Head & Neck

Sinus and Nasal Cancer

The nasal cavity begins above the roof of your mouth, extending into the passageway from the back of your mouth that curves down to your throat. The two nasal passages in your nose lead into the nasal cavity.

Your four paranasal sinuses are hollow spaces in the bones around your nose: behind your cheekbones; above, below and between your eyes; and in the center of your skull. Named for the bones that surround them, they are the frontal, ethmoid, maxillary and sphenoid sinuses. The sinuses and the nasal cavity work together to filter, warm and moisten the air you breathe before it reaches your lungs. Cells in the sinuses make mucus to keep your nose from drying out.

Cancer typically develops in thin, flat squamous (SKWAY-mus) cells lining the sinuses and nasal cavity. It occurs most often in the maxillary sinuses.

Symptoms may include sinus pressure or blocked sinuses that don’t clear, sinus pain or headaches, runny nose, nosebleeds, a sore or lump in the nose that doesn’t heal, swelling around the eyes, pain in upper teeth, loose teeth or dentures that no longer fit well, vision changes, facial numbness, or a lump on the face, roof of the mouth or neck.

Common Treatments

Surgery, radiation therapy and chemotherapy are commonly used to treat sinus and nasal cancer. As you consider these and other options, talk with your doctor about the goal of treatment. Ask about the potential side effects and late effects of each option so you know what to expect during and after treatment. One or more of the following options, or a clinical trial, may be part of your treatment plan. (See Treatment Options for general descriptions of each treatment type.)

Surgery

Surgery may be used on any stage of sinus and nasal cancer, and it may be the only treatment needed for early-stage cancer. The surgeon will remove the cancer and some surrounding bone or other nearby tissues. Many types are available. Your doctor will consider the location and stage of your cancer to choose the appropriate surgery for you.

Wide local excision is a common surgery for the removal of the tumor and an area of normal tissue around it. It may be used if the cancer is found in the nasal cavity. If the tumor is found in the septum (dividing wall of the nose), the whole septum may be removed.

Medial maxillectomy may be used to treat a tumor in the side wall of the nasal cavity and may involve removing the side wall.

Maxillectomy may be done if the tumor has grown into the maxillary sinus. A maxillectomy may involve removal of bone from the roof of the mouth, upper teeth, part or all of the eye socket, part of the cheekbone, and/or the bony part of the upper nose.

Endoscopic ethmoidectomy may be used if the tumor is small and found only in the ethmoid sinuses. This involves the use of an endoscope (a thin, lighted tube) to reach the ethmoid sinuses through the nose.

External ethmoidectomy is another option if the tumor is small and found only in the ethmoid sinuses. This involves making an incision (cut) between the nasal bridge and the eye to reach the ethmoid sinuses. This procedure may also be done with an endoscope.

Craniofacial resection may be done if the cancer is found in the ethmoid sinuses, frontal sinuses and/or the sphenoid sinuses. This surgery is more extensive than a maxillectomy because it can include removal of the upper parts of the eye socket and front of the skull base.

Surgery often involves removal of lymph nodes in the neck, regardless of whether the cancer is in the sinus or nasal cavity. A selective neck dissection involves removal of lymph nodes from a limited area of the neck. A modified radical neck dissection involves removal of most of the lymph nodes on one side of the neck between the jawbone and collarbone, in addition to some muscle and nerve tissue. A radical neck dissection involves removal of nearly all of the lymph nodes on one side of the neck and even more muscle, nerves and veins.

After surgery, reconstructive surgery may be recommended to replace missing tissue, skin or bone to restore a person’s appearance and function (see Reconstructive Surgery).

Radiation Therapy

Radiation therapy is generally used for cancers in the sphenoid sinuses because these sinuses are difficult to reach surgically. It may be used as the main treatment instead of surgery if your general health is too poor for surgery. Radiation therapy can be used after surgery as adjuvant treatment. It may also be combined with chemotherapy (chemoradiation).

The way radiation therapy is given depends on the type and stage of the cancer. External-beam radiation therapy in the form of three-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT), or internal radiation therapy, also known as brachytherapy, may be used.

Chemotherapy

Chemotherapy may be given before (neoadjuvant therapy) or after surgery (adjuvant therapy). It may be used in combination with radiation therapy (chemoradiation). Chemotherapy for sinus and nasal cancers is usually given when the disease is advanced.

Immunotherapy

Immunotherapy in the form of immune checkpoint inhibitors may be part of your treatment plan if you have recurrent or metastatic sinus and nasal cancers that are not responding to chemotherapy. Other immunotherapy options may be available in clinical trials.

Targeted Therapy

This may be an option to treat certain types of sinus and nasal cancer. Targeted therapy drugs may be used with or without chemotherapy, after surgery, for advanced cancers.

Clinical Trials

Other types of immunotherapy and targeted therapy, alone and in combination, are being evaluated in clinical trials. Ask your doctor if a clinical trial is an option for you (see Clinical Trials).

Staging

Diagnosing your type of sinus and nasal cancer is an important step in creating the best treatment plan for you. Your doctor will perform a thorough exam, imaging studies, blood tests and a biopsy and use these test results to stage the cancer. Staging determines the extent of your cancer, where it is located and whether it has metastasized (spread) to nearby organs, tissues or lymph nodes, or to other parts of your body.

