Sinonasal cancer is a rare but serious cancer in the lining of the sinuses and nasal cavity. Early detection is crucial for successful treatment.
What is sinonasal cancer?
Sinonasal cancer, sometimes called sinus cancer, develops in the lining of the sinuses and nasal cavity. Sinuses are air-filled spaces in the skull that connect to the nose and regulate temperature, humidity, and voice resonance. The cancer can spread to other parts of the head and neck, and, in some cases, to other parts of the body.
Early symptoms are often hard to spot and can be mistaken for other conditions. Sinonasal cancer accounts for about 3% of all head and neck cancers, with approximately 3,000 new cases diagnosed in the United States each year. While sinonasal cancer is rare, it’s crucial to be aware of its symptoms and seek medical attention if you experience any persistent or unusual symptoms in your nose or sinuses.
AHN Head and Neck Cancer Center of Excellence
At the AHN Head and Neck Cancer Center of Excellence, we have extensive experience in treating patients with sinonasal cancer. You can expect compassionate care, a comprehensive diagnosis, and a personalized treatment plan. At the Cancer Institute, our patients can access robust support services including cancer support groups and palliative care. We also have a cancer genetics department that can help provide more insight into your diagnosis and prognosis.
Our team has a deep understanding of the latest sinonasal cancer treatments. We are committed to personalized care and finding the right treatment for you. Our compassionate team of medical oncologists, radiation oncologists, and otolaryngologists uses the latest research to treat even the most complex cases of cancer. We use minimally invasive techniques whenever possible, so your recovery is shorter and more comfortable. At the Cancer Institute, you can find expert cancer care, close to home.
Sinonasal cancer symptoms and signs
Early symptoms of sinonasal cancer are often subtle and can be mistaken for common ailments like allergies or a cold. As the cancer progresses, symptoms may become more severe. If you notice a worsening of the following symptoms, see your doctor. Sinonasal cancer symptoms include:
- Nasal obstruction: Prolonged difficulty breathing through the nose, feeling of congestion.
- Nasal discharge: Thick, bloody, or foul-smelling mucus.
- Facial pain or pressure: Pain in the face, forehead, or around the eyes.
- Headaches: Persistent or worsening headaches.
- Loss of smell or taste: Difficulty smelling or tasting.
- Bleeding from the nose: Frequent or unexplained nosebleeds.
- Facial swelling: Swelling around the eyes, cheeks, or nose.
- Changes in appearance: Bulging of the eyes, drooping of the eyelid, or changes in facial features.
- Hearing loss: Difficulty hearing, especially in one ear.
- Dental problems: Loose teeth or pain in the teeth or gums.
If you experience any of these symptoms, it’s important to see a doctor right away.
Sinonasal cancer risk factors
The exact cause of sinonasal cancer is unknown, but certain factors can increase the risk. If you have any of the following risk factors, it’s important to talk to your doctor and have regular preventive care:
- Exposure to wood, leather, or nickel dust: Workers in the wood, leather, or nickel refining industry have a higher risk.
- Exposure to formaldehyde: Workers in the furniture and construction industries may be at risk.
- Smoking: Smoking significantly increases the risk of sinonasal cancer.
- Genetic predisposition: Some individuals may have a genetic predisposition to developing sinonasal cancer.
- Epstein-Barr virus (EBV) infection: EBV infection has been linked to some types of sinonasal cancer.
Sinonasal cancer screening and diagnosis
There is no routine screening test for sinonasal cancer. Diagnosing sinonasal cancer involves a combination of reviewing your medical history, conducting a physical examination, and having diagnostic testing. However, if you experience any of the symptoms listed above, it’s important to see a doctor for evaluation.
Imaging tests
Once sinonasal cancer is confirmed, imaging tests are used to determine the extent of the cancer. These tests can help determine the size and location of the tumor, whether it has spread to nearby lymph nodes, and if it has metastasized to other parts of the body.
Common imaging tests to help determine the extent of the disease for sinonasal cancer include:
- CT scans: Computed Tomography (CT) provides detailed cross-sectional images of the sinuses, nasal cavity, and surrounding structures, helping to determine the size and extent of the tumor.
- MRI scans: Magnetic Resonance Imaging (MRI) provides detailed cross-sectional images of the sinuses, nasal cavity, and surrounding structures, helping to determine the size and extent of the tumor.
Endoscopy
This procedure uses a thin, flexible tube with a camera inserted into the nose to examine the sinuses. It can be used to obtain biopsies and to assess the extent of the cancer.
Biopsy
If a suspicious area is found during a visual examination, a biopsy is typically performed. This involves taking a small sample of tissue from the affected area and examining it under a microscope.
A biopsy is considered one of the best ways to confirm a cancer diagnosis, including sinonasal cancer. Biopsies give doctors the information needed to understand the cancer type and characteristics.
Types and stages of sinonasal cancer
Staging sinonasal cancer helps doctors determine the best treatment options, estimate the prognosis (outlook), and plan follow-up care. Sinonasal cancer is classified based on the type of cells involved and the stage of the cancer.
Types:
- Squamous cell carcinoma: The most common type, originating from the squamous cells lining the sinuses and nasal cavity.
- Adenocarcinoma: This type of sinonasal cancer arises from glandular cells.
- Undifferentiated carcinoma: Sometimes cancer cells are poorly differentiated and difficult to classify. This is referred to as undifferentiated carcinoma.
- Other types: Sinonasal cancer can also include melanoma, lymphoma, and sarcoma.
Sinonasal cancer is staged using the TNM system, which stands for Tumor, Node, Metastasis. This system helps doctors determine the extent of the cancer and plan the most appropriate treatment. The staging system is a guide, and the actual prognosis can vary depending on individual factors, such as age, overall health, and response to treatment. Here’s a breakdown of the common stages:
- Stage zero (Carcinoma in Situ): This is the earliest stage, where abnormal cells are confined to the sinuses and nasal cavity at less than 3 cm in size.
- Stage one and two: These are considered early stages, and the cancer is typically confined to the nasal cavity or sinuses. Treatment options may include surgery and/or radiation therapy.
- Stage three: The cancer has spread beyond the nasal cavity or sinuses, but not to distant organs. Treatment options may include surgery, radiation therapy, and/or chemotherapy.
- Stage four: The cancer has spread to distant organs, such as the lungs, liver, or bones. Treatment options may include surgery, radiation therapy, chemotherapy, and/or targeted therapy.
The prognosis for sinonasal cancer depends on the stage of the cancer, the type of cells involved, and the patient’s overall health. Early detection and treatment offer the best chance of survival.
Sinonasal cancer treatment
Treatment for sinonasal cancer depends on the type, stage, and location of the cancer, as well as the patient’s overall health. The goal of treatment is to cure the cancer, control its growth, or relieve symptoms. Treatment may involve a combination of different therapies.
Surgery
Surgery aims to remove the sinonasal cancer and any involved lymph nodes. The extent of surgery depends on the tumor’s location and size, ranging from endoscopic procedures for smaller tumors to more extensive procedures like maxillectomy (removal of part of the upper jaw) or craniofacial resection (removal of portions of the skull and face). Reconstruction is often necessary after extensive surgeries to restore facial structure and function. Surgical margins are carefully examined under a microscope to ensure complete tumor removal. Your AHN care team takes a multidisciplinary approach to your care, so your doctors will work together to before, during, and after surgery to pursue the best outcome for you.
Radiation therapy
Radiation therapy uses high-energy beams to kill sinonasal cancer cells and shrink tumors. It can be used alone or in combination with surgery or chemotherapy, often as adjuvant therapy (after surgery) to eliminate any remaining microscopic sinonasal cancer cells. External beam radiation is most common, delivering radiation from a machine outside the body. Proton therapy is a more precise form of radiation that may reduce side effects.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells throughout the body. It’s often used in advanced sinonasal cancer or when the cancer has spread to other parts of the body (metastatic disease). Chemotherapy regimens typically involve combinations of drugs administered intravenously. It may be used before surgery to shrink the tumor (neoadjuvant) or after surgery to kill any remaining cancer cells. Common side effects include nausea, vomiting, fatigue, hair loss, and decreased blood cell counts.
Targeted therapy
Targeted therapy uses drugs that specifically target cancer cells based on their unique characteristics, such as specific genes or proteins. These therapies aim to inhibit the growth and spread of cancer cells with minimal damage to healthy cells. In sinonasal cancer, targeted therapies are often used in advanced disease, either alone or in combination with other treatments. The specific targeted therapies used depend on the molecular characteristics of the individual tumor. Side effects vary depending on the specific drug but can include fatigue, skin rashes, and diarrhea.
Immunotherapy
Immunotherapy aims to harness the body’s own immune system to fight cancer. It works by stimulating the immune system to recognize and attack cancer cells. In sinonasal cancer, immunotherapy agents like checkpoint inhibitors are sometimes used, particularly in advanced or recurrent disease. These drugs block proteins that prevent the immune system from attacking cancer cells. Immunotherapy can lead to significant and durable responses, but side effects, including immune-related adverse events, can occur.
Contact us
Call the AHN Cancer Help Line anytime at (412) NURSE-4-U (412) 687-7348 to schedule a cancer-related appointment or to just talk with our nurses about diagnoses, treatments, and side effects.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.