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Sinus cancer treatments

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 3, 2021.

Because sinus cancer and its treatments may affect everyday functions, like breathing and eating, doctors generally take into consideration a patient’s quality of life when recommending a treatment plan. The three main treatment options for sinus cancer are chemotherapy, radiation therapy and surgery, although reconstructive surgery may also be an option for certain patients.

As sinus cancer is rare and affects a delicate area of the body, it’s important that you work with an experienced team of doctors with different specialties. Together, these experts can formulate a treatment plan that is suited to you and the cancer.

Some of the types of doctors who may help treat sinus cancer include:

  • Otolaryngologist or ear, nose and throat (ENT) doctor, who treats conditions and diseases that affect the head and neck
  • Neurosurgeon, who performs surgery on parts of the nervous system, including the brain and spine
  • Radiation oncologist, who uses radiation therapy to treat cancer
  • Medical oncologist, who uses drugs such as chemotherapy, immunotherapy and targeted therapy to treat cancer
  • Plastic surgeon, who replaces or repairs parts of the body using surgery and other methods

Throughout treatment, you will likely work with many medical providers in addition to your core cancer care team, including nurses, pharmacists, psychologists, oncology dietitians and social workers.

Chemotherapy

Chemotherapy is typically used in conjunction with radiation to treat sinus cancer.

In general, chemotherapy, or a combination of chemotherapy and radiation therapy, tends to be used before surgery or after surgery as an additional treatment for sinus cancers. For patients with widespread (metastatic) sinus cancer, or those who are unable to withstand surgery, chemotherapy alone or in combination with other options may be used as the main treatment option.

For most maxillary sinus cancers (those that grow within the cheekbones near the nose), surgery is typically the first line of treatment. However, doctors may use a combination of chemotherapy and radiation therapy to treats aggressive maxillary sinus tumors or advanced-stage maxillary cancers (stage 3 or stage 4). Chemotherapy combined with radiation therapy may help lower the chance that any cancer is left behind after other treatments such as surgery, but it may cause more side effects than radiation alone.

Nasal cavity cancers are also often treated with a combination of chemotherapy and radiation therapy. However, as with maxillary sinus cancers, chemotherapy is generally not the primary treatment option, and surgery is typically done first.

All stages of ethmoid sinus cancer, which occurs in the upper nasal bones nearest to the eye, tend to be treated with a combination of chemotherapy and radiation therapy after surgery. In some cases, your care team may opt to treat advanced-stage ethmoid sinus cancers (stage 3 or 4) first with chemotherapy and radiation therapy to attack the tumor before surgery. For ethmoid sinus cancers that have metastasized or spread widely within the body, chemotherapy may be the main treatment option.

Chemotherapy combined with radiation therapy is also an option for sarcomas of the nasal cavity or sinuses after surgery has been performed. For melanoma in this area, chemotherapy, radiation therapy, immunotherapy or targeted therapy may be used on tumors that doctors cannot remove surgically.

As chemotherapy destroys cancer cells, it may also harm healthy cells, leading to side effects. The severity and amount of side effects vary widely depending on personal factors, the type of chemotherapy drugs and the duration of treatment.

In the short term, patients may experience side effects such as:

  • Stomach upset
  • Nausea
  • Vomiting
  • Poor appetite
  • Unintentional weight loss
  • Hair loss
  • Mouth sores
  • Loose stools

Chemotherapy may also make you more prone to infections, bleeding and excessive tiredness or shortness of breath.

Radiation therapy

Radiation therapy is often used in conjunction with surgery. Patients may undergo radiation treatment before or after the surgical procedure. Radiation may also be used in conjunction with chemotherapy.

Some types of radiation are designed to deliver stronger treatment doses while causing less damage to healthy tissue around the tumor. This may lead to fewer side effects.

Some radiation therapies commonly used to treat sinus cancer include:

CyberKnife®: A tumor in the sinuses is often difficult to reach with standard radiation. CyberKnife software allows for targeted radiation in concentrated doses. This may reduce damage to the surrounding healthy tissues and delicate areas, such as the eyes. Because CyberKnife treatment delivers higher doses of radiation than traditional radiation, the course of treatment may be shorter, and include fewer radiotherapy sessions.

Intensity modulated radiation therapy (IMRT): When compared to standard radiotherapy, IMRT enables radiation oncologists to deliver stronger doses of radiation, with less damage to the areas surrounding sinus tumors. The machine revolves around the patient to deliver targeted, 3D therapy, and adjusts radiation intensity to reach cancerous regions, reducing the impact on healthy tissue.

For early-stage (1 and 2) maxillary sinus cancers, radiation therapy may be used after surgery if the surgery couldn’t extract all of the tumor. For example, if cancer cells are found in tissues surrounding the tumor, the surgeon may recommend radiation therapy to target any remaining cancer and reduce the chances that cancer cells are left behind. For advanced-stage (3 and 4) maxillary sinus cancers, surgery followed by radiation therapy is generally the primary treatment option. However, cancers that have metastasized or spread widely within the body may be treated primarily with systemic treatments such as chemotherapy or targeted therapy.

For early-stage nasal cavity cancer (0, 1 and 2), the treatment options may include surgery, radiation therapy, or surgery followed by radiation therapy. Surgery followed by radiation therapy generally comes with the lowest risk of cancer returning after treatment. Stage 3 and 4 nasal cavity cancer also tend to be treated with radiation therapy after surgery. In some cases, when the tumor is particularly aggressive, radiation therapy combined with chemotherapy or targeted therapy may be an option.

Some early-stage cancer, small tumors in the nasal cavity may be treated with radiation therapy alone. This treatment option may come with a higher risk of recurrence than surgery combined with radiation therapy, but the benefit is that it doesn’t alter the look of your nose and face as much as surgery. People with large sinus tumors that cannot be removed surgically may also undergo radiation therapy as their primary treatment. Otherwise, radiation therapy is generally used before or after surgery.

Radiation therapy may also be an option for melanoma or sarcoma of the nasal cavity or sinuses. For sphenoid sinus cancer, which occurs in the bones directly behind the nose, radiation therapy may be the primary treatment used, as surgical removal of a tumor in this area may be difficult to perform successfully and safely.

The potential side effects of radiation therapy for sinus cancer include:

  • Redness, blistering, peeling or other skin changes at the treatment site
  • Nausea and vomiting
  • Poor appetite
  • Fatigue
  • Weakness
  • Difficulty swallowing
  • Changes in hearing
  • Dryness in the eyes or mouth
  • Taste changes
  • Bone damage or pain
  • Mouth sores
  • Difficulty breathing due to narrowed nasal cavity
  • Damage to the brain (rarely)

In most cases, side effects of radiation resolve after treatment has concluded, though some may be permanent.

Surgery

Surgery may be performed on early- and advanced-stage sinus cancers. Early-stage sinus cancers may be treated with local excisions or minimally invasive endoscopic surgery. More advanced sinus cancers may require open surgeries, such as a full or partial maxillectomy, or removal of the eye. Reconstruction or plastic surgeries may follow procedures that remove a significant amount of tissues in certain areas.

Surgery is a central part of treatment for most sinus cancers. Combined with other treatments like chemotherapy and radiation therapy, surgery to remove the tumor often results in the most favorable outcomes for patients with sinus cancer.

In most cases, early-stage maxillary sinus cancers (stage 0, 1 and 2) are treated first with surgery to take out the tumor. Surgical removal of the cancer is also an option for more advanced maxillary sinus cancers (stage 3 and 4), but it may be more extensive and involve removing lymph nodes in the neck if the cancer has spread there. Some advanced-stage maxillary sinus tumors are too large to be safely and successfully removed via surgery. In this case, doctors may suggest other treatment options in place of surgery. However, you may still have the option of an operation if the tumor is blocking your sinuses or causing symptoms that can be resolved by surgery.

In most cases, nasal cavity cancers and ethmoid sinus cancers are treated with surgery at all stages unless the cancer has metastasized and become too widespread in the body to benefit from surgery. As with other types of sinus cancer, surgery is usually followed or preceded by other therapies (such as radiation).

Surgery is generally not the primary treatment method for sphenoid sinus cancer. It’s often too dangerous or difficult to perform surgery on a tumor located in the bones behind the nose.

Surgical procedures to treat sinus cancer may involve:

Excision: Surgeons may remove tumors and some local tissue during an excision. This procedure is typically performed on early-stage cancers, for small nasal cavity tumors.

