Article: Paranasal Sinus and Nasal Cavity Cancer Treatment

Description

What is cancer of the paranasal sinus and nasal cavity?

Cancer of the paranasal sinus and nasal cavity is a disease in which cancer (malignant) cells are found in the tissues of the paranasal sinuses or nasal cavity. The paranasal sinuses are small hollow spaces around the nose. The sinuses are lined with cells that make mucus, which keeps the nose from drying out; the sinuses are also a space through which the voice can echo to make sounds when a person talks or sings. 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 paranasal sinuses, including the frontal sinuses above the nose, the maxillary sinuses in the upper part of either side of the upper jawbone, the ethmoid sinuses just behind either side of the upper nose, and the sphenoid sinus behind the ethmoid sinus in the center of the skull.

Cancer of the paranasal sinus and nasal cavity most commonly starts in the cells that line the oropharynx. Much less often, cancer of the paranasal sinus and nasal cavity starts in the color-making cells called melanocytes, and is called a melanoma. If the cancer starts in the muscle or connecting tissue, it is called a sarcoma. Another type of cancer that can occur here, but grows more slowly, is called an inverting papilloma. Cancers called midline granulomas may also occur in the paranasal sinuses or nasal cavity, and they cause the tissue around them to break down.

A doctor should be seen if:

• The sinuses are blocked and don't clear.
• There is a sinus infection.
• Bleeding through the nose.
• A lump or sore that doesn't heal inside the nose.
• Frequent headaches or pain in the sinus region.
• Swelling or other trouble with the eyes.
• Pain in the upper teeth.
• Problems with dentures.

If there are symptoms, a doctor will examine the nose using a mirror and lights. The doctor may order a CT scan (a special x-ray that uses a computer) or an MRI scan (an x-ray-like procedure that uses magnetic energy) to make a picture of the inside of parts of the body. A special instrument (called a rhinoscope or a nasoscope) may be put into the nose to see inside. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Sometimes the doctor will need to cut into the sinus to do a biopsy.

The chance of recovery (prognosis) depends on where the cancer is in the sinuses, whether the cancer is just in the area where it started or has spread to other tissues (the stage), and the patient's general state of health.

Stage Explanation

Stages of cancer of the paranasal sinus and nasal cavity

Once cancer of the paranasal sinus and nasal cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. There is no staging system for cancer of the nasal cavity or for some of the less common paranasal sinus cancers. The following stages are used for cancer of the maxillary sinus, the most common type of paranasal sinus cancer:

Stage I

The cancer is in only the maxillary sinus and has not destroyed any of the bone in the sinus. The cancer has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II

The cancer has begun to destroy the bones around the sinus, but has not spread to lymph nodes in the area.

Stage III

Either of the following may be true:

• The cancer has spread no further than the bones around the sinus and to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).



• The cancer has spread to the cheek, the back of the maxillary sinus, the eye socket, or the ethmoid sinus in front of the maxillary sinus. The cancer may or may not have spread to one lymph node on the same side of the neck as the cancer.

Stage IV

Any of the following may be true:

• The cancer has spread to the eye or to other sinuses or places around the sinuses. The lymph nodes in the area may or may not contain cancer.



• The cancer is in only the sinuses or has spread to the areas around it. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).



• The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the paranasal sinuses or nasal cavity or in another part of the body.

Treatment Option Overview

How cancer of the paranasal sinus and nasal cavity is treated

There are treatments for all patients with cancer of the paranasal sinus and nasal cavity. Three kinds of treatment are used:

• Surgery (taking out the cancer).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells).
• Chemotherapy (using drugs to kill cancer cells).

Surgery is commonly used to remove cancers of the paranasal sinus or nasal cavity. Depending on where the cancer is and how far it has spread, a doctor may need to cut out bone or tissue around the cancer. If cancer has spread to lymph nodes in the neck, the lymph nodes may be removed (lymph node dissection).

Radiation therapy is also a common treatment of cancer of the paranasal sinus and nasal cavity. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Because the paranasal sinuses and nasal cavity help in talking and breathing, and are close to the face, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help in recovery from treatment. Patients may need plastic surgery if a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out.

Treatment by stage

Treatment of cancer of the paranasal sinus and nasal cavity depends on where the cancer is, the stage of the disease, and the patient's age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with cancer of the paranasal sinus and nasal cavity. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy may be given after surgery.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Radiation therapy if the cancer cannot be removed with surgery.
2. Surgery followed by radiation therapy.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy.

If cancer is in the nasal cavity, treatment may be surgery, radiation therapy, or both.

