Nasal Cavity and Paranasal Sinus Cancer

This section has been reviewed and approved by theCancer.Net

Editorial Board, 8/2013

Overview
Statistics
ON THIS PAGE: You will find some basic information about these diseases
and the parts of the body they may affect. This is the first page of
Cancer.Nets Guide to Nasal Cavity and Paranasal Sinus Cancer. To see other
pages, use the colored boxes on the right side of your screen. Think of
those boxes as a roadmap to this full guide. Or, click Next at the bottom of
each page.
Cancer begins when normal cells in the body change and grow
uncontrollably, forming a mass called a tumor. A tumor can be benign or
malignant. A benign tumor is not cancerous and usually can be removed
without growing back. A malignant tumor is cancerous and can invade and
damage the bodys healthy tissues and organs.
Nasal cavity and paranasal sinus cancer are malignant tumors that begin in
the inside of the nose or paranasal cavities around the nose. The nasal
cavity is the space just behind the nose where air passes on the way to the
throat. The paranasal sinuses are air-filled areas that surround the nasal
cavity on the cheeks (maxillary sinuses), above and between the eyes
(ethmoid and frontal sinuses), and behind the ethmoids (sphenoid sinuses).
The maxillary sinus is the most common location of paranasal sinus cancer.
Nasal cavity and paranasal sinus cancer are two of the major types of
cancer in the head and neck region and belong to a group of tumors known
as head and neck cancer.
Types of nasal cavity and paranasal sinus cancer
The nasal cavity and paranasal sinuses contain several types of tissue, and
each contains several types of cells. Different cancers can develop from
each kind of cell. The differences are important because they determine
how fast growing the cancer is and the type of treatment needed.
The nasal cavity and paranasal sinuses are lined by a layer of mucusproducing tissue with the following cell types: squamous epithelial cells,
minor salivary gland cells, nerve cells, infection- fighting cells, and blood
vessel cells. Some tumor types found in these cells and tissues include the
following:
Squamous cell carcinoma. This is the most common type of nasal cavity
and paranasal sinus cancer. Squamous cells are flat cells that make up the
thin surface layer of the structures of the head and neck.
Adenocarcinoma. Beginning in the gland cells, this is the second most
common type of nasal cavity and paranasal sinus cancer.
Malignant melanoma. Developing from cells called melanocytes that give
the skin its color, this is usually an invasive, fast growing cancer; however, it

only accounts for about 1% of tumors found in this area of the body. Learn
more about melanoma.
Inverting papilloma. These are benign, wart-like growths that may
develop into squamous cell carcinoma. Approximately 10% to 15% of these
can develop into cancer.
Esthesioneuroblastoma. Related to the nerves that control the sense of
smell, this type of cancer occurs on the roof of the nasal cavity and involves
a structure called the cribriform plate, a bone located deep in the skull
between the eyes and the sinuses. This type of cancer looks similar
to neuroendocrine cancer, so it is important to figure out which one it is.
Midline granuloma. This refers to a group of several unrelated conditions
that cause the breakdown of the healthy tissue of the nose, sinuses, and
nearby tissues. Some cases are due to immune system problems, and many
others are actually a type of lymphoma (a cancer of the lymph system).
Lymphoma. This is a type of cancer that originates in the lymph tissue
within the mucosa (lining) of the nasal cavity and paranasal sinuses.
Sarcoma. Sarcoma is a type of cancer that begins in muscle, connective
tissue, or bone.

Statistics
ON THIS PAGE: You will find information about how many people learn
they have this type of tumor each year and some general survival
information. Remember, survival rates depend on several factors. To see
other pages in this guide, use the colored boxes on the right side of your
screen, or click Next at the bottom.
Both nasal cavity and paranasal sinus cancer are uncommon. Each year,
about 2,000 people are diagnosed with nasal cavity or paranasal sinus
cancer in the United States. Cancer of the nasal cavity or paranasal sinus is
found slightly more often in men than in women, and it tends to occur in
people who are at least 45 years old.
The five-year survival rate is the percentage of people who survive at least
five years after the cancer is detected, excluding those who die from other
diseases. The five-year survival rate of people with nasal cavity or paranasal
sinus cancer varies by stage as described in the table below. Stage I means
the cancer hasnt spread outside the nasal cavity, and stage IV means the
cancer has spread to distant parts of the body. Learn more about staging.
Cancer survival statistics should be interpreted with caution. These
estimates are based on data from thousands of people with this type of
cancer in the United States each year, but the actual risk for a particular
individual may differ. It is not possible to tell a person how long he or she
will live with nasal cavity or paranasal sinus cancer. Because the survival
statistics are measured in five-year intervals, they may not represent

advances made in the treatment or diagnosis of this cancer. Learn more

about understanding statistics.
Statistics adapted from the American Cancer Society.

Stage

5-year
relative survival

63%

II

61%

III

50%

IV

35%

Last Updated:
Friday, February 28, 2014

Risk Factors and Prevention

ON THIS PAGE: You will find out more about what factors increase the
chance of developing these types of cancer and things you can do to help
prevent them. To see other pages in this guide, use the colored boxes on
the right side of your screen, or click Next at the bottom.
A risk factor is anything that increases a persons chance of developing
cancer. Although risk factors often influence the development of cancer,
most do not directly cause cancer. Some people with several risk factors
never develop cancer, while others with no known risk factors do. However,
knowing your risk factors and talking about them with your doctor may help
you make more informed lifestyle and health care choices.
Two risk factors greatly increase the risk of nasal cavity and paranasal sinus
cancer:
Tobacco use. Use of tobacco (including cigarettes, cigars, pipes, chewing
tobacco, and snuff) is the single largest risk factor for head and neck

cancer. Eighty-five percent (85%) of head and neck cancer is linked to

tobacco use. Recent research suggests that people who have used
marijuana may be at higher risk for head and neck cancer. Secondhand
smoke may also increase a persons risk of head and neck cancer.
Alcohol. Frequent and heavy consumption of alcohol is a risk factor for
head and neck cancer. Using alcohol and tobacco together increases this
risk even more.
Other factors can raise a persons risk of developing nasal cavity or
paranasal sinus cancer:
Human papillomavirus (HPV). Research indicates that infection with this
virus is a risk factor for nasal cavity and paranasal sinus cancer. HPV is most
commonly passed from person to person during sexual activity. There are
different types, or strains, of HPV, and some strains are more strongly
associated with certain types of cancers. HPV vaccines protect against
certain strains of the virus.
Specific inhalants. Breathing in certain substances, most commonly found
in the work environment, may increase the risk of developing nasal cavity
or paranasal sinus cancer. These substances include:

Dust from the wood, textiles, or leather industries

Flour dust

Nickel dust

Chromium dust

Mustard gas

Asbestos

Isopropyl (rubbing) alcohol fumes

Radium fumes

Glue fumes

Formaldehyde fumes

Solvent fumes used in furniture and shoe production

Exposure to air pollution. Being exposed to air pollution may increase a

persons risk of nasal cavity and paranasal sinus cancer.
Gender. Nasal cavity and paranasal sinus cancer occurs twice as often in
men than women.
Age. This type of cancer is most commonly found in people between the
ages of 45 and 85.
Prevention
Research continues to look into what factors cause this type of cancer and
what people can do to lower their personal risk. There is no proven way to
completely prevent nasal cavity and paranasal sinus cancer, but there may
be steps you can take to lower your cancer risk. Talk with your doctor if you
have concerns about your personal risk of developing these types of cancer.
Although some risk factors for nasal cavity and paranasal sinus cancer
cannot be changed, such as a persons age and gender, several can be
avoided by making lifestyle changes. Stopping the use of all tobacco
productsis the most important thing a person can do, even for people who
have been smoking for many years.
Also, avoiding exposure to substances that have been known to increase the
risk of cancer and wearing a protective facemask to reduce breathing in
potentially harmful substances may help reduce this risk. Workplace
exposure and industrial-related hazards can be reduced by appropriate air
filtering, and workers in these areas need to be aware of their potential risk
of exposure.

Symptoms and Signs

ON THIS PAGE: You will find out more about body changes and other
things that can signal a problem that may need medical care. To see other
pages in this guide, use the colored boxes on the right side of your screen,
or click Next at the bottom.
People with nasal cavity or paranasal sinus cancer may experience the
following symptoms or signs. Sometimes, people with nasal cavity or
paranasal sinus cancer do not show any of these symptoms. In fact, these
types of cancer are usually diagnosed in their later stages because early
stage cancer typically does not cause any symptoms. Nasal cavity or
paranasal sinus cancer is often discovered when a person is being treated
for seemingly benign, inflammatory disease of the sinuses, such as sinusitis.
However, these symptoms may be caused by a medical condition that is not
cancer. If you are concerned about a symptom or sign on this list, please
talk with your doctor.

Nasal obstruction or persistent nasal congestion and stuffiness, which

is often called sinus congestion

Chronic sinus infections that do not respond to antibiotic treatment

Frequent headaches or pain in the sinus region

Pain or swelling in the face, eyes, or ears

Persistent tearing of the eyes

Bulging of one of the eyes or vision loss

Decreased sense of smell

Pain or numbness in the teeth

Loosening of teeth

A lump on the face, nose, or inside the mouth

Frequent runny nose

Frequent nosebleeds

Difficulty opening the mouth

A lump or sore inside the nose that does not heal

Fatigue

Unexplained weight loss

A lump in the neck

A person who notices any of these warning signs should talk with a doctor
and/or dentist right away and ask for a detailed physical examination,
particularly if the symptoms continue for several weeks. Nasal cavity and
paranasal sinus cancer has a much better chance of being treated
successfully when they are found early.
Your doctor will ask you questions about the symptoms you are
experiencing to help find out the cause of the problem, called a diagnosis.

This may include how long youve been experiencing the symptom(s) and
how often.
Because many of these symptoms can be caused by other, noncancerous
health conditions, it is always important to receive regular health and dental
screenings; this is particularly important for people who routinely drink
alcohol or who currently use tobacco products or have used them in the
past. In fact, people who use alcohol and tobacco should receive a general
physical examination at least once a year even if they do not have any
symptoms. This is a simple, quick procedure in which the doctor looks in the
nose, mouth, and throat for abnormalities and feels for lumps in the neck. If
anything unusual is found, the doctor will recommend a more extensive
examination using one or more of the diagnostic procedures mentioned in
theDiagnosis section.
If cancer is diagnosed, relieving symptoms and side effects remains an
important part of cancer care and treatment. This may also be called
symptom management, palliative care, or supportive care. Be sure to talk
with your health care team about symptoms you experience, including any
new symptoms or a change in symptoms.

Diagnosis
ON THIS PAGE: You will find a list of the common tests, procedures, and
scans that doctors can use to find out whats wrong and identify the cause
of the problem. To see other pages in this guide, use the colored boxes on
the right side of your screen, or click Next at the bottom.
Doctors use many tests to diagnose cancer and find out if it has
metastasized (spread). Some tests may also determine which treatments
may be the most effective. For most types of cancer, a biopsy is the only
way to make a definitive diagnosis. If a biopsy is not possible, the doctor
may suggest other tests that will help make a diagnosis. Imaging tests may
be used to find out whether the cancer has spread. This list describes
options for diagnosing these types of cancer, and not all tests listed will be
used for every person. Your doctor may consider these factors when
choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Signs and symptoms

Previous test results

To make the diagnosis, a complete medical history and physical examination

are necessary. Signs of nasal cavity and paranasal sinus cancer are often
very similar to symptoms of chronic or allergic sinusitis. The physical
examination is important, and doctors may perform one or more of the
tests listed below to reach a diagnosis. There are no specific blood or urine
tests that can be performed to help make an early diagnosis of either of
these types of cancer.
The following tests may be used to diagnose nasal cavity or paranasal sinus
cancer:
Physical examination. The doctor feels for any lumps on the neck, lips,
gums, and cheeks. Also, the doctor will inspect the nose, mouth, throat,
and tongue for abnormalities, often using a light and/or mirror for a clearer
view.
Biopsy. A biopsy is the removal of a small amount of tissue for examination
under a microscope. Other tests can suggest that cancer is present, but
only a biopsy can make a definite diagnosis. The sample removed during
the biopsy is analyzed by a pathologist (a doctor who specializes in
interpreting laboratory tests and evaluating cells, tissues, and organs to
diagnose disease).
Endoscopy. This test allows the doctor to see inside the body with a thin,
lighted, flexible tube called an endoscope. The person may be sedated as
the tube is inserted through the mouth or nose to examine the head and
neck areas. The examination has different names depending on the area of
the body that is examined, such as laryngoscopy (larynx), pharyngoscopy
(pharynx), or nasopharyngoscopy (nasal cavity, nasopharynx).
In some cases, a diagnosis of paranasal sinus cancer will be made during an
endoscopic surgery for what is believed to be benign chronic sinusitis.
During the endoscopic sinus surgery, it is important for the surgeon to
obtain a biopsy sample of normal-looking tissues and confirm the diagnosis
in a procedure called a frozen section examination before completing the
endoscopic surgery for benign chronic sinusitis. For more information about
surgery, see the Treatment Options section.
X-ray. An x-ray is a picture of the inside of the body. An x-ray can show if
the sinuses are filled with something other than air. If so, it is usually not
cancer but, instead, an infection that is treatable. If treatment doesnt work
to clear the sinuses, then other more specialized x-ray tests may be done to
identify the blockage. Signs of cancer on an x-ray may be followed up with
a
computed
tomography
(CT)
scan.
Computed tomography (CT or CAT) scan. A CT scan creates a threedimensional picture of the inside of the body with an x-ray machine. A

