Nasal cavity and paranasal cancers are a relatively rare type of head and neck cancer. In fact, they occur in less than 3 percent of head and neck cancers, says Dr. Richard Bakst, assistant professor of radiation oncology at the Icahn School of Medicine at Mount Sinai.
Nasal cancers occur in the nose itself. Paranasal cancers arise in one of the four pair of sinuses (empty spaces) near the nose. These sinuses — the frontal, maxillary, ethmoid and sphenoid sinuses — are lined with cells that make mucous, which keeps the inside of your nose moist when you breathe. Most people develop cancers in the nose, followed by the maxillary sinuses, Bakst says. The maxillary sinus is adjacent to the nose and under the eyes. “This is where people get a lot of sinusitis [sinus infection] or pressure in the face,” he says.
There are substantial differences among nasal and paranasal cancers, say Dr. Richard Lebowitz, a rhinologist and professor in the department of otolaryngology-head and neck surgery at NYU Langone Health. “The issues related to surgery surrounding vital structures, the likelihood of a cure, the side effects of treatment — these are very different depending on which sinus we’re talking about. There are really a variety of different pathologies and types of tumors,” Lebowitz says. These differences, coupled with the relatively rare nature of these cancers, make it hard to standardize treatment recommendation, Bakst says.
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“The biggest problem with nasal and paranasal cancers is they don’t really tend to present with symptoms early on,” Lebowitz says. Take tumors in the ethmoid sinus, for example. If they get large enough, they may cause trouble breathing through the nose and nosebleeds. “There’s nothing really much beyond that,” Lebowitz says. “[These symptoms are] often attributed to normal sinus and nasal problems. We rarely see early stages cancers except when they are found incidentally. We see them when they grow and become more advanced and affect the structures around the sinus, such as the eye or the nasal cavity itself.”
The two main risk factors for nasal and paranasal cancers are tobacco and environmental exposures, such as inhaled adhesives and chemicals, including formaldehyde, solvents and asbestos. Types of work that may pose a high risk for these types of cancer include woodworking and leatherworking.
Treating Nasal and Paranasal Cancers
Since nasal and paranasal cancers are often advanced when they present, Lebowitz says, “we tend to throw everything we can at them. There’s not a lot of margin for error. If they recur, it’s likely not in an area that’s surgically resectable,” meaning one where a surgeon can remove all visible parts of the tumor.
“The challenge in treating theses cancers is all the critical structures adjacent to the nose and sinuses,” Bakst says, “including the optic structures — the eye and the nerves that innervate the eye. What sits above the nasal cavity is the brain. These all affect our ability to either operate or treat with radiation.” That said, most nasal and paranasal cancers are treated surgically, often with minimally invasive endoscopic surgery. Assuming it’s resectable, Bakst says, doctors can decide if they also want to give radiation or radiation with chemotherapy. “It depends how the tumor comes out, what it looks like, if are there lymph nodes involved.”
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Bakst says if a surgeon can’t remove the cancer, it’s because the tumor is too big, it’s wrapped around a critical structure or because the patient is too sick to go to the operating room. In lieu of surgery, sometimes oncologists treat patients with a combination of chemotherapy or radiation to try to make the tumor go away.
Since these are rare cancers, Bakst says, it’s crucial to see a surgeon who specializes in head and neck cancers. “The anatomy is pretty complex,” he says. “It’s important to get an adequate surgical resection, if indeed it’s resectable. It’s also important to go to a place with a multi-disciplinary team that includes a medical oncologist and a radiation oncologist who specializes in head and neck cancers.” You want to make sure all treatment options are considered to maximize curability and minimize treatment-related harms, Bakst says.
The prognosis for early stage disease is good, Bakst says, with cure rates of 75 to 80 percent at five years. If the cancer is advanced at diagnosis, survival could fall to 30 to 40 percent. Patients are followed rigorously after treatment, with scans every three to four months and regular endoscopies to make sure there is no new cancer.
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There’s nothing about these cancers that make them particularly aggressive, Lebowitz says. The poor prognosis is about where they are located and the fact they present at later stage. Early detection is important and it’s relatively simple. An ear, nose and throat doctor can put a scope in your nose and see if something is there.
If you have a persistent stuffy nose or bleeding from the nose, you should always get it evaluated, Lebowitz says. “Polyps don’t bleed. Polyps are the most common growth in the nose, but they are not malignant and they have no potential to become malignant. They’re just inflammatory tissue.” Lebowitz says bloody nasal discharge — especially when it just occurs on one side of the nose — is a classic sign something is amiss. Tumors tend to be on one side and not the other, he says. One-sided symptoms are a tipoff it’s time to see an ENT doctor.
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What You Need to Know About Nasal and Paranasal Cancers originally appeared on usnews.com
