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Paranasal Sinus and Nasal Cavity Cancer

What is cancer of the paranasal sinus and nasal cavity?
Cancer is the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Cancer of the paranasal sinus and nasal cavity is a disease in which malignant (cancerous) 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, a substance that keeps the nose from drying out. The maxillary sinuses are air-filled bony cavities that are located above the teeth, and below the eyes. The ethmoid sinuses are located in the space between the eye sockets and above the nose. 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.

What are the risk factors for paranasal sinus and nasal cavity cancer?
Smoking increases the likelihood that a person will develop paranasal sinus and nasal cavity cancer. In addition, occupational risk factors can make a person more likely to develop this form of cancer. Occupational exposure to dusts from wood, textiles, and other substances have been linked to cases of paranasal sinus and nasal cavity cancer. Additional substances including glues, formaldehyde, nickel and chromium dust, mustard gas and radium have been linked to paranasal sinus and nasal cavity cancer.

What are the symptoms of paranasal sinus and nasal cavity cancer?
Some of the symptoms below might be signs of paranasal sinus and nasal cavity cancer or of other conditions. These symptoms include:

  • Sinuses that are blocked and do not clear
  • A growth or mass on the face, nose, or palate
  • A lump or sore inside the nose that does not heal
  • Frequent headaches or pain affecting the sinus region
  • Pus draining from the nose
  • Decreased sense of smell
  • Numbness or pain in parts of the face
  • Loosening, pain, or numbness of the teeth
  • Swelling or other problems with the eyes
  • Problems with dentures

How is paranasal sinus and nasal cavity cancer diagnosed?
 If there are symptoms, a doctor will take a medical history and perform a physical exam. The exam might include the doctor’s checking of the nose with a special telescope-like instrument called a nasal endoscope. Other tests might include:

  • Chest X-rays—These X-rays might be done to determine whether nasal cavity or paranasal sinus cancer has spread to the lungs.
  • CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography)—This is a scan that involves taking a series of detailed pictures of areas inside the body. The images are created by a computer linked to an X-ray machine.
  • MRI (also called magnetic resonance imaging)—This is a procedure during which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.

What are the stages of paranasal sinus and nasal cavity cancer?
Following are the stages for maxillary sinus cancer, which is the most common kind of sinus cancer:

Stage 0 — In this stage, cancer is found in the innermost lining of the maxillary sinus only. Stage 0 cancer is also called carcinoma in situ.

Stage I — In this stage, the cancer is found in the mucous membranes of the maxillary sinus.

Stage II —  Cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bones at the back of the maxillary sinus or the base of the skull.

Stage III — In stage III, cancer is found in any of the following places:

  • Bone at the back of the maxillary sinus
  • Tissues under the skin
  • The eye socket
  • The base of the skull
  • The ethmoid sinuses
  • The lymph nodes
  • Bones around the maxillary sinus

Stage IV – This stage, which includes three parts, involves the spread of cancer to areas including:

  • The skin of the cheek
  • Behind the jaw
  • The bone between the eyes
  • The sphenoid or frontal sinuses
  • The lymph nodes
  • The brain
  • Other parts of the body

The following stages are used for nasal cavity and ethmoid sinus cancer:

Stage 0 — In stage 0, cancer is found in the innermost lining of the nasal cavity or ethmoid sinus only. Stage 0 cancer is also called carcinoma in situ.

Stage I — In this stage, cancer is found in only one area (of either the nasal cavity or the ethmoid sinus) and might have spread into bone.

Stage II — This stage involves the location of cancer in the nasal cavity or the ethmoid sinus. Cancer might have spread to a nearby area and possibly into bone.

Stage III — In stage III, cancer is found in any of the following places:

  • The eye socket
  • The maxillary sinus
  • The roof of the mouth
  • The bone between the eyes
  • The nasal cavity or ethmoid sinus

Stage IV — Stage IV is divided into three parts. During this stage, cancer can be found in:

  • The nasal cavity or ethmoid sinus
  • The eye socket
  • The maxillary sinus
  • The roof of the mouth
  • The bone between the eyes
  • The skin of the nose or cheek
  • Front parts of the skull
  • The base of the skull
  • The sphenoid or frontal sinuses
  • Other parts of the body

How is cancer of the paranasal sinus and nasal cavity treated?
Following are treatments that are used for cancer of the paranasal sinuses and nasal cavity:

  • Surgery—Removal of the cancer
  • Radiation therapy—The use of high-dose X-rays or other high-energy rays to kill cancer cells
  • Chemotherapy—The use of drugs to kill cancer cells

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

  • Surgery
  • External-beam and/or internal radiation therapy
  • Surgery if the cancer comes back following treatment
  • A clinical trial of chemotherapy before surgery or radiation therapy
  • A clinical trial of chemotherapy following surgery with or without radiation therapy
  • A clinical trial of chemotherapy combined with radiation therapy

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

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

Can cancer of the paranasal sinus and nasal cavity be prevented?
 Many people with cancer of the nasal cavity and paranasal sinuses have no known risk factors, so there is no way to prevent all of the cancers.

People who smoke can reduce their risk, however, by no longer using tobacco products. People who work with potentially harmful substances should find out if they are being protected from harmful exposure to those substances.

What is the prognosis (chance of recovery) for someone with paranasal sinus and nasal cavity cancer?
 The 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. Five-year survival rates for people with nasal cavity and sinus cancer range from 11 percent for people with advanced cancers to almost 100 percent for people with very small cancers that have not spread and are found and treated early.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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