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Paranasal Sinus and Nasal Cavity Cancer General Information What is cancer of the paranasal sinus and nasal cavity? Cancer of the paranasal sinus and nasal cavity is a disease in which cancer (malignant) cells are found in the tissues of the paranasal sinuses or nasal cavity. The paranasal sinuses are small hollow spaces around the nose. The sinuses are lined with cells that make mucus, which keeps the nose from drying out; the sinuses are also a space through which the voice can echo to make sounds when a person talks or sings. The nasal cavity is the passageway just behind the nose through which air passes on the way to the throat during breathing. The area inside the nose is called the nasal vestibule. There are several paranasal sinuses, including the frontal sinuses above the nose, the maxillary sinuses in the upper part of either side of the upper jawbone, the ethmoid sinuses just behind either side of the upper nose, and the sphenoid sinus behind the ethmoid sinus in the center of the skull. Cancer of the paranasal sinus and nasal cavity most commonly starts in the cells that line the oropharynx. Much less often, cancer of the paranasal sinus and nasal cavity starts in the color-making cells called melanocytes, and is called a melanoma. If the cancer starts in the muscle or connecting tissue, it is called a sarcoma. Another type of cancer that can occur here, but grows more slowly, is called an inverting papilloma. Cancers called midline granulomas may also occur in the paranasal sinuses or nasal cavity, and they cause the tissue around them to break down. A doctor should be seen if the sinuses are blocked and don't clear, or if there is a sinus infection, bleeding through the nose, a lump or sore that doesn't heal inside the nose, frequent headaches or pain in the sinus region, swelling or other trouble with the eyes, pain in the upper teeth, or problems with dentures. If there are symptoms, a doctor will examine the nose using a mirror and lights. The doctor may order a CT scan (a special x-ray that uses a computer) or an MRI scan (an x-ray-like procedure that uses magnetic energy) to make a picture of the inside of parts of the body. A special instrument (called a rhinoscope or a nasoscope) may be put into the nose to see inside. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. Sometimes the doctor will need to cut into the sinus to do a biopsy. The chance of recovery (prognosis) depends on where the cancer is in the sinuses, whether the cancer is just in the area where it started or has spread to other tissues (the stage), and the patient's general state of health. Stage Information Stages of cancer of the paranasal sinus and nasal cavity: Once cancer of the paranasal sinus and nasal cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. There is no staging system for cancer of the nasal cavity or for some of the less common paranasal sinus cancers. The following stages are used for cancer of the maxillary sinus, the most common type of paranasal sinus cancer: Stage I The cancer is in only the maxillary sinus and has not destroyed any of the bone in the sinus. The cancer has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells). Stage II The cancer has begun to destroy the bones around the sinus, but has not spread to lymph nodes in the area. Stage III Either of the following may be true: The cancer has spread no further than the bones around the sinus and to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch). The cancer has spread to the cheek, the back of the maxillary sinus, the eye socket, or the ethmoid sinus in front of the maxillary sinus. The cancer may or may not have spread to one lymph node on the same side of the neck as the cancer. Stage IV Any of the following may be true: The cancer has spread to the eye or to other sinuses or places around the sinuses. The lymph nodes in the area may or may not contain cancer. The cancer is in only the sinuses or has spread to the areas around it. The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches). The cancer has spread to other parts of the body. Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the paranasal sinuses or nasal cavity or in another part of the body. Treatment Option Overview How cancer of the paranasal sinus and nasal cavity is treated: There are treatments for all patients with cancer of the paranasal sinus and nasal cavity. Three kinds of treatment are used: -surgery (taking out the cancer) -radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells) -chemotherapy (using drugs to kill cancer cells) Surgery is commonly used to remove cancers of the paranasal sinus or nasal cavity. Depending on where the cancer is and how far it has spread, a doctor may need to cut out bone or tissue around the cancer. If cancer has spread to lymph nodes in the neck, the lymph nodes may be removed (lymph node dissection). Radiation therapy is also a common treatment of cancer of the paranasal sinus and nasal cavity. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation therapy). External radiation to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may wish to test the thyroid gland before and after therapy to make sure it is working properly. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Because the paranasal sinuses and nasal cavity help in talking and breathing, and are close to the face, patients may need special help adjusting to the side effects of the cancer and its treatment. A doctor will consult with several kinds of doctors who can help determine the best treatment. Trained medical staff can also help in recovery from treatment. Patients may need plastic surgery if a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out. Treatment By Stage Treatment of cancer of the paranasal sinus and nasal cavity depends on where the cancer is, the stage of the disease, and the patient's age and overall health. Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with cancer of the paranasal sinus and nasal cavity. Stage I Paranasal Sinus and Nasal Cavity Cancer Treatment depends on the type of cancer and where the cancer is found. If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy may be given after surgery. If cancer is in the ethmoid sinus, treatment may be one of the following: 1. Radiation therapy if the cancer cannot be removed with surgery. 2. Surgery followed by radiation therapy. If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. If cancer is in the nasal cavity, treatment may be surgery, radiation therapy, or both. If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given. If the cancer is a midline granuloma, treatment will probably be radiation therapy. If cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy. Stage II Paranasal Sinus and Nasal Cavity Cancer Treatment depends on the type of cancer and where the cancer is found. If cancer is in the maxillary sinus, treatment will probably be surgery to remove the cancer. Radiation therapy is given before or after surgery. If cancer is in the ethmoid sinus, treatment may be one of the following: 1. External beam radiation therapy. 2. Surgery followed by radiation therapy. If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. If cancer is in the nasal cavity, treatment may be surgery, radiation therapy, or both. If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy. If the cancer is a melanoma or sarcoma, treatment will probably be surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given. If the cancer is a midline granuloma, treatment will probably be radiation therapy. If the cancer is in the nose (nasal vestibule), treatment may be surgery or radiation therapy. Stage III Paranasal Sinus and Nasal Cavity Cancer Treatment depends on the type of cancer and where the cancer is found. If cancer is in the maxillary sinus, treatment may be one of the following: 1. Surgery to remove the cancer. Radiation therapy is given before or after surgery. 2. A clinical trial of a special type of radiation therapy given before or after surgery. 3. A clinical trial of chemotherapy combined with radiation therapy. If cancer is in the ethmoid sinus, treatment may be one of the following: 1. Surgery followed by radiation therapy. 2. A clinical trial of chemotherapy before surgery or radiation therapy. 3. A clinical trial of chemotherapy following surgery with or without radiation therapy. 4. A clinical trial of chemotherapy combined with radiation therapy. If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. If cancer is in the nasal cavity, treatment may be one of the following: 1. Surgery. 2. Radiation therapy. 3. Surgery plus radiation therapy. 4. A clinical trial of chemotherapy before surgery or radiation therapy. 5. A clinical trial of chemotherapy following surgery with or without radiation therapy. 6. A clinical trial of chemotherapy combined with radiation therapy. If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy. If the cancer is a melanoma or sarcoma, treatment will probably be surgery. Radiation therapy may be given if the cancer cannot be removed with surgery. For certain types of sarcoma, surgery, radiation therapy, and chemotherapy may be given. If the cancer is a midline granuloma, treatment will probably be radiation therapy. If the cancer is in the nose (nasal vestibule), treatment may be one of the following: 1. External beam and/or internal radiation therapy. 2. Surgery if the cancer comes back following treatment. 3. A clinical trial of chemotherapy before surgery or radiation therapy. 4. A clinical trial of chemotherapy following surgery with or without radiation therapy. 5. A clinical trial of chemotherapy combined with radiation therapy. Stage IV Paranasal Sinus and Nasal Cavity Cancer Treatment depends on the type of cancer and where the cancer is found. If cancer is in the maxillary sinus, treatment will probably be one of the following: 1. Radiation therapy. 2. A clinical trial of chemotherapy before surgery or radiation therapy. 3. A clinical trial of chemotherapy following radiation therapy. 4. A clinical trial of chemotherapy combined with radiation therapy. If cancer is in the ethmoid sinus, treatment may be one of the following: 1. Surgery followed by radiation therapy. 2. Radiation therapy followed by surgery. 3. A clinical trial of chemotherapy before surgery or radiation therapy. 4. A clinical trial of chemotherapy following surgery with or without radiation therapy. 5. A clinical trial of chemotherapy combined with radiation therapy. If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. If cancer is in the nasal cavity, treatment may be one of the following: 1. Surgery. 2. Radiation therapy. 3. Surgery plus radiation therapy. 4. A clinical trial of chemotherapy before surgery or radiation therapy. 5. A clinical trial of chemotherapy following surgery with or without radiation therapy. 6. A clinical trial of chemotