Nasal and paranasal tumors are abnormal growths that begin in and around the passageway within your nose (nasal cavity). Nasal tumors begin in the nasal cavity. Paranasal tumors begin in air-filled chambers around the nose called the paranasal sinuses.
INTRODUCTIONKnow More Nasal and sinus cancers develop in the nasal cavity or sinuses, which are air-filled structures inside and around the nose. This type of cancer is also called paranasal sinus cancer.
These tumors can affect your ability to breathe, and they grow near vital organs and nerves, including the brain and eyes. That's why it is important to enlist a team of experts who are experienced in treating these rare cancers.
Different types of cancer affect the nasal cavity and sinuses, including the following:
RISK FACTORS Know More It is important to understand the risk factors for developing sinus and nasal cancer for prevention and early detection of the disease. Studies show that those who work in certain industries are more likely to develop the disease. Exposure to particular chemicals and elements in the workplace can increase your risk, such as:
Other risk factors include :
SIGN & SYMPTOMS Know More Some of the symptoms associated with nasal and sinus cancer are similar to those you may experience with allergies or sinusitis, including the following:
You should seek an appointment with your primary care doctor or an ear, nose and throat (ENT) specialist if these symptoms are severe, chronic or recurring, particularly if only one side of the nose is affected. Other serious symptoms that warrant a doctor visit include the following :
DIAGNOSIS & TREATMENTS Know More In addition to routine history and physical examination, the physician may perform ancillary tests and procedures in order to confirm the presence and type of sinonasal cancer, as well as to determine the presence of second primary cancers (SPC) or the spread of malignant disease elsewhere.
Oftentimes the first step in the diagnosis of sinonasal cancer is to perform a biopsy. Taking a biopsy will confirm the presence of abnormal cells under the microscopic view, and is imperative in making the diagnosis of sinonasal cancer.
In-Office Biopsy If the lesion can be visualized directly it may be determined that an in-office biopsy is the most efficient and effective method of obtaining tissue for analysis. This can be performed under local anesthesia with minimal discomfort to the patient.
Operative Biopsy. If the area to be biopsied is too difficult to access in the office a biopsy may be performed under general anesthesia in the operating room.
Lymph Node Biopsy. If a patient presents with a neck mass, particularly in the setting of no identifiable lesion, the physician may sample tissue from lymph node. There are several types of lymph node biopsy.
The physician may elect to perform routine blood analysis to assist in determining the presence of sinonasal cancer or other diseases. Blood work may not be necessary, and the decision to obtain blood work is individualized to every patient.
Liver Function Tests (LFTs): Can be utilized to determine the presence of concurrent liver disease that may be associated with risk factors for the development of sinonasal cancer (alcohol consumption, hepatitis). Furthermore, abnormal values may indicate the presence of metastatic liver disease.
Complete Blood Count (CBC): This will identify the presence of any anemia that can sometimes be associated with poor nutrition, or chronic illness.
Nutritional Blood Work: If a patient seems nutritionally depleted, particularly in advanced cases, the clinician may elect to obtain laboratory work up to measure nutrition markers in the blood work. This may assist in determining if a patient requires supplemental nutrition.
Often times a physician may elect to obtain imaging that will help in better understanding the presence of cancer and any other underlying issues. Imaging may be performed of the primary site, or of the general region to better define disease extent. The physician may elect to obtain further imaging in situations in which they are concerned for local invasion (e.g. into bone, muscle, adjacent sites), or regional invasion (to the neck).
Chest X-rays: Chest radiography may be obtained in order to define the presence of disease in the lungs. Often times patients with sinonasal cancer, have a longstanding history of smoking may have associated lesions in their lungs that should be identified.
Computed Tomography (CT): CT-Scans usually provide a more detailed image of the head and neck region, identifying parts of the tumor that is not readily seen on exam, as well as the presence of regional disease not readily detected (e.g. in the neck). CT-Scans can be obtained with or without contrast. Given the complexity of the region, usually CT scans are obtained with contrast, to help in identify the vascular architecture within the neck. However, this is not always necessary, and CT scans may be obtained without contrast in circumstances that preclude patient receiving contrast (iodine allergies, kidney disease).
Magnetic Resonance Imaging (MRI): MRI can also be utilized with or without contrast in order to provide superior visualization of soft tissue as well as the brain. Often times an MRI may be needed if there is indeterminate findings on other imaging modalities, with a need for more accurate mapping. MRI can also assist in determining if there is involvement of nerves or the eye which is important in counseling patients regarding future directions of targeted therapies.
18-Fluorodeoxyglucose Positron Emission Tomography (18-FDG PET): FDG-PET scans may be performed with CT or MRI imaging modalities and are utilized for the identification of regional or distant metastases.
Ultrasound (US): Ultrasound may be utilized to better characterize neck masses, or used in conjunction with biopsy techniques. US can indicate suspicious characters of lesions that would direct a physician to more aggressive workup (biopsy, excision).
Your treatment plan may include one or more of the following:
With advances in sinus endoscopy, many paranasal sinus tumors can now be removed in a minimally invasive manner. Dr. Dipen Patel has expertise in removing these tumors while preserving healthy surrounding tissues, which improves your quality of life by minimizing loss of smell and taste, facial scarring and chronic sinusitis.
Endoscopic approaches : With endoscopic sinus surgery, ENT surgeons use a telescope with a tiny video camera and instruments to operate through the nose and remove the tumor. This approach means no facial scars and a much quicker recovery.
Traditional surgery : When traditional open surgery is required, ENT surgeons work side-by-side with neurosurgeons and eye surgeons, as needed, to achieve complete tumor removal while preserving brain and vision function as much as possible.
Reconstructive surgery : Dr. Dipen Patel is specially trained to rebuild facial tissue or bones that must be removed to extract the tumor.
The goal of radiation is to target cancer cells with minimal damage to healthy tissue.
Stereotactic radiosurgery : This nonsurgical radiation therapy may be used for small, well-defined nasal and sinus tumors. A single high dose of radiation is delivered to the tumor, using the TrueBeam STx system, which minimizes damage to healthy surrounding tissue and eliminates the need for weeks of radiation therapy.
Image-guided radiation therapy (IGRT): When treating a paranasal tumor with radiation, radiation oncologists may use an image-guided system (TomoTherapy Hi-Art or Varian Trilogy) to better pinpoint the tumor. IGRT can adjust for changes in the patient's position as well as tumor changes throughout treatment; this allows clinicians to deliver the radiation more precisely and minimize the amount of radiation to sensitive surrounding tissue.
Proton radiotherapy : This type of radiation therapy uses beams of protons (the positively charged particles in an atom) instead of X-rays to destroy cancer cells. Because proton beams can be better controlled and more precisely targeted to the tumor than X-ray beams, radiation oncologists are able to deliver higher doses with less risk to healthy tissue. As a result, proton radiation may be a good option for recurrent paranasal sinus tumors located in the base of the skull near critical structures like the brainstem or spinal cord.
Oncologists may recommend various cancer-fighting drugs :
Chemotherapy : These drugs attack cancer cells to kill them or stop them from duplicating.
Targeted therapies: Designed to attack genetic mutations in tumors and leave noncancerous cells alone, targeted therapies tend to cause fewer side effects than chemotherapy drugs.
Immunotherapies: These promising drugs, which help the body's immune system attack cancer cells, may help some people with nasal and sinus cancers.
Our supportive oncology program offers counseling, massage, acupuncture and other therapies to cancer patients and their families.
Sometimes a paranasal tumor, or the approaches used to treat the tumor, can make it hard to swallow or eat. In these cases, you may be referred to one or more of the following:
