Questions to ask your doctor

Sinus cancer often isn’t diagnosed until a patient experiences symptoms. But because the symptoms of sinus cancer are often confused with more common conditions, such as the post-nasal drip typical of a cold, it’s important to know the signs of sinus cancer and pay attention when they develop, taking particular note of how long they last. Experts recommend a sinus cancer diagnostic evaluation for symptoms that last longer than two weeks.

Do I have sinus cancer?

The first step in developing a personalized treatment plan is an accurate and timely diagnosis. Diagnostic tools for sinus cancer usually include a biopsy and imaging tests, such as X-rays, CT scans and/or MRI scans.

The most common types of biopsies for nasal and paranasal sinus tumors are incisional and excisional biopsies. In an incisional biopsy, the surgeon cuts out a small piece of the tumor using special instruments placed in the nose. In an excisional biopsy, the surgeon removes the entire tumor.

How long will treatment last?

Sinus cancer treatments may take hours, weeks or months, depending on several factors, including the stage of the cancer and the type of treatment you receive. For sinus cancer that is caught early, for example, surgery may be the only treatment required. More advanced cancers may require further treatments, such as radiation therapy, chemotherapy and/or targeted therapy, in combination with or instead of surgery. Also, for patients who experience changes in their physical appearance or ability to perform basic functions after surgery, reconstructive surgery may be recommended, which would naturally extend the length of treatment.

What should I expect after treatment is complete?

After treatment ends, you should receive a schedule detailing the timing of follow-up appointments and tests recommended by your doctor. These follow-ups are typically spaced further and further apart as time passes.

If your treatment includes surgery, your doctor may recommend radiation and/or chemotherapy treatment afterward to kill any remaining cancer cells.

Also, you may still experience side effects after treatment ends. Ask your doctor about certain supportive care therapies that may help, such as speech therapy to help with challenges in speaking, breathing and swallowing, or dietary counseling to help you get the nutrients you need to stay strong.

Is there a chance my cancer could come back?

Living with the fear of a recurrence is a reality many cancer patients face after treatment ends. Cancer recurrence is possible, as is the risk of a secondary cancer. That’s why follow-up appointments and tests are crucial in monitoring your post-treatment health.

It’s also important to report new symptoms to your doctor as soon as possible. If your cancer does recur, your treatment will likely depend on the location of the cancer and what treatments you had in the past.

Next topic: What are the facts about sinus cancer?