The TNM staging system, developed by the American Joint Committee on Cancer (AJCC), is typically used to classify and stage sinus and nasal cancers This system classifies the cancer by tumor (T), node (N) and metastasis (M). The T category describes the size and location of the primary tumor. The N category indicates whether the lymph nodes show evidence of cancer cells. The number and location of these lymph nodes are important because they show how far the disease has spread. The M category describes metastasis (spread of cancer to another part of the body), if any.

Staging Criteria

Once the cancer is classified, an overall stage is assigned. Sinus and nasal cancer may be Stage 0 through Stage IV. Also known as “in situ,” Stage 0 is a precursor of an invasive cancer. Stages I and II are generally confined to the local area where the cancer is found, and Stage III has spread to the regional lymph nodes in the neck. Stage IV is further divided into Stages IVA, IVB and IVC. Stages IVA and IVB are locally or regionally advanced disease, and Stage IVC has spread to distant sites, such as the liver, lungs or bone.

These basic stages are designed to group patients who have a similar prognosis (outlook). This grouping allows doctors to more accurately predict outcomes for patients depending on the type of treatment they receive. In certain cancers, the stage is also determined by other factors.

Sometimes your doctor may reassess your stage after treatment or if cancer recurs. This is known as restaging. It is rarely done but typically involves the same diagnostic tests used for the original staging. If a new stage is assigned, it’s often preceded by an “r” to denote that it’s been restaged and different from the original stage given at diagnosis.

TNM Classification for Sinus and Nasal Cancer

Classification Definition
Tumor (T)
TX Primary tumor cannot be assessed.
Tis Carcinoma in situ.
Maxillary Sinus
T1 Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone.
T2 Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates.
T3 Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit (eye socket), pterygoid fossa, ethmoid sinuses.
T4 Moderately advanced or very advanced local disease.
  T4a Moderately advanced local disease.
Tumor invades anterior orbital contents (eye socket), skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses.
  T4b Very advanced local disease.
Tumor invades any of the following: orbital apex (eye socket), dura (membrane surrounding the brain and spinal cord), brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx (upper part of throat) or clivus (bony base of skull).
Nasal Cavity and Ethmoid Sinus
T1 Tumor restricted to any one subsite, with or without bony invasion.
T2 Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion.
T3 Tumor extends to invade the medial wall or floor of the orbit (eye socket), maxillary sinus, palate, or cribriform plate.
T4 Moderately advanced or very advanced local disease.
  T4a Moderately advanced local disease.
Tumor invades any of the following: anterior orbital contents (eye socket), skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses.
  T4b Very advanced local disease.
Tumor invades any of the following: orbital apex (eye socket), dura (membrane surrounding the brain and spinal cord), brain, middle cranial fossa, cranial nerves other than (V2), nasopharynx (upper part of throat) or clivus (bony base of skull).
Node (N)
NX Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 Metastasis in a single ipsilateral (on the same side) lymph node 3 cm or smaller in greatest dimension and ENE*(-).
N2 Metastasis in a single ipsilateral (on the same side) lymph node 3 cm or smaller in greatest dimension and ENE*(+);
or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-);
or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(-);
or in bilateral (on both sides) or contralateral (on the opposite side) lymph node(s), none larger than 6 cm in greatest dimension and ENE(-).
  N2a Metastasis in single ipsilateral (on the same side) node 3 cm or smaller in greatest dimension and ENE*(+);
or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(-).
  N2b Metastases in multiple ipsilateral (on the same side) nodes none larger than 6 cm in greatest dimension and ENE*(-).
  N2c Metastases in bilateral (on both sides) or contralateral (on the opposite side) lymph node(s), none larger than 6 cm in greatest dimension and ENE*(-).
N3 Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE*(-);
or metastasis in a single ipsilateral (on the same side) node larger than 3 cm in greatest dimension and ENE(+);
or multiple ipsilateral, contralateral (on the opposite side) or bilateral (on both sides) nodes, any with ENE(+);
or a single contralateral node of any size and ENE(+).
  N3a Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE*(-).
  N3b Metastasis in a single ipsilateral (on the same side) node larger than 3 cm in greatest dimension and ENE*(+);
or multiple ipsilateral, contralateral (on the opposite side) or bilateral (on both sides) nodes, any with ENE(+);
or a single contralateral node of any size and ENE(+).
Metastasis (M)
M0 No distant metastasis.
M1 Distant metastasis.

*Extranodal extension (ENE) refers to cancer cells that have spread beyond the lymph node into surrounding tissues.

Staging Sinus and Nasal Cancer

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
III T3
T1, T2, T3
N0
N1
M0
M0
IVA T4a
T1, T2, T3, T4a
N0, N1
N2
M0
M0
IVB Any T
T4b
N3
Any N
M0
M0
IVC Any T Any N M1

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer Science+Business Media.

 

Key Takeaways

  • Your sinuses and nasal cavity work together to filter, warm and moisten the air you breathe.
  • These types of cancers usually develop in squamous cells lining the nasal cavity and sinuses.
  • This cancer often occurs in the maxillary sinuses.

Additional Resources

 

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