If the cancer is an inverting papilloma, treatment will probably be surgery.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy.

Stage II Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy is given before or after surgery.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. External-beam radiation therapy.
2. Surgery followed by radiation therapy.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy.

If cancer is in the nasal cavity, treatment may be surgery, radiation therapy, or both.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy.

Stage III Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment may be one of the following:

1. Surgery to remove the cancer. Radiation therapy is given before or after surgery.
2. A clinical trial of a special type of radiation therapy given before or after surgery.
3. A clinical trial of chemotherapy combined with radiation therapy.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Surgery followed by radiation therapy.
2. A clinical trial of chemotherapy before surgery or radiation therapy.
3. A clinical trial of chemotherapy following surgery with or without radiation therapy.
4. A clinical trial of chemotherapy combined with radiation therapy.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy.

If cancer is in the nasal cavity, treatment may be one of the following:

1. Surgery.
2. Radiation therapy.
3. Surgery plus radiation therapy.
4. A clinical trial of chemotherapy before surgery or radiation therapy.
5. A clinical trial of chemotherapy following surgery with or without radiation therapy.
6. A clinical trial of chemotherapy combined with radiation therapy.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery. Radiation therapy may be given if the cancer cannot be removed with surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. External-beam and/or internal radiation therapy.
2. Surgery if the cancer comes back following treatment.
3. A clinical trial of chemotherapy before surgery or radiation therapy.
4. A clinical trial of chemotherapy following surgery with or without radiation therapy.
5. A clinical trial of chemotherapy combined with radiation therapy.

Stage IV Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer and where the cancer is found.

If cancer is in the maxillary sinus, treatment will probably be one of the following:

1. Radiation therapy.
2. A clinical trial of chemotherapy before surgery or radiation therapy.
3. A clinical trial of chemotherapy following radiation therapy.
4. A clinical trial of chemotherapy combined with radiation therapy.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. Surgery followed by radiation therapy.
2. Radiation therapy followed by surgery.
3. A clinical trial of chemotherapy before surgery or radiation therapy.
4. A clinical trial of chemotherapy following surgery with or without radiation therapy.
5. A clinical trial of chemotherapy combined with radiation therapy.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy.

If cancer is in the nasal cavity, treatment may be one of the following:

1. Surgery.
2. Radiation therapy.
3. Surgery plus radiation therapy.
4. A clinical trial of chemotherapy before surgery or radiation therapy.
5. A clinical trial of chemotherapy following surgery with or without radiation therapy.
6. A clinical trial of chemotherapy combined with radiation therapy.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy.

If the cancer is a melanoma or sarcoma, treatment will probably be surgery, if possible. Radiation therapy or chemotherapy may be given if the cancer cannot be removed with surgery.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. External beam and/or internal radiation therapy.
2. Surgery if the cancer comes back following treatment.
3. A clinical trial of chemotherapy before surgery or radiation therapy.
4. A clinical trial of chemotherapy following surgery with or without radiation therapy.
5. A clinical trial of chemotherapy combined with radiation therapy.

Recurrent Paranasal Sinus and Nasal Cavity Cancer

Treatment depends on the type of cancer, where the cancer is found, and the type of treatment the patient received before.

If cancer is in the maxillary sinus, treatment will probably be one of the following:

1. If surgery was done before, more extensive surgery followed by radiation therapy or radiation therapy alone.
2. If radiation therapy was given before, surgery.
3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

If cancer is in the ethmoid sinus, treatment may be one of the following:

1. If limited surgery was done before, more extensive surgery followed by radiation therapy or radiation therapy alone.
2. If radiation therapy was given before, surgery.
3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. Chemotherapy is given if radiation therapy does not work.

If cancer is in the nasal cavity, treatment may be one of the following:

1. If limited surgery was done before, radiation therapy alone or more extensive surgery followed by radiation therapy.
2. If radiation therapy was given before, surgery.
3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy.

If the cancer is a melanoma or sarcoma, treatment may be surgery or chemotherapy.

If the cancer is a midline granuloma, treatment will probably be radiation therapy.

If the cancer is in the nose (nasal vestibule), treatment may be one of the following:

1. If radiation therapy was given before, surgery.
2. If surgery was done before, radiation therapy alone or more extensive surgery followed by radiation therapy.
3. Chemotherapy. Clinical trials are testing new chemotherapy drugs.

Changes to This Summary (06/06/2003)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

To Learn More

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Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

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Bethesda, MD 20892-8322

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PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

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PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Source: National Cancer Institute
Cache Date: December 10, 2004