Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®)

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General Information About Paranasal Sinus and Nasal Cavity Cancer

Paranasal sinuses

"Paranasal" means near the nose. The paranasal sinuses are hollow, air-filled spaces in the bones around the nose. The sinuses are lined with cells that make mucus, which keeps the inside of the nose from drying out during breathing.

There are several paranasal sinuses named after the bones that surround them:

Nasal cavity

The nose opens into the nasal cavity, which is divided into two nasal passages. Air moves through these passages during breathing. The nasal cavity lies above the bone that forms the roof of the mouth and curves down at the back to join the throat. The area just inside the nostrils is called the nasal vestibule. A small area of special cells in the roof of each nasal passage sends signals to the brain to give the sense of smell.

Together the paranasal sinuses and the nasal cavity filter and warm the air, and make it moist before it goes into the lungs. The movement of air through the sinuses and other parts of the respiratory system help make sounds for talking.

The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma. This type of cancer forms in the squamous cells (thin, flat cells) lining the inside of the paranasal sinuses and the nasal cavity.

Other types of paranasal sinus and nasal cavity cancer include the following:

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for paranasal sinus and nasal cavity cancer include the following:

  • Being exposed to certain workplace chemicals or dust, such as those found in the following jobs:
    • Furniture-making.
    • Sawmill work.
    • Woodworking (carpentry).
    • Shoemaking.
    • Metal-plating.
    • Flour mill or bakery work.
  • Being infected with human papillomavirus (HPV).
  • Being male and older than 40 years.
  • Smoking.

These and other symptoms may be caused by paranasal sinus and nasal cavity cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:

  • Blocked sinuses that do not clear, or sinus pressure.
  • Headaches or pain in the sinus areas.
  • A runny nose.
  • Nosebleeds.
  • A lump or sore inside the nose that does not heal.
  • A lump on the face or roof of the mouth.
  • Numbness or tingling in the face.
  • Swelling or other trouble with the eyes, such as double vision or the eyes pointing in different directions.
  • Pain in the upper teeth, loose teeth, or dentures that no longer fit well.
  • Pain or pressure in the ear.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Physical exam of the nose, face, and neck: An exam in which the doctor looks into the nose with a small, long-handled mirror to check for abnormal areas and checks the face and neck for lumps or swollen lymph nodes.
  • X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted into the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

The prognosis (chance of recovery) and treatment options depend on the following:

  • Where the tumor is in the paranasal sinus or nasal cavity and whether it has spread.
  • The size of the tumor.
  • The type of cancer.
  • The patient's age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Paranasal sinus and nasal cavity cancers often have spread by the time they are diagnosed and are hard to cure. After treatment, a lifetime of frequent and careful follow-up is important because there is an increased risk of developing a second kind of cancer in the head or neck.

Stages of Paranasal Sinus and Nasal Cavity Cancer

The process used to find out if cancer has spread within the paranasal sinuses and nasal cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an opening in the body, such as the nose or mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. Sometimes a substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Pea, peanut, walnut, and lime show tumor sizes.

In stage 0, abnormal cells are found in the innermost lining of the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

In stage I, cancer has formed in the mucous membranes of the maxillary sinus.

In stage II, cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.

In stage III, cancer has spread to any of the following:

or

Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:

  • The lining of the maxillary sinus.
  • Bones around the maxillary sinus, including the roof of the mouth and the nose.
  • Tissues under the skin.
  • The eye socket.
  • The base of the skull.
  • The ethmoid sinuses.

Stage IV is divided into stage IVA, IVB, and IVC.

Stage IVA

In stage IVA, cancer has spread either:

  • to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
  • to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
  • to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.

and cancer has spread to any of the following:

  • The lining of the maxillary sinus.
  • Bones around the maxillary sinus, including the roof of the mouth and the nose.
  • Tissues under the skin.
  • The eye socket.
  • The base of the skull.
  • The ethmoid sinuses.

or

Cancer has spread to any of the following:

  • The front of the eye.
  • The skin of the cheek.
  • The base of the skull.
  • Behind the jaw.
  • The bone between the eyes.
  • The sphenoid or frontal sinuses.

and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.

Stage IVB

In stage IVB, cancer has spread to any of the following:

  • The back of the eye.
  • The brain.
  • The middle parts of the skull.
  • The nerves in the head that go to the brain.
  • The upper part of the throat behind the nose.
  • The base of the skull.

and cancer may be found in one or more lymph nodes of any size, anywhere in the neck.

or

Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.

Stage IVC

In stage IVC, cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.

In stage 0, abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

In stage I, cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.

In stage II, cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.

In stage III, cancer has spread to any of the following:

  • The eye socket.
  • The maxillary sinus.
  • The roof of the mouth.
  • The bone between the eyes.

or

Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:

Stage IV is divided into stage IVA, IVB, and IVC.

Stage IVA

In stage IVA, cancer has spread either:

  • to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
  • to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
  • to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.

and cancer has spread to any of the following:

or

Cancer has spread to any of the following:

  • The front of the eye.
  • The skin of the nose or cheek.
  • Front parts of the skull.
  • The base of the skull.
  • The sphenoid or frontal sinuses.

and cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.

Stage IVB

In stage IVB, cancer has spread to any of the following:

  • The back of the eye.
  • The brain.
  • The middle parts of the skull.
  • The nerves in the head that go to the brain.
  • The upper part of the throat behind the nose.
  • The base of the skull.

and cancer may be found in one or more lymph nodes of any size, anywhere in the neck.

or

Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.

Stage IVC

In stage IVC, cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.

Recurrent Paranasal Sinus and Nasal Cavity Cancer

Recurrent paranasal sinus and nasal cavity cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the paranasal sinuses and nasal cavity or in other parts of the body.

Treatment Option Overview

Different types of treatment are available for patients with paranasal sinus and nasal cavity cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. The medical oncologist works with other doctors who are experts in treating patients with head and neck cancer and who specialize in certain areas of medicine and rehabilitation. Patients who have paranasal sinus and nasal cavity cancer may need special help adjusting to breathing problems or other side effects of the cancer and its treatment. If a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out, plastic surgery may be done to repair or rebuild the area. The treatment team may include the following specialists:

Surgery (removing the cancer in an operation) is a common treatment for all stages of paranasal sinus and nasal cavity cancer. A doctor may remove the cancer and some of the healthy tissue and bone around the cancer. If the cancer has spread, the doctor may remove lymph nodes and other tissues in the neck.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. The total dose of radiation therapy is sometimes divided into several smaller, equal doses delivered over a period of several days. This is called fractionation. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid gland may be tested before and after treatment.

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Information about clinical trials is available from the NCI Web site.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I Paranasal Sinus and Nasal Cavity Cancer

Treatment of stage I paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage II Paranasal Sinus and Nasal Cavity Cancer

Treatment of stage II paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage III Paranasal Sinus and Nasal Cavity Cancer

Treatment of stage III paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity.

If cancer is in the maxillary sinus, treatment may include the following:

If cancer is in the ethmoid sinus, treatment may include the following:

  • Surgery followed by radiation therapy.
  • A clinical trial of combination chemotherapy before surgery or radiation therapy.
  • A clinical trial of combination chemotherapy after surgery or other cancer treatment.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may include the following:

  • Surgery and/or radiation therapy.
  • Chemotherapy and radiation therapy.
  • A clinical trial of combination chemotherapy before surgery or radiation therapy.
  • A clinical trial of combination chemotherapy after surgery or other cancer treatment.

For inverting papilloma, treatment is usually surgery with or without radiation therapy.

For melanoma and sarcoma, treatment may include the following:

  • Surgery.
  • Radiation therapy.
  • Surgery, radiation therapy, and chemotherapy.

For midline granuloma, treatment is usually radiation therapy.

If cancer is in the nasal vestibule, treatment may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IV Paranasal Sinus and Nasal Cavity Cancer

Treatment of stage IV paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity.

If cancer is in the maxillary sinus, treatment may include the following:

If cancer is in the ethmoid sinus, treatment may include the following:

  • Radiation therapy before or after surgery.
  • Chemotherapy and radiation therapy.
  • A clinical trial of chemotherapy before surgery or radiation therapy.
  • A clinical trial of chemotherapy after surgery or other cancer treatment.
  • A clinical trial of chemotherapy and radiation therapy.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may include the following:

  • Surgery and/or radiation therapy.
  • Chemotherapy and radiation therapy.
  • A clinical trial of chemotherapy before surgery or radiation therapy.
  • A clinical trial of chemotherapy after surgery or other cancer treatment.
  • A clinical trial of chemotherapy and radiation therapy.

For inverting papilloma, treatment is usually surgery with or without radiation therapy.

For melanoma and sarcoma, treatment may include the following:

  • Surgery.
  • Radiation therapy.
  • Chemotherapy.

For midline granuloma, treatment is usually radiation therapy.

If cancer is in the nasal vestibule, treatment may include the following:

  • External radiation therapy and/or internal radiation therapy with or without surgery.
  • A clinical trial of chemotherapy before surgery or radiation therapy.
  • A clinical trial of chemotherapy after surgery or other cancer treatment.
  • A clinical trial of chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Paranasal Sinus and Nasal Cavity Cancer

Treatment of recurrent paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity.

If cancer is in the maxillary sinus, treatment may include the following:

If cancer is in the ethmoid sinus, treatment may include the following:

  • Surgery and/or radiation therapy.
  • Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of chemotherapy.

If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and may include radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.)

If cancer is in the nasal cavity, treatment may include the following:

  • Surgery and/or radiation therapy.
  • Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of chemotherapy.

For inverting papilloma, treatment is usually surgery with or without radiation therapy.

For melanoma and sarcoma, treatment may include the following:

  • Surgery.
  • Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.

For midline granuloma, treatment is usually radiation therapy.

If cancer is in the nasal vestibule, treatment may include the following:

  • Surgery and/or radiation therapy.
  • Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Paranasal Sinus and Nasal Cavity Cancer

For more information from the National Cancer Institute about paranasal sinus and nasal cavity cancer, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following:



Cancer Care Services

Clinical Trials