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Cancers
What is cancer?
The body is made up of trillions of living cells. Normal body cells grow, divide into new
cells, and die in an orderly fashion. During the early years of a person's life, normal cells
divide faster to allow the person to grow. After the person becomes an adult, most cells
divide only to replace worn-out or dying cells or to repair injuries.
Cancer begins when cells in a part of the body start to grow out of control. There are
many kinds of cancer, but they all start because of out-of-control growth of abnormal
cells.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells
continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into)
other tissues, something that normal cells cannot do. Growing out of control and invading
other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA. DNA is in every cell and directs
all its actions. In a normal cell, when DNA gets damaged the cell either repairs the
damage or the cell dies. In cancer cells, the damaged DNA is not repaired, but the cell
doesnt die like it should. Instead, this cell goes on making new cells that the body does
not need. These new cells will all have the same damaged DNA as the first cell does.
People can inherit damaged DNA, but most DNA damage is caused by mistakes that
happen while the normal cell is reproducing or by something in our environment.
Sometimes the cause of the DNA damage is something obvious, like cigarette smoking.
But often no clear cause is found.
In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form
tumors. Instead, these cancer cells involve the blood and blood-forming organs and
circulate through other tissues where they grow.
Cancer cells often travel to other parts of the body, where they begin to grow and form
new tumors that replace normal tissue. This process is called metastasis. It happens when
the cancer cells get into the bloodstream or lymph vessels of our body.
No matter where a cancer may spread, it is always named for the place where it started.
For example, breast cancer that has spread to the liver is still called breast cancer, not
liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate
cancer, not bone cancer.
Different types of cancer can behave very differently. For example, lung cancer and
breast cancer are very different diseases. They grow at different rates and respond to
different treatments. That is why people with cancer need treatment that is aimed at their
particular kind of cancer.
Not all tumors are cancerous. Tumors that arent cancer are called benign. Benign tumors
can cause problems they can grow very large and press on healthy organs and tissues.
But they cannot grow into (invade) other tissues. Because they cant invade, they also
cant spread to other parts of the body (metastasize). These tumors are almost never life
threatening.
The nose opens into the nasal passageway, or cavity. This cavity is a space that runs
along the top of the roof of the mouth (the palate, which separates your nose from your
mouth) and then turns downward to join the passage from the mouth to the throat.
Sinuses are cavities (spaces) or small tunnels. They are called paranasal because they are
around or near the nose. The nasal cavity opens into a network of paired sinuses:
Maxillary sinuses are in the cheek area, below the eyes on either side of the nose.
Frontal sinuses are above the inner eye and eyebrow area.
Sphenoid sinuses are situated deep behind the nose, between the eyes.
Ethmoid sinuses are made up of many sieve-like sinuses formed of thin bone and
mucous tissues. They are above the nose, between the eyes.
Normally, these sinuses are filled with air. When you have a cold or sinus infection the
sinuses can become blocked (obstructed) and fill with mucus and pus, which can be
uncomfortable.
The nasal cavity and paranasal sinuses have several functions:
They help filter, warm, and moisten the air you breathe.
They give your voice resonance.
They lighten the weight of the skull.
They provide a bony framework for the face and eyes.
The nasal cavity and the paranasal sinuses are lined by a layer of mucus-producing tissue
called mucosa. The mucosa has many types of cells, including:
Squamous epithelial cells, which are flat cells that line the sinuses and make up most
of the mucosa
Glandular cells such as minor salivary gland cells, which produce mucus and other
fluids
Nerve cells, which are responsible for sensation and the sense of smell in the nose
Infection-fighting cells (which are part of the immune system), blood vessel cells, and
other supporting cells
Other types of cells in the nasal cavity and paranasal sinuses, including bone and
cartilage cells, can also become cancerous.
Cells that give the skin its tan or brown color are called melanocytes. These cells give
rise to a type of cancer called melanoma. This is typically a cancer that can grow and
spread quickly. These cancers usually are found on sun-exposed areas of the skin but
can form on the lining of the nasal cavity and sinuses or other areas inside the body.
Esthesioneuroblastoma is a cancer that starts in the olfactory nerve (the nerve for the
sense of smell). This tumor is also known as olfactory neuroblastoma. This type of
cancer usually occurs on the roof of the nasal cavity and involves a structure called
the cribriform plate. The cribriform plate is a bone deep in the skull, between the
eyes, and above the ethmoid sinuses. These tumors can sometimes be mistaken for
other types of tumors, like undifferentiated carcinoma or lymphoma.
Lymphomas (cancers arising from immune system cells called lymphocytes) can also
occur in the nasal cavity and paranasal sinuses. One type of lymphoma seen in this
area, T-cell/natural killer cell nasal-type lymphoma, was previously called lethal
midline granuloma. Information about the diagnosis and treatment of lymphomas can
be found in our document Non-Hodgkin Lymphoma.
Sarcomas are cancers of muscle, bone, cartilage, and fibrous cells that can start
anywhere in the body, including the nasal cavity and paranasal sinuses. Information
about sarcomas can be found in some of our other documents.
Each of these types of cancer has a distinct behavior and outlook. They cannot all be
treated the same way. Many of these cancers rarely affect the nasal cavity and paranasal
sinuses, so they have been hard to study thoroughly. Because of this, doctors must base
treatment decisions on their experience with similar cancers elsewhere in the head and
neck area.
Nasal polyps
Nasal polyps are abnormal growths inside the nasal cavity or paranasal sinuses. Polyps
usually have a teardrop shape and tend to have a smooth surface. Most nasal polyps are
benign (non-cancerous) and are caused by some type of chronic inflammation in the nose.
Using standard exams and tests, doctors can often tell benign polyps from cancer, but in
some cases polyps may need to be evaluated more thoroughly to be sure. Small polyps
that cause no symptoms may not need treatment, but larger polyps that cause problems
may need to be treated with medicine or surgery.
Papillomas
Papillomas are warts that can grow inside the nasal cavity or paranasal sinuses and
destroy healthy tissue. They usually have a bumpy surface. Papillomas are not cancer, but
sometimes a squamous cell carcinoma will start in a papilloma. Because of the risk of
cancer, papillomas in the nasal cavity and paranasal sinuses are removed by surgery.
Inverting papilloma. This is a type of papilloma that is officially classified as a benign
tumor, but it tends to act more like a cancer. It has a tendency to recur (come back) and
can grow into surrounding tissues. The treatment of inverting papilloma often includes
the same type of surgery that is used for cancer.
Workplace exposures
People who work in certain jobs are more likely to develop nasal cavity and paranasal
sinus cancer. The increased risk seems to be related to breathing in certain substances
while at work, such as:
Wood dusts from carpentry (such as furniture and cabinet builders), sawmills, and
other wood-related industries
Dusts from textiles (textile plants)
Leather dusts (shoemaking)
Flour (baking and flour milling)
Nickel and chromium dust
Mustard gas (a poison used in chemical warfare)
Radium (a radioactive element rarely used today)
These workplace exposures have less clear links to nasal and paranasal sinus cancer:
Glues
Formaldehyde
Organic solvents
Smoking
Some studies have found that smoking might increase the risk of nasal cavity cancer.
Retinoblastoma
People with the inherited form of retinoblastoma, a type of eye cancer that typically
develops in children, have an increased risk of nasal cavity cancer if their retinoblastoma
was treated with radiation.
Most people with cancer of the nasal cavity and paranasal sinuses have no known risk
factors, so there is currently no way to prevent most of these cancers.
Screening
Screening refers to tests and exams used to detect a disease, such as cancer, in people
who do not have any symptoms. Screening can find some types of cancer early, when
treatment is most likely to be effective. But at this time there is no simple screening test
that can routinely find nasal cavity and paranasal sinus cancers early. These cancers are
also fairly rare. Because of this, neither the American Cancer Society nor any other group
recommends routine screening for these cancers.
Your doctor may also examine the nasal cavity with a headlight or even look inside your
nose with a special instrument called a nasal endoscope (a thin tube designed to allow the
doctor to see into the nasal passages).
If your doctor suspects you might have cancer of the nasal cavity or paranasal sinuses,
you will be referred to an otolaryngologist (a doctor who specializes in diseases of the
ear, nose, and throat; also known as an ENT doctor), who will more thoroughly examine
your nasal passages and the rest of your head and neck area. This might include an exam
of your throat, which can be done with small mirrors or with a fiber-optic scope a thin,
flexible, lighted tube that is passed down through the mouth or nose.
Imaging tests
Imaging tests use x-rays, magnetic fields, or other means to create pictures of the inside
of your body. Imaging tests are not used to diagnose nasal cavity or paranasal sinus
cancers, but they may be done for a number of reasons both before and after a cancer
diagnosis, including:
To help look for a tumor if one is suspected
To learn how far cancer may have spread
To help determine if treatment has been effective
To look for possible signs of cancer recurrence after treatment
these pictures into an image of a slice of your body. Unlike a regular x-ray, a CT scan
creates detailed images of the soft tissues and organs in the body.
Often after the first set of pictures is taken, you may receive an injection of a dye or
radiocontrast agent into an intravenous (IV) line. This dye helps to better outline
structures in your body. A second set of pictures is then taken. Some people are allergic
to the dye and get hives, a flushed feeling, or, rarely, more serious reactions like trouble
breathing and low blood pressure. Be sure to tell your doctor if you have any allergies or
have ever had a reaction to any contrast material used for x-rays.
Chest x-ray
If you have been diagnosed with nasal cavity or paranasal sinus cancer, this test might be
done to find out if the cancer has spread to your lungs, which is the most common site of
spread other than lymph nodes.
Biopsy
A biopsy is a procedure in which a doctor removes a sample of tissue to be looked at
under a microscope. It is the only way to confirm the diagnosis of nasal cavity or
paranasal sinus cancer. If cancer is found, the biopsy can also help the doctor tell what
type of cancer it is and how aggressive it is. This is important to help plan the most
effective treatment.
Often, biopsies are done in the doctors office or clinic. If the tumor is in a hard-to-reach
area, the biopsy will be done in the operating room. Several types of biopsies can be used
to diagnose nasal cavity or paranasal sinus cancer.
T categories
The T group of nasal cavity and paranasal sinus cancers is based on the results of head
and neck exams and on any imaging tests of the area, such as CT or MRI scans. Higher T
group numbers indicate more growth within the nasal cavity or paranasal sinuses or
spread to other nearby areas. The T groups for cancers that start in the maxillary sinuses
differ from those for cancers that start in the nasal cavity or ethmoid sinuses.
T4a: Tumor has grown into other structures such as the front part of the eye socket, the
skin of the nose or cheek, the sphenoid sinus, the frontal sinus, or certain bones in the
face (pterygoid plates). This is also known as moderately advanced local disease.
Cancers that are T4a are usually resectable (meaning they can be removed with surgery).
T4b: Tumor is growing into the back of the eye socket, the brain, the dura (the tissue
covering the brain), some parts of the skull (the clivus or the middle cranial fossa),
certain nerves, or the nasopharynx (throat behind the nasal cavity). This is also known as
very advanced local disease. These tumors are not resectable (they cannot be removed
with surgery).
N categories
The N groups are based on spread of the cancer to nearby (regional) lymph nodes and on
the size of the nodes. These groups are the same for all nasal cavity and paranasal sinus
cancers:
NX: Nearby (regional) lymph nodes cannot be assessed.
N0: Cancer has not spread into the lymph nodes.
N1: Cancer has spread to a single lymph node that is on the same side as the tumor and is
no larger than 3 centimeters (cm) across (slightly larger than 1 inch).
N2: Cancer has spread to a single lymph node on the same side as the tumor that is larger
than 3 cm but no larger than 6 cm (slightly larger than 2 inches) across; or cancer has
spread to more than one lymph node on the same side as the tumor, all of which are no
larger than 6 cm across; or cancer is in at least one lymph node that is not on the same
side as the tumor (but none are larger than 6 cm across).
N3: Cancer has spread to at least one nearby lymph node that is larger than 6 cm across.
M categories
The M groups for all nasal cavity and paranasal sinus cancers are the same:
M0: No cancer spread (metastasis) distant organs or tissues
M1: The cancer has spread to distant organs such as the lung or distant bones.
Stage groupings
Once the T, N, and M groups have been assigned, this information is combined to assign
an overall stage for the cancer. This process is called stage grouping. Stage grouping
rules are the same for all cancers of the nasal cavity and paranasal sinuses.
Stage
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage II
T2
N0
M0
T3
N0
M0
T1, T2, or T3
N1
M0
T1, T2, or T3
N2
M0
T4a
N0, N1, or N2
M0
Any T
N3
M0
T4b
Any N
M0
Any T
Any N
M1
Stage III
Stage IVA
Stage IVB
Stage IVC
In general, patients with lower stage cancers tend to have a better outlook for a cure or
long-term survival.
To get 5-year survival rates, doctors have to look at people who were treated at least 5
years ago. Improvements in treatment since then may result in a more favorable outlook
for people now being diagnosed with these cancers.
The following statistics were published in 2010 in the 7th edition of the AJCC Staging
Manual. They come from the National Cancer Data Base and are based on nasal and
paranasal sinus cancers diagnosed between 1998 and 1999. They include people with all
types of nasal and paranasal sinus cancers.
Stage
5-year relative
survival rate
63%
II
61%
III
50%
IV
35%
Survival rates are often based on previous outcomes of large numbers of people who had
the disease, but they cannot predict what will happen in any particular persons case.
Many other factors may affect a persons outlook, such as their general state of health,
the exact type and location of the cancer, the treatment received, and how well the cancer
responds to treatment. Your doctor can tell you how the numbers above may apply to the
aspects of your particular situation.
In creating your treatment plan, the most important factors to consider are the type,
location, and the stage (extent) of the cancer. Your cancer care team will also take into
account your general state of health and your personal preferences.
Treatment for nasal cavity or paranasal sinus cancer may include:
Surgery
Radiation therapy
Chemotherapy
Targeted therapy
Palliative treatment
Depending on the stage of the cancer and your general medical condition, different
treatment options may be used alone or in combination. For early stage cancer, surgery
may be all that is needed. For more advanced cancer, other treatments like radiation
therapy, chemotherapy, or targeted therapy may be needed in addition to or instead of
surgery. Be sure to ask your doctor to explain the stage of your cancer so that you can
make the best choice about your treatment.
Based on the treatment options, you may have different types of doctors on your
treatment team. These doctors may include:
An otolaryngologist: a doctor who specializes in certain diseases of the head and neck
(also known as an ear, nose, and throat, or ENT doctor)
A neurosurgeon: a doctor who specializes in surgery on the brain, spine, and other
parts of the nervous system.
A radiation oncologist: a doctor who treats cancer with radiation therapy.
A medical oncologist: a doctor who treats cancer with medicines such as
chemotherapy.
Many other specialists may be involved in your care as well, including nurse
practitioners, nurses, nutrition specialists, social workers, and other health professionals.
It is important to discuss all of your treatment options, including their goals and possible
side effects, with your doctors to help make the decision that best fits your needs. If time
permits, it is often a good idea to get a second opinion. A second opinion can give you
more information and help you feel confident about your chosen treatment plan. These
are uncommon cancers, and not all hospitals and doctors have a lot of experience in
treating them.
If the cancer is too advanced to be cured, the goal may be to remove or destroy as much
of the cancer as reasonable to keep the tumor from growing, spreading, or returning for as
long as possible. Some of the treatments above can also be used as palliative treatment if
all the cancer cannot be removed. Palliative treatment is meant to relieve symptoms such
as pain, but it is not expected to cure the cancer.
The next few sections describe the different types of treatment for nasal cavity and
paranasal sinus cancers. This is followed by a discussion of the most common treatment
options based on the location and stage of the cancer.
that usually includes an otolaryngologist (head and neck surgeon) and a neurosurgeon (a
surgeon who operations on the brain, spinal cord, and other nerves).
Endoscopic surgery
In this type of surgery, the surgeon uses an endoscope (a thin, flexible lighted tube
inserted into the nose to reach the nasal cavity or sinus) to see and remove the tumor.
That way, the surgeon does not have to cut through bone to open up the whole cavity.
This reduces the actual amount of normal tissue destroyed. In general, recovering from
this type of surgery takes less time.
Endoscopic surgery is most often used for smaller tumors. For larger tumors, it may be
used to help try to control the tumor in people who are not healthy enough for a bigger
operation. Usually it is combined with radiation treatment.
Endoscopic approaches to remove nasal and sinus cancers are being used more
commonly as an increasing number of surgeons are trained in these techniques. These
approaches might be less invasive but are best performed by teams of experienced
surgeons at specialized centers. Some medical centers (and surgeons) have more
experience than others with endoscopic surgery for nasal and sinus cancers. If you are
considering endoscopic surgery as a part of your treatment, be sure to ask about your
surgeons training and experience, which are key to successful endoscopic surgery.
For more information on surgery, see our document Understanding Cancer Surgery: A
Guide for Patients and Families.
Several newer techniques help doctors focus the radiation more precisely, and may be
helpful in some situations.
Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses the results
of imaging tests such as MRI and special computers to map the location of the tumor
precisely. Several radiation beams are then shaped and aimed at the tumor from different
directions. Each beam alone is fairly weak, which makes it less likely to damage normal
tissues, but the beams converge at the tumor to give a higher dose of radiation there.
Patients are fitted with a mold or cast to keep the body part still so the radiation can be
aimed more accurately.
Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D
therapy. It uses a computer-driven machine that actually moves around the patient as it
delivers radiation. In addition to shaping the beams and aiming them at the tumor from
several angles, the intensity (strength) of the beams can be adjusted to minimize the dose
reaching the most sensitive nearby normal tissues. This may let the doctor deliver a
higher dose to the tumor. Many major hospitals and cancer centers now use IMRT as the
standard way to deliver external beam radiation.
Stereotactic radiosurgery (SRS): SRS is not really surgery, but a type of radiation
treatment that gives a large dose of radiation to a small tumor area in one session. It is
mostly used for brain tumors and other tumors inside the head. In some cases, a head
frame or shell may be used to help keep the patients head still and aim the radiation
beams precisely. Once the exact location of the tumor is known from the CT or MRI
scans, radiation is sent to the area from a machine. The radiation is very precise and
nearby tissues are affected as little as possible. Most of the time, stereotactic radiosurgery
treatment gives the whole radiation dose in one session. The main advantage of SRS over
IMRT is the shortened treatment time.
Brachytherapy
Another way to deliver radiation is to insert (implant) very thin metal rods containing
radioactive materials in or near the cancer. The radiation travels only a very short
distance, which limits its effects on nearby normal tissues. This method is called internal
radiation, interstitial radiation, or brachytherapy. This is sometimes done if the cancer
comes back after external beam radiation therapy.
The implant is usually left in place for several days while the patient stays in a private
hospital room. The length of time that visitors, nurses, and other caregivers can spend
with the patient may be limited because of potential radiation exposure, but this depends
on the type of radiation. The implants are removed before the patient goes home.
Sometimes, internal and external beam radiation therapy are used together. With more
modern approaches to delivering radiation such as IMRT and SRS, brachytherapy is less
commonly performed.
However, there are ways to relieve many of the side effects caused by radiation, so its
important to discuss any symptoms with your cancer care team.
For more information on radiation therapy, see the Radiation Therapy section of our
website, or our document Understanding Radiation Therapy: A Guide for Patients and
Families.
Chemo drugs may be used alone, but more often they are used in combination with one
another. The drugs used depend on several factors, including the extent of the cancer, the
persons overall health, and whether chemo is combined with radiation therapy. Cisplatin
(sometimes combined with 5-FU) is the drug most often given with radiation. Some
studies have shown that giving docetaxel with these 2 drugs may work even better.
New chemo drugs and combination treatments are also being studied. Some doctors give
the drugs directly into arteries leading to the tumor. This concentrates the chemotherapy
into the area that needs it to try to reduce side effects.
Different chemo drugs are used for sarcomas and melanomas. Information about
chemotherapy for sarcomas may be found in our document Sarcoma: Adult Soft Tissue
Cancer. Drug therapy for melanoma is covered in our document Melanoma Skin Cancer.
Some side effects continue long after treatment is stopped. For example, cisplatin can
cause nerve damage (neuropathy), which can lead to numbness in the hands and feet or
hearing loss. These symptoms usually improve after the drug is stopped, but may not go
away completely.
If your doctor plans treatment with chemo you should be sure to discuss which drugs will
be used and the possible side effects. Once chemo is started, let your health care team
know if you have side effects, so they can be treated.
For more information on chemotherapy, see the Chemotherapy section on our website,
or our document A Guide to Chemotherapy.
After surgery, most people with these cancers are treated with radiation. Radiation may
not be needed for people with stage I cancers if the cancer was removed completely with
negative margins (meaning that there are no cancer cells at the edge of the removed
specimen), and the cancer was not growing into the area around the nerves (called
perineural invasion).
For stage II cancers and stage I cancers that couldnt be removed completely, had
positive margins (cancer cells were found in the edges of the tissue removed), or
perineural invasion, radiation is often given after surgery. Some doctors may recommend
chemotherapy (chemo) or targeted therapy along with the radiation.
Radiation is often recommended for cancers that are the type called adenoid cystic, even
if the margins are negative and there is no perineural invasion.
In situations where surgery to remove the cancer would be risky because of other medical
problems, treatment may be radiation therapy alone. Sometimes chemo is given with the
radiation.
Stages III and IVA: People with these stages of maxillary sinus cancer are also treated
with surgery to remove the tumor. If there are signs that the cancer has spread to the
lymph nodes in the neck, these lymph nodes are removed as well (a neck dissection).
After surgery, the area where the tumor had been is treated with radiation therapy.
Sometimes the lymph nodes in the neck are also treated with radiation. This is more
likely if the cancer has spread to a neck lymph node. Chemo (or targeted therapy) may be
given along with the radiation therapy. This has more side effects than giving either
treatment alone, but it may also reduce the risk that the cancer will grow back after
treatment. Sometimes the radiation (and chemo) are given before the surgery to try to
shrink the tumor so that it can be more easily or more completely removed.
Stage IVB: Some cancers are in this stage because the main tumor is not resectable (it
cannot be removed completely with surgery). People with these cancers are usually
treated with radiation therapy. They may also receive chemo (or targeted therapy).
Surgery is sometimes done before radiation therapy to help relieve sinus blockage, but it
is not meant to cure or completely remove the cancer on its own.
Stage IVB also includes some cancers where the main tumor can be removed with
surgery (is resectable) but the cancer has spread to lymph nodes, making them larger than
6 cm (about 2 inches, across). These cancers are treated like stage IVA cancers
surgery to remove the tumor and neck lymph nodes, followed by radiation and maybe
chemo. Again, sometimes radiation and chemo are given before the operation to try to
shrink the tumor and make it easier to remove.
Stage IVC: These cancers have spread to organs beyond the head and neck. Cancers in
this stage are extremely hard to cure, so the goal of treatment is usually to stop or slow
the growth of the cancer for as long as possible and to help relieve any symptoms it may
be causing.
Treatment for this stage varies, depending on where the cancer is, the problems it is
causing, and a persons general health. Chemo (or targeted therapy) is often the main
form of treatment if a person can tolerate it because it reaches all parts of the body.
Radiation therapy may be directed at areas of cancer that are causing problems. Because
these cancers are hard to treat, clinical trials of newer treatments may be a good option
for some people.
Cancers that have spread to distant parts of the body are extremely hard to cure, so the
goal of treatment is usually to stop or slow the growth of the cancer for as long as
possible and to help relieve any symptoms it may be causing.
Treatment depends on where the cancer is, the problems it is causing, and a persons
general health. Chemo (or targeted therapy) is often the main treatment if a person can
tolerate it because it reaches all parts of the body. Radiation therapy may be directed at
areas of cancer that are causing problems. Because these cancers are hard to treat, clinical
trials of newer treatments may be a good option for some people.
Melanomas
Most melanomas of the nasal cavity or paranasal sinuses are treated with surgery to
remove the tumor and a surrounding area of normal tissue. Lymph nodes in the neck may
also be removed in an operation called a neck dissection. Radiation therapy is usually
given after surgery.
For cancers that cant be removed, radiation therapy, chemo, or other treatments
(immunotherapy or targeted therapy) may be used. Although a melanoma that forms in
the nasal cavity or a paranasal sinus is different in many ways from a melanoma skin
cancer, it is often treated the same way when it is advanced. For more information about
the treatment of advanced melanomas, see our document Melanoma Skin Cancer.
Sarcomas
Like with other cancers of the nasal cavity and the paranasal sinuses, surgery is the main
treatment for most types of sarcoma. In some cases radiation and/or chemo may also be
used.
Rhabdomyosarcoma is a type of sarcoma that is most common among infants and young
children. It is usually treated with a combination of surgery, radiation therapy, and
chemo. For more information about the treatment of rhabdomyosarcoma, please see our
document Rhabdomyosarcoma.
For other types of sarcoma, please see our document Sarcoma: Adult Soft Tissue Cancer.
For a local recurrence, if radiation was the first treatment for the cancer, surgery may be
used. If the first treatment was surgery without radiation, radiation therapy may be tried.
Chemo (or targeted therapy) may be used with radiation, or it may be used by itself to
treat recurrences that are not controlled by radiation therapy or surgery.
Recurrences of sphenoid sinus cancer are usually treated with chemotherapy (or targeted
therapy).
In a regional recurrence, the cancer comes back in the lymph nodes in the neck. This is
often treated with surgery to remove many lymph nodes in the neck (a neck dissection)
that are on the same side as the cancer. This may be followed with radiation to the neck,
sometimes combined with chemo and/or targeted therapy.
Recurrent melanomas or sarcomas of the nasal cavity or paranasal sinuses are treated by
surgery, if possible. Depending on the exact type of cells forming the cancers, chemo or
other treatments may also be given.
When a nasal cavity or paranasal sinus cancer comes back in other organs, it is often
treated with chemo and/or targeted therapy, although radiation could also be an option if
it wasnt given before.
Treatments for recurrent nasal cavity or paranasal sinus cancer may temporarily shrink
cancers and help relieve symptoms, but these cancers are very difficult to cure. If further
treatment is recommended, its important to talk to your doctor so that you understand
what the goal of treatment is whether it is to try to cure the cancer or to keep it under
control for as long as possible and relieve symptoms. This can help you weigh the pros
and cons of each treatment. Because these cancers are hard to treat, clinical trials of
newer treatments could be a good option for some people.
work or activity schedule. Or you may want to ask about second opinions or about
clinical trials for which you may qualify.
Follow-up care
If you have completed treatment, your doctors will still want to watch you closely. It is
very important to go to all follow-up appointments. People with cancer of the nasal cavity
or paranasal sinuses are at risk for developing recurrences, so they must be observed
closely after treatment. Your health care team will discuss which tests should be done and
how often based on the type and initial stage of your cancer, the type of treatment you
received, and the response to that treatment.
Experts typically recommend a doctors exam at least every 3 months for the first year
after treatment. After a year, the exams can occur less often. For someone who was
treated with radiation to the neck, blood tests to look at thyroid function may be needed.
The cancer care team will recommend which other tests should be done and how often.
CT or MRI scans of the head and neck and other imaging tests may be ordered shortly
after you finish treatment and if new symptoms develop to check for a recurrence or for a
new tumor.
Almost any cancer treatment can have side effects. Some may last for a few weeks to
several months, but others can last the rest of your life. Dont hesitate to tell your cancer
care team about any symptoms or side effects that bother you so they can help you
manage them.
Its very important to report any new symptoms to the doctor right away, because they
may prompt your doctor to do tests that could help find recurrent cancer as early as
possible, when the likelihood of successful treatment is greatest.
Its important to keep your health insurance. Tests and doctor visits cost a lot, and even
though no one wants to think of their cancer coming back, this could happen.
If cancer does recur, treatment will depend on the location of the cancer and what
treatments youve had before. For more information on how recurrent cancer is treated,
see the section Treatment options by type, location, and stage for nasal cavity and
paranasal sinus cancers. For more general information on dealing with a recurrence, you
may also want to see the document When Your Cancer Comes Back: Cancer Recurrence.
The doctor may want copies of this information for his records, but always keep copies
for yourself.
Eating better
Eating right can be a challenge for anyone, but it can get even tougher during and after
cancer treatment. This is especially true for cancers of the head and neck, such as nasal
cavity or paranasal sinus cancer. The cancer or its treatment may affect how you swallow
or cause other problems. Nausea can be a problem from some treatments. You may lose
your appetite for a while and lose weight when you dont want to.
If you are losing weight or have taste problems during treatment, do the best you can with
eating and remember that these problems usually improve over time. You might find it
helps to eat small portions every 2 to 3 hours until you feel better and can go back to a
more normal schedule. You might also want to ask your cancer team for a referral to a
dietitian, an expert in nutrition who can give you ideas on how to deal with these
treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into
place. You may be surprised at the long-term benefits of some simple changes, like
increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight,
eating a healthy diet, and limiting your alcohol intake may lower your risk for a number
of types of cancer, as well as having many other health benefits.
For more information, see our document Nutrition and Physical Activity During and
After Cancer Treatment: Answers to Common Questions.
church. Others may feel more at ease talking one-on-one with a trusted friend or
counselor. Whatever your source of strength or comfort, make sure you have a place to
go with your concerns.
The cancer journey can feel very lonely. It is not necessary or good for you to try to deal
with everything on your own. And your friends and family may feel shut out if you do
not include them. Let them in, and let in anyone else who you feel may help. If you arent
sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put
you in touch with a group or resource that may work for you. You can also read our
document Distress in People with Cancer or see the Emotional Side Effects section of
our website for more information.
bones. Or chemo might be used to help shrink a tumor and keep it from blocking the
bowels. But this is not the same as treatment to try to cure the cancer.
You can learn more about the changes that occur when curative treatment stops working,
and about planning ahead for yourself and your family, in our documents Nearing the
End of Life and Advance Directives.
At some point, you may benefit from hospice care. This is special care that treats the
person rather than the disease; it focuses on quality rather than length of life. Most of the
time, it is given at home. Your cancer may be causing problems that need to be managed,
and hospice focuses on your comfort. You should know that while getting hospice care
often means the end of treatments such as chemo and radiation, it doesnt mean you cant
have treatment for the problems caused by your cancer or other health conditions. In
hospice the focus of your care is on living life as fully as possible and feeling as well as
you can at this difficult time. You can learn more about hospice in our document called
Hospice Care.
Staying hopeful is important, too. Your hope for a cure may not be as bright, but there is
still hope for good times with family and friends times that are filled with happiness
and meaning. Pausing at this time in your cancer treatment gives you a chance to refocus
on the most important things in your life. Now is the time to do some things youve
always wanted to do and to stop doing the things you no longer want to do. Though the
cancer may be beyond your control, there are still choices you can make.
Genetics
There are no known inherited tendencies for nasal cavity and paranasal sinus cancer, but
scientists are finding some of the changes in the genes in these cancers that occur during
the patients lifetime. These changes are what transform normal cells into cancer cells.
Understanding these gene changes may help doctors develop better methods of
diagnosing this disease as well as treatments that are more effective and have fewer side
effects than ones currently available.
For example, researchers have found that many head and neck cancers have mutations
(changes) of the tumor suppressor gene TP53. These changes lead to additional mutations
of other genes, which make the cells better able to grow and spread. Scientists have tried
gene therapies to give good copies of this gene, but so far the results have been
disappointing.
Treatment
Surgery
Surgeons are looking at newer ways of removing these cancers while trying to do as little
damage as possible to nearby normal tissues. One example of a newer technique is
endoscopic surgery, in which certain tumors can be removed using long, thin instruments
passed through the nose. It may be useful only for certain tumors, but if it can be used it
may significantly reduce some of the side effects a person has.
Radiation therapy
Doctors are always looking at newer ways of focusing radiation on tumors more precisely
to help them get more radiation to the tumor while limiting side effects to nearby areas.
This is especially important for head and neck tumors like nasal cavity and paranasal
sinus cancers, where there are often many important structures very close to the tumor.
With more powerful computers and newer radiation techniques, doctors are now able to
plan and deliver radiation therapy more precisely than ever before.
Clinical trials are also studying ways to make radiation therapy more effective by using
radiosensitizers. These drugs make cancer cells more sensitive to radiation therapy. Other
studies are testing radioprotective agents. These drugs protect normal cells from damage
by radiation and thereby reduce side effects of radiation therapy. Reducing side effects
not only helps people feel better during treatment, but may also help people tolerate
higher radiation doses that can kill more cancer cells.
Targeted therapies
Clinical trials are studying several targeted therapies that block the action of the
substances (such as growth factors and growth factor receptors) that cause head and neck
cancers to grow and spread. Some of the drugs being studied include erlotinib, sunitinib,
sorafenib, lapatinib, and nimotuzumab. Many of these studies are testing combinations of
targeted therapies plus chemo or radiation.
Because nasal cavity and paranasal sinus cancers are rare, nearly all of these clinical trials
include patients with other types of head and neck cancer as well. Although these studies
are not specific to nasal cavity and paranasal sinus cancers, doctors will be able to apply
their results to choosing treatment for patients with nasal cavity and paranasal sinus
cancers.
Books
Your American Cancer Society also has books that you might find helpful. Call us at 1800-227-2345 or visit our bookstore online at cancer.org/bookstore to find out about
costs or to place an order
Support for People with Oral and Head and Neck Cancer (SPOHNC)
Toll-free number: 1-800-377-0928
Website: www.spohnc.org
Offers free telephone support for survivors and their families, as well as resources
and referrals on all aspects of oral and head and neck cancer; also has a survivorto-survivor network; and resource and product information, including a free
resource guide called We Have Walked in Your Shoes
*Inclusion on this list does not imply endorsement by the American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or night, for information
and support. Call us at 1-800-227-2345 or visit www.cancer.org.