Endoscopic sinus surgery: This minimally invasive procedure may be used on early-stage nasal or sinus cancer patients. A thin tube, or endoscope, is inserted into an incision in the sinus or nasal cavity to remove tumors. It’s less invasive than other sinus cancer surgeries that require cutting and opening up the nasal cavity (open surgeries). This operation may have a quicker recovery time and, when done by experienced surgeons on eligible cancers, may be just as successful as more aggressive surgical methods.

Maxillectomy: This operation removes all or part (partial maxillectomy) of the hard palate, the front of the roof of the mouth. A special denture can be created to fill the hole formed by this surgery. Your doctor will likely refer you to a prosthodontist, a specialized dentist, who can make a prosthetic tailored to your mouth. This surgery may be used for nasal cavity cancers that grow on the nasal cavity wall or for maxillary sinus cancers. For early-stage maxillary sinus cancers (stages 0, 1 and 2), a maxillectomy is often the first treatment option used.

Microvascular reconstruction: Microvascular reconstruction surgery uses tissues from other parts of the body, such as a rib graft or ear cartilage, to rebuild the upper jaw or other areas impacted by tissue removal following a maxillectomy. Surgeons use a microscope to connect blood vessels from the free flap in the neck to keep the recently transplanted tissue alive and healthy.

Free flaps: Using microvascular surgery, in which small blood vessels are sewn together under a microscope, reconstructing the sinuses may be possible by using tissue and muscle from other areas of the body, such as the intestines, arm, leg or abdomen.

The risks associated with surgery vary. In general, all surgeries can cause complications, such as infections, blood clots and reactions to anesthesia.

Some of the potential side effects of surgery to treat sinus cancer include:

  • Pain
  • Nasal fluid drainage and crusting
  • Nosebleeds
  • Scarring
  • Problems eating and talking
  • Disfiguration of the face
  • Eye changes (if surgery involves the eyes or surrounding area)

Surgery for sinus cancer may change the appearance of your face and how different parts of your face move and function. The extent of these changes depends on the type of surgery performed.

Before undergoing surgery for sinus cancer, it’s important to speak with your care team about what to expect and what your options are after surgery. Your care team can give you a sense of how extensive any facial changes may be and what options you have to replace or repair the affected areas using reconstructive surgery, grafts of tissue, or an artificial replacement (prosthesis).

Recurrent sinus cancer

When cancer returns after scans show no evidence of disease, it’s referred to as recurrent cancer. Cancer may recur in the same place it originated or in another part of the body.

Patients with recurrent cancer typically undergo another round of testing to determine where the cancer has returned and whether it has spread, allowing the care team to better determine a treatment plan.

When sinus cancer recurs at the same point of origin, doctors may begin treatment with a different method than was used the first time. For example, if the original cancer was treated with radiation first, doctors may opt to use surgery first on the recurrent cancer. Systemic treatments such as chemotherapy or targeted therapy, which treat cancer throughout the body, may also be an option, either alone or alongside radiation or surgery.

If sinus cancer recurs and has spread to the lymph nodes within the neck, it’s typically treated with a surgical procedure to remove the lymph nodes. After that, radiation therapy may be used.

When possible, surgery is the standard option for melanomas or sarcomas that recur in the sinuses.

Recurrent sinus cancers that metastasize (spread to distant parts of the body) may be treated with systemic treatments such as chemotherapy and targeted therapy.

Clinical trials may also be an option for any type of recurrent sinus cancer.

Clinical trials

Due to the rarity of nasal and sinus cancers, research is ongoing and doctors are continuously refining treatment options for all of the different types and stages. This is why clinical trials may be a beneficial option for many patients with these cancers.

Clinical trials may enable you to receive new therapies that are currently being investigated. These treatments may or may not end up being more beneficial than the traditional treatment options. Still, due to the evolving understanding of sinus cancer treatment, a majority of doctors recommend that patients consider enrolling in a clinical trial, according to the American Cancer Society.

Clinical trials may even be one of the primary treatment options for certain types and stages of sinus cancers. For example, the National Cancer Institute designates clinical trials as one of the potential treatment options for stage III cancer in the maxillary sinus, ethmoid sinus and nasal cavity. These trials test therapies like combination chemotherapy or fractionated radiation therapy before or after other treatments.

Cancer Treatment Centers of America® (CTCA) may offer clinical trials to eligible patients with sinus cancer. Before undergoing treatment, ask your doctor if enrolling in a clinical trial may be a good option for you.

Next topic: What are the top questions about sinus cancer?

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