To understand these cancers, it is important to have some knowledge about the nasal cavity, the sinuses and the type of cells present in these areas – which can develop cancer.
The nasal cavity is the region that runs along the top of the roof of the mouth (the palate, which separates the nose from the mouth) and goes down to join the passage from the mouth to the throat. The sinuses are cavities (spaces) or small tunnels, called paranasal because they are around or near the nose. The nasal cavity opens into a network of sinuses—maxillary, frontal, sphenoid, and ethmoid sinuses—which are filled with air. When there is a cold or infection, the sinuses can become blocked (clogged) and fill with mucus and pus.
The nasal cavity and sinuses are lined with a layer of mucus-producing tissue (mucosa). The mucosa has many types of cells, including squamous epithelial, glandular, nerve, infection-fighting cells, blood vessel cells, and other supporting cells. Other cell types in the nasal cavity and sinuses, including bone and cartilage cells, can also develop into cancer.
Types of cancer of the nasal cavity and paranasal sinuses
Any cell that makes up the mucosa can develop into cancer with its own characteristics, which means that they cannot all be treated in the same way. The following are the main types of cancer of the nasal cavity and paranasal sinuses are:
- Squamous cell cancer – occurs when there is a change in squamous epithelial cells. It is the most common type of cancer in the nasal cavity and paranasal sinuses. It corresponds to a little more than half of cancer cases in these areas;
- Adenocarcinoma, adenoid cystic carcinoma, and mucoeidermoid cancer – are formed when cells in the minor salivary glands begin to grow out of control. These are also relatively common nasal and sinus cancers;
- Undifferentiated carcinoma – type of cancer that can come from the cells of the mucosa. It’s a fast-growing cancer in which the cells look so abnormal that it’s hard to tell what type of cell it started in;
- Melanoma – the cells that give skin its color are called melanocytes, and melanoma is a type of cancer that starts in these cells. It can grow and spread quickly. Although these cancers are usually found on sun-exposed areas of the skin, they can form in the lining of the nasal cavity and sinuses;
- Esthesioneuroblastoma – also called olfactory neuroblastoma, is a cancer that starts in the olfactory nerve (the nerve for the sense of smell). It usually starts at the roof of the nasal cavity and involves a structure called the cribriform plate – bone between the eyes and above the ethmoid sinuses;
- Lymphoma – starts in immune system cells (called lymphocytes) and can occur in the nasal cavity and sinuses. One type of lymphoma seen in this area is nasal-type T-cell/natural killer cell lymphoma;
- Sarcoma – is a cancer of muscles, bones, cartilage and fibrous cells that can start anywhere in the body, including the nasal cavity and sinuses. There are also benign tumors of the nasal cavity and paranasal sinuses that, despite not being cancerous, can still cause problems;
- Nasal polyps – are abnormal growths inside the nasal cavity or paranasal sinuses. Most nasal polyps are benign (not cancer) and are caused by some type of chronic (long-lasting) inflammation in the nose. Small polyps that aren’t causing problems may not need treatment. Larger polyps, in turn, cause problems and may need to be treated with medication or surgery.
- Papillomas – are warts that can grow inside the nasal cavity or paranasal sinuses and destroy healthy tissue. Papillomas are not cancer, but sometimes a squamous cell carcinoma starts in a papilloma. Due to the risk of cancer, papillomas of the nasal cavity and sinuses are surgically removed;
- Inverted papilloma – type of papilloma classified as a benign tumor, but tends to act more like a cancer. It is often treated with the same type of surgery used to remove cancer.
Symptoms and signs of cancer of the nasal cavity and paranasal sinuses
The symptoms of cancer of the nasal cavity and paranasal sinuses are quite nonspecific, and the suspicion is always made in cases of symptoms that do not improve over a period of at least three weeks. The most common signs are:
- Nasal congestion that does not improve;
- Pain above or below the eyes;
- Blockage on one side of the nose;
- Nasal drip at the back of the nose and throat;
- Nose bleed;
- Purulent discharge from the nose;
- Decreased sense of smell;
- Numbness or pain in parts of the face;
- Loosening or numbness of teeth;
- Appearance of a lump on the face or neck;
- Bulging of an eye;
- Loss or alteration of vision;
- Pain or pressure in the ears;
- Difficulty opening the mouth.
Diagnosis of cancer of the nasal cavity and paranasal sinuses
Tumors of the nasal cavity and sinuses are diagnosed based on the symptoms they cause – diagnosis in a person who does not have symptoms is very rare.
After a clinical examination or a radiological examination, if the doctor suspects cancer, they will order a biopsy. Once the disease is confirmed, tests are carried out to verify the local and distant extension of the disease, through imaging tests. The main ones are:
- Computed tomography – very useful in identifying cancers of the nasal cavity and paranasal sinuses. A CT scan can show whether a tumor has destroyed the surrounding bone. If performed on the chest, it can also show whether the cancer has spread to the lungs;
- MRI – images are better than CT scans for looking at cancers of the nasal cavities and sinuses and determining if a alteration represents a fluid or a tumor. They can also show whether a tumor has spread to nearby soft tissues, such as the eyeball, brain, or blood vessels.
- PET Scan (positron emission tomography) – uses a form of radioactive sugar that is injected into the blood. As cancer cells use glucose at a higher rate than normal cells, they absorb more radioactive sugar. A special scanner is then used to create images of the places where radioactivity has accumulated.
To close the diagnosis, it is necessary to perform a biopsy. In this procedure, a small piece of tissue is removed to be examined under a microscope, and this is the only way to know for sure whether the tumor can be determined as cancer of the nasal cavity or paranasal sinuses.
If cancer is found, laboratory tests can determine how aggressive the cancer is.
Biopsies are often done in the doctor’s office or clinic under local anesthesia. If the tumor is in an area that is difficult to reach or can bleed profusely, the biopsy will be done in the operating room.
Deep tumors can be reached by endoscopic biopsy. Long, thin surgical tools are passed through the endoscope to obtain a biopsy sample.
Finally, for tumors within the sinuses, the doctor may have to cut through the skin near the nose and the underlying bones to reach them, in a procedure called an open (surgical) biopsy.
Treatment depends on the type of cancer, where it is located and how far it has spread. The most common types of treatment for sinus and nasal cavity cancer include surgery, radiation therapy, and chemotherapy.
If the cancer is detected at an early stage, surgery can successfully remove the entire tumor. If it is growing rapidly, several combination therapies may be needed. Understand, below, the main ways to fight against cancer of the nasal cavity and paranasal sinuses.
Surgery – the goal of surgery in these areas is to remove the entire tumor and a small amount of normal tissue around it, while keeping appearance and function (such as breathing, speaking, chewing, and swallowing) as normal as possible. Rebuilding and/or repairing the area around the tumor is an important part of the surgery protocol.
If the margins around the tumor, analyzed in the laboratory, show cancer cells, it is more likely that some cancer has been left behind. Often, that indicates that more treatment will be needed, such as another surgery or radiation.
Endoscopic surgery – is most often used for small tumors. In this type of surgery, an endoscope (a thin, flexible tube that is placed in the nose to reach the nasal cavity or sinus) is used to view and remove the tumor. That way, the surgeon does not have to cut through skin and bone to open the entire cavity, which reduces damage to normal tissue. In general, recovery from this type of surgery takes less time.
In larger tumors, this type of surgery can be used to help try to control cancer in people who are not healthy enough for a more invasive, larger operation. It is usually combined with radiation treatment.
Removal of Lymph Nodes – Cancers of the nasal cavity or paranasal sinuses sometimes spread to the lymph nodes in the neck. Depending on the stage and location of the cancer, these lymph nodes may need to be removed in an operation called a neck dissection.
Radiotherapy – People with small tumors in the nasal cavity can usually be cured with radiation alone. Patients who cannot have surgery due to health problems or because the tumor is too advanced to be removed may also benefit from radiation therapy – usually their only option for treatment.
After surgery, radiation can be used to kill any cancer cells that may have remained. This is called adjuvant treatment. Before surgery it can also be used to shrink the tumor, which makes removal easier.
Chemotherapy – Chemotherapy drugs can be administered orally or through an IV. They enter the bloodstream and reach all areas of the body, making this treatment useful for metastatic cancer that has spread to organs beyond the nasal cavity and sinuses.
Chemotherapy may be used before surgery to try to shrink the tumor and make it easier to remove it. It can also be helpful in trying to save the eyeball if the cancer has spread there. Before surgery, chemotherapy quickly relieves symptoms that the tumor is causing. After surgery, usually along with radiation therapy, it reduces the risk of the cancer coming back.
If there is no possibility of surgery or radiation, chemotherapy is one of the forms of palliative care, to alleviate the symptoms of the disease and provide comfort to the patient.
At the moment, there are no available screening tests to diagnose nasal cavity and paranasal sinus cancer early, and there is no known way to prevent it.