computer then combines these images into a detailed, cross-sectional view

that shows any abnormalities or tumors. A CT scan can also be used to
measure the tumors size. Sometimes, a contrast medium (a special dye) is
injected into a patients vein or given orally (by mouth) to provide better
detail. CT scans are very useful in identifying cancer of the nasal cavity or
paranasal sinus.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not xrays, to produce detailed images of the body, especially images of soft
tissue, such as the eye in its socket and the part of the brain near the
sinuses. A contrast medium may be injected into a patients vein or given
orally to create a clearer picture.
Bone scan. This test may be done to see if cancer has spread to the bones.
A bone scan uses a radioactive tracer to look at the inside of the bones. The
tracer is injected into a patients vein. It collects in areas of the bone and is
detected by a special camera. Healthy bone appears gray to the camera,
and areas of injury, such as those caused by cancer, appear dark.
Positron emission tomography (PET) scan. A PET scan is a way to
create pictures of organs and tissues inside the body. A small amount of a
radioactive substance is injected into a patients body. This substance is
absorbed mainly by organs and tissues that use the most energy. Because
cancer tends to use energy actively, it absorbs more of the radioactive
substance. A scanner then detects this substance to produce images of the
inside of the body.
After these diagnostic tests are done, your doctor will review all of the
results with you. If the diagnosis is cancer, these results also help the
doctor describe the cancer; this is called staging.

Stages and Grades

ON THIS PAGE: You will learn about how doctors describe a cancers
growth or spread, as well as the way the tumor cells look when viewed
under a microscope. This is called the stage and grade. To see other pages
in this guide, use the colored boxes on the right side of your screen, or click
Next at the bottom.
Staging is a way of describing where the cancer is located, if or where it has
spread, and whether it is affecting other parts of the body. Doctors use
diagnostic tests to determine the cancers stage, so staging may not be
complete until all of the tests are finished. Knowing the stage helps the
doctor to decide what kind of treatment is best and can help predict a
patients prognosis (chance of recovery). There are different stage
descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is
an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look
at these three factors to determine the stage of cancer:

How large is the primary tumor and where is it located?(Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)
Has
the
cancer
metastasized
to
other
parts
of
the
body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person.
There are five stages: stage 0 (zero) and stages I through IV (one through
four). The stage provides a common way of describing the cancer, so
doctors can work together to plan the best treatments.
Here are more details on each part of the TNM system for nasal cavity and
paranasal sinus cancer:
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is
used to describe the size and location of the tumor. Some stages are also
divided into smaller groups that help describe the tumor in even more
detail. Specific tumor stage information is listed below.
TX: The primary tumor cannot be evaluated.
T0: No evidence of a tumor is found.
Tis: A stage called carcinoma (cancer) in situ. This is a very early cancer
where cancer cells are found only in one layer of tissue.
Tumors of the paranasal sinuses are also evaluated by their exact location.
(See the Overview section for descriptions.)
Primary tumor (T) in the maxillary sinus
T1: The tumor is limited to the inside of the sinus and does not erode or
invade bone.
T2: The tumor erodes or invades bone surrounding the sinuses.
T3: The tumor invades the surrounding bone, the skin of the cheek, or the
other sinuses.
T4a: The tumor invades the bone surrounding the eye, the skin of the
cheek, or the bones in the back of the throat.
T4b: The tumor invades any of the following: the back of the eye, the brain
area, or the bones of the skull, other than those behind the nose or the
back of the head.
Primary tumor (T) in the nasal cavity and ethmoid sinus

T1: The tumor is limited to the inside of the sinus with no involvement with
the bone.
T2: The tumor extends into the nasal cavity.
T3: The tumor extends into the maxillary sinus or to the bone surrounding
the eye.
T4a: The tumor has spread throughout the facial bones or into the base of
the skull.
T4b: The tumor invades any of the following: the back of the eye, the brain
area, or the back of the head.
Node. The N in the TNM staging system stands for lymph nodes, the tiny,
bean-shaped organs that help fight infection. Lymph nodes near the head
and neck are called regional lymph nodes. Lymph nodes in other parts of
the body are called distant lymph nodes. Since there are many nodes in the
head and neck area, the doctors careful evaluation of lymph nodes is an
important part of staging.
NX: The regional lymph nodes cannot be evaluated.
N0: There is no evidence of cancer in the regional lymph nodes.
N1: The cancer has spread to a single lymph node on the same side as the
primary tumor, and the cancer found is 3 centimeters (cm) or smaller.
N2: This describes any of these conditions:
N2a: The cancer has spread to a single lymph node on the same side as the
primary tumor, and it is larger than 3 cm but not larger than 6 cm.
N2b: The cancer has spread to more than one lymph node on the same
side as the primary tumor, but none measure larger than 6 cm.
N2c: The cancer has spread to more than one lymph node on either side of
the body, but none measure larger than 6 cm.
N3: The cancer is found in at least one nearby lymph node and is larger
than 6 cm.
Distant metastasis. The "M" in the TNM system indicates whether the
cancer has spread to other parts of the body.
MX: Distant metastasis cannot be evaluated.
M0: The cancer has not spread to other parts of the body.
M1: The cancer has spread to another part(s) of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M
classifications.
Stage 0: This is a very early cancer (Tis) with no spread to lymph nodes
(N0) or distant metastasis (M0).

Larger image
Stage I: This is a noninvasive cancer (T1) with no spread to lymph nodes
(N0) and no distant metastasis (M0).

Larger image
Stage II: This is an invasive cancer (T2) that has not spread to lymph
nodes (N0) or to distant parts of the body (M0).

Larger image
Stage III: This includes invasive cancer (T3) with no spread to regional
lymph nodes (N0) or metastasis (M0), as well as invasive cancer (T1, T2,

T3) that has spread to regional lymph nodes (N1) but shows no sign of
metastasis (M0).

Larger image
Stage IVA: This is an invasive cancer (T4a) that either has no lymph node
involvement (N0) or has spread to only one same-sided lymph node (N1)
but with no metastasis (M0). It is also used for any cancer (any T) with
more significant nodal involvement (N2) but with no metastasis (M0).

Larger image
Stage IVB: This is an invasive cancer (any T) that has spread to lymph
nodes (any N) but has no metastasis (M0). It is also used for any cancer
(any T) that is found in lymph nodes and is larger than 6 cm (N3) but has
no metastasis (M0).

Larger image
Stage IVC: This refers to any tumor (any T, any N) when there is evidence
of distant spread (M1).

Larger image
Tumor grade. Doctors also describe a primary tumor by its grade (G),
which is determined by using a microscope to examine tissue from a tumor.

The doctor compares the tumor tissue with healthy tissue. Healthy
contains many different types of cells grouped together, which is
differentiated. Tissue from tumors usually has cells that look more
called poorly differentiated. Generally, the more differentiated the
(the lower the grade), the better the prognosis.

tissue
called
alike,
tissue

GX: The grade cannot be evaluated.

G1: The cells look more like healthy tissue (well differentiated).
G2: The cells are only moderately differentiated.
G3: The cells dont resemble healthy tissue (poorly differentiated).
Recurrent: Recurrent cancer is cancer that has come back after treatment.
If there is a recurrence, the cancer may need to be staged again (called restaging) using the system above.

Treatment Options
ON THIS PAGE: You will learn about the different ways doctors use to treat
people with these types of cancer. To see other pages in this guide, use the
colored boxes on the right side of your screen, or click Next at the bottom.
This section outlines treatments that are the standard of care (the best
proven treatments available) for these specific types of cancer. When
making treatment plan decisions, patients are also encouraged to consider
clinical trials as an option. A clinical trial is a research study to test a new
treatment to evaluate whether it is safe, effective, and possibly better than
the standard treatment. Your doctor can help you review all treatment
options. For more information, see the Clinical Trials and Latest
Research sections.
Treatment overview
In cancer care, different types of doctors often work together to create a
patients overall treatment plan that combines different types of treatments.
This is called a multidisciplinary team. For nasal cavity or paranasal sinus
cancer, the team may include medical and radiation oncologists (doctors
who specialize in treating people with cancer), surgeons, otolaryngologists
(ear, nose, and throat doctors), dentists, maxillofacial prosthodontists
(specialists who perform restorative surgery in the head and neck areas),
physical therapists, speech pathologists, psychiatrists, nurses, dietitians,
and social workers. A neurosurgeon (a doctor who specializes in surgery on
the brain and spinal cord) should also be part of this team when a tumor in
the skull or facial area needs to be removed.

Nasal cavity and paranasal sinus cancer can often be cured, especially if
found early. Although curing the cancer is the primary goal of treatment,
preserving the function of the nearby nerves, organs, and tissues is also
very important. When doctors plan treatment, they consider how treatment
might affect a persons quality of life, such as how the person feels, looks,
talks, eats, and breathes.
Descriptions of the most common treatment options for nasal cavity and
paranasal sinus cancer are listed below. The three main treatment options
are surgery, radiation therapy, and chemotherapy. One of these treatments,
or a combination of them, may be used. Treatment options and
recommendations depend on several factors, including the type and stage of
cancer, possible side effects, and the patients preferences and overall
health. Take time to learn about your treatment options and be sure to ask
questions about things that are unclear. Also, talk about the goals of each
treatment with your doctor and what you can expect while receiving the
treatment. Learn more about making treatment decisions.
Surgery
Surgery is frequently used to remove cancer of the paranasal sinus or nasal
cavity. A surgical oncologist is a doctor who specializes in treating cancer
using surgery. The goal of surgery is to remove all of the tumor and leave
negative margins (no trace of cancer in the healthy tissue). However, its
usually not possible to completely remove the cancer with an operation, so
additional treatments may be necessary. This may include more than one
operation to remove the cancer and to help restore the appearance and
function of the tissues affected.
Common types of surgery for nasal cavity and paranasal sinus cancer
include:
Excision. During an excision, the doctor performs an operation to remove
the cancerous tumor and some of the healthy tissue around it (called a
margin).
Maxillectomy. This is a surgery that removes part or all of the hard palate,
which is the bony roof of the mouth. Prostheses (artificial devices), or more
recently, the use of flaps of soft tissue with and without bone can be placed
to fill gaps from this operation. A maxillectomy is sometimes recommended
to treat paranasal sinus cancer, and occasionally it is possible to save the
eye on the side of the cancer.
Craniofacial resection/skull base surgery. This is an extensive surgery
often recommended for paranasal sinus cancer that removes additional
tissue beyond that needed in a maxillectomy. It requires the close
cooperation of the health care team, particularly between a neurosurgeon
and a head and neck surgeon.
Endoscopic sinus surgery. This relatively new approach is less
destructive to healthy tissue than traditional operations and can occasionally

be used for nasal cavity and paranasal sinus tumors, especially if they are
benign. The surgeon makes a small incision to remove the tumor using a
thin, telescope-like tube inserted into the nasal cavity or sinus. As
mentioned in the Diagnosis section, endoscopic sinus surgery is often used
for chronic sinusitis, and cancer may be discovered during such surgery.
Neck dissection. This is the surgical removal of lymph nodes in the neck
area. If the doctor suspects the cancer has spread, a neck dissection may
be performed, often at the same time as another surgery. A neck dissection
may cause numbness of the ear, weakness when raising the arm above the
head, and weakness of the lower lip. The side effects are caused by injury
to nerves in the area. Depending on the type of neck dissection, weakness
of the lower lip and arm may go away in a few months. Weakness will be
permanent if a nerve is removed as part of a dissection.
Reconstructive (plastic) surgery. If surgery requires removing large or
specific areas of tissue, reconstructive surgery may be recommended. If the
eye is removed, a specialist called a prosthodontist can provide a prosthesis
(an artificial replacement). More often, when the maxilla (upper jaw) is
removed,
a
prosthodontist
may
play
a
large
role
in
the rehabilitation process.
In general, surgery often includes risks because the eyes, mouth, brain, and
important nerves and blood vessels are nearby. Surgery often causes
swelling of the face, mouth, and throat, making it difficult to breathe;
sometimes a tracheostomy (hole in the windpipe) may be necessary to
make breathing easier for some period of time after surgery. It is important
to talk with your surgeon(s) about what side effects to expect before having
the surgery and your plan for recovery. Learn more about cancer surgery.
Radiation therapy
Radiation therapy is the use of high energy x-rays or other particles to kill
cancer cells. A doctor who specializes in giving radiation therapy to treat
cancer is called a radiation oncologist.
For this type of cancer, radiation therapy is most often used in combination
with surgery, given either before or after the operation. It may also be given
along with chemotherapy (see below). For some types of tumors in the
nasal cavity or paranasal sinus, radiation therapy may also be the main
treatment. It can also be an option if a person cannot have surgery or
decides not to have surgery.
The most common type of radiation treatment is called external-beam
radiation therapy, which is radiation given from a machine outside the body.
Specific types of external radiation therapy include intensity-modulated
radiation therapy (IMRT) and proton therapy (also called proton beam
therapy). Intensity-modulated radiation therapy allows for more effective
doses of radiation therapy to be delivered while reducing the damage to
healthy cells and causing fewer side effects. Proton therapy uses protons,
rather than x-rays. At high energy, protons can destroy cancer cells. Proton

therapy may be used in nasal cavity or paranasal sinus cancer when the
tumor is located close to the eye or central nervous system (brain and
spinal cord). An external-beam radiation therapy regimen (schedule) usually
consists of a specific number of treatments given over a set period of time.
When radiation treatment is given using implants, it is called internal
radiation therapy or brachytherapy. Internal radiation therapy involves tiny
pellets or rods containing radioactive materials that are surgically implanted
in or near the tumor site. The implant is left in place for several days while
the person stays in the hospital.
Before beginning any type of radiation therapy for these types of cancer,
people should receive a thorough examination from an oncologic dentist (a
dentist experienced in treating people with head and neck cancer). Since
radiation therapy can cause tooth decay, damaged teeth may need to be
removed. Often, tooth decay can be prevented with proper treatment from
a dentist before beginning cancer treatment. After radiation therapy for
nasal cavity or paranasal sinus cancer, dental care should continue to help
prevent further dental problems. People may receive fluoride treatment to
prevent dental caries (cavities). Read more about dental and oral health
during cancer treatment.
In addition, radiation therapy to the head and neck may cause redness or
skin irritation in the treated area, dry mouth or thickened saliva from
damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and/or
sore throat. Other side effects may include pain or difficulty swallowing; loss
of appetite, due to a change in sense of taste; hearing loss, due to buildup
of fluid in the middle ear; and buildup of earwax that dries out because of
the radiation therapys effect on the ear canal. Radiation therapy may also
cause a condition called hypothyroidism in which the thyroid gland (located
in the neck) slows down, causing people to feel tired and sluggish. Every
patient who receives radiation therapy to the neck area should have his or
her thyroid checked regularly. There are numerous studies underway to find
ways to reduce or better relieve the side effects of radiation therapy.
Learn more about radiation therapy.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping
the cancer cells ability to grow and divide. Systemic chemotherapy is
delivered through the bloodstream to reach cancer cells throughout the
body. Chemotherapy is given by a medical oncologist, a doctor who
specializes in treating cancer with medication. A chemotherapy regimen
(schedule) usually consists of a specific number of cycles given over a set
period of time. A patient may receive one drug at a time or combinations of
different drugs at the same time.
The use of chemotherapy before or after surgery and/or radiation therapy or
in
combination
with
radiation
therapy
(called
concurrent
chemoradiotherapy) is frequently recommended for these types of cancer.

However, chemoradiotherapy is still being investigated and should be done

as part of a clinical trial.
For nasal cavity or paranasal sinus cavity cancer, chemotherapy may also be
used to treat advanced cancer (see below) or to treat symptoms. Some
chemotherapy is available in clinical trials that may treat cancer at an
earlier stage.
The side effects of chemotherapy depend on the individual and the dose
used, but they can include fatigue, risk of infection, nausea and vomiting,
hair loss, loss of appetite, and diarrhea. These side effects usually go away
once treatment is finished.
Learn more about chemotherapy and preparing for treatment. The
medications used to treat cancer are continually being evaluated. Talking
with your doctor is often the best way to learn about the medications
prescribed for you, their purpose, and their potential side effects or
interactions with other medications. Learn more about your prescriptions by
using searchable drug databases.
Getting care for symptoms and side effects
Cancer and its treatment often cause side effects. In addition to treatment
to slow, stop, or eliminate the cancer, an important part of cancer care is
relieving a persons symptoms and side effects. This approach is called
palliative or supportive care, and it includes supporting the patient with his
or her physical, emotional, and social needs.
Palliative care can help a person at any stage of illness. People often receive
treatment for the cancer and treatment to ease side effects at the same
time. In fact, patients who receive both often have less severe symptoms,
better quality of life, and report they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional
changes, relaxation techniques, and other therapies. You may also receive
palliative treatments similar to those meant to eliminate the cancer, such as
chemotherapy, surgery, and radiation therapy. Talk with your doctor about
the goals of each treatment in the treatment plan.
Before treatment begins, talk with your health care team about the possible
side effects of your specific treatment plan and supportive care options. And
during and after treatment, be sure to tell your doctor or another health
care team member if you are experiencing a problem so it is addressed as
quickly as possible. Learn more about palliative care.
Recurrent nasal cavity and paranasal sinus cancer
A remission is when cancer cannot be detected in the body and there are no
symptoms. This may also be called no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty leads to many

survivors feeling worried or anxious that the cancer will come back. While
many remissions are permanent, its important to talk with your doctor
about the possibility of the cancer returning. Understanding the risk of
recurrence and the treatment options may help you feel more prepared if
the cancer does return. Learn more about coping with the fear of
recurrence.
If the cancer does return after the original treatment, it is called recurrent
cancer. It may come back in the same place (called a local recurrence),
nearby (regional recurrence), or in another place (distant recurrence).
When this occurs, a cycle of testing will begin again to learn as much as
possible about the recurrence, including whether the cancers stage has
changed. After testing is done, you and your doctor will talk about your
treatment options. Often the treatment plan will include the therapies
described above (such as surgery, chemotherapy, and radiation therapy),
but they may be used in a different combination or given at a different
pace. Your doctor may also suggest clinical trials that are studying new
ways to treat this type of recurrent cancer.
People with recurrent cancer often experience emotions such as disbelief or
fear. Patients are encouraged to talk with their health care team about these
feelings and ask about support services to help them cope. Learn more
about dealing with cancer recurrence.
Metastatic nasal cavity and paranasal sinus cancer
If cancer has spread to another location in the body, it is called metastatic
cancer. Patients with this diagnosis are encouraged to talk with doctors who
are experienced in treating this stage of cancer, because there can be
different opinions about the best treatment plan. Learn more about seeking
a second opinion before starting treatment, so you are comfortable with the
treatment plan chosen. This discussion may include clinical trials.
Your health care team may recommend a treatment plan that consists of
chemotherapy or a combination of surgery, radiation therapy, and
chemotherapy. Supportive care will also be important to help relieve
symptoms and side effects.
For most patients, a diagnosis of metastatic cancer is very stressful and, at
times, difficult to bear. Patients and their families are encouraged to talk
about the way they are feeling with doctors, nurses, social workers, or other
members of the health care team. It may also be helpful to talk with other
patients, including through a support group.
If treatment fails
Recovery from cancer is not always possible. If treatment is not successful,
the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people.
However, it is important to have open and honest conversations with your
doctor and health care team to express your feelings, preferences, and
concerns. The health care team is there to help, and many team members
have special skills, experience, and knowledge to support patients and their
families. Making sure a person is physically comfortable and free from pain
is extremely important.
Patients who have advanced cancer and who are expected to live less than
six months may want to consider a type of palliative care called hospice
care. Hospice care is designed to provide the best possible quality of life for
people who are near the end of life. You and your family are encouraged to
think about where you would be most comfortable: at home, in the hospital,
or in a hospice environment. Nursing care and special equipment can make
staying at home a workable alternative for many families. Learn more
about advanced cancer care planning.