Nasal and paranasal sinus cancer

Nasal and paranasal sinus cancer is a type of head and neck cancer.

Nasal and paranasal sinus cancer (malignant cells) form in the tissues of the nasal cavity (the space behind your nose) and the sinuses (small air-filled cavities inside your nose, cheekbones and forehead).

• 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 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.
• 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 4 paranasal sinuses:
    • 1) The Frontal sinuses are in the lower forehead above the nose
    • 2) The Maxillary sinuses are in the cheekbones on either side of the nose
    • 3) The Ethmoid sinuses are beside the upper nose, between the eyes
    • 4) The Sphenoid sinuses are behind the nose, in the center of the skull
• Different types of cells in the paranasal sinus and nasal cavity may become malignant.
  • 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:
    • 1) Melanoma: Cancer that starts in cells called melanocytes, the cells that give skin its natural color.
    • 2) Sarcoma: Cancer that starts in muscle or connective tissue.
    • 3) Inverting papilloma: Benign tumors that form inside the nose. A small number of these change into cancer.
    • 4) Midline granulomas: Cancer of tissues in the middle part of the face.

Risk factors:

• Being exposed to certain chemicals or dust in the workplace can increase the risk of paranasal sinus and nasal cavity cancer.
• Jobs such as: 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
• A study has shown that people who have had non Hodgkin lymphoma may have a higher risk of nasal cavity cancer compared to the general population.

Signs of paranasal sinus and nasal cavity cancer:

• There may be no signs or symptoms in the early stages.
• Signs and symptoms may appear as the tumor grows.
• 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.

Diagnosis:

• If cancer is suspected, a MRI, CT or PET scan may be used to diagnose the condition.
• An endoscope can be used to biopsy the suspected mass, either using local or general anesthesia. The removed sample is analyzed by a pathologist to determine whether it is cancerous

Prognosis (chance of recovery):

• 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.

Incidence and Mortality

• Malignant neoplasms, or cancerous tumors, of the nasal cavity and paranasal sinuses are relatively rare, with about 2,000 people in the United States developing these cancers each year.
• About 3 percent of malignant cancers of the head and neck affect the nasal cavity and paranasal sinuses.
  • Overall, these cancers make up about 0.5 percent of all malignant cancers.
  • Men are more likely to fall ill with these cancers, and 4 of 5 people affected are aged 55 years and older.
• Only around 400 cases are diagnosed in the UK each year. Compared with around 41,300 cases of bowel cancer diagnosed each year.
• They occur much more often in certain areas of the world such as Japan and South Africa.
• The majority of tumors of the paranasal sinuses present with advanced disease, and cure rates are generally poor (≤50%). Squamous cell carcinoma (SCC) is the most frequent type of malignant tumor in the nose and paranasal sinuses (70%–80%). Papillomas are distinct entities that may undergo malignant degeneration. The cancers grow within the bony confines of the sinuses and are often asymptomatic until they erode and invade adjacent structures.
• Cancers of the maxillary sinus are the most common of the paranasal sinus cancers. Tumors of the ethmoid sinuses, nasal vestibule, and nasal cavity are less common, and tumors of the sphenoid and frontal sinuses are rare.
• The most recent incidence and mortality statistics for nasal cavity and paranasal sinus cancer are from 2013. (from: Canadian Cancer Society - Nasal Cavity & Paranasal Cavity Sinus Cancer Statistics):
  • 360 Canadians were diagnosed with nasal cavity and paranasal sinus cancer.
  • 80 Canadians died from nasal cavity and paranasal sinus cancer.
  • 220 men were diagnosed with nasal cavity and paranasal cavity sinus cancer and 52 died from it.
  • 135 women were diagnosed with nasal cavity and paranasal sinus cancer and 28 died from it.
• The outlook varies, depending on the specific type of nasal and sinus cancer, its exact location, how far it's spread before being diagnosed and treated, and the overall level of health and fitness of the person.
• More than 70 out of every 100 people with nasal and sinus cancer will survive for 1 year or more after diagnosis. Around 50 out of 100 people will survive for 5 years or more after being diagnosed.
• Cancer of the nasal cavity generally has a better outlook than cancer of the sinuses.
• Cancer Research 37, 3473-3474, Oct 1977 - A Death Certificate Analysis of Nasal Cancer among Furniture Workers in North Carolina, By: Louise A Brinton, William J Blot, BJ Stone & Joseph F Fraumeni, Jr

Resources & Additional Reading:

• National Cancer Institute - Paranasal Sinus & Nasal Cavity Cancer Treatment - Health Professional Version
• Cancer Research UK - Nasal & Paranasal Sinus Cancer, Risks & causes
• Very well health.com - Understanding Nasal Cavity & Paranasal Sinus Cancers
• MedlinePlus Nasal Cancer
• American Cancer Society - What Are the Key Statistics About Nasal Cavity and Paranasal Sinus Cancers?
• Merck Manual Consumer Version - Overview of Mouth, Nose & Throat Cancer. by Bradley A Schiff, MD
• https://www.nhs.uk/conditions/nasal-and-sinus-cancer/ NHS - Nasal & Sinus Cancer]
• Cancer Council Victoria - Head & neck cancers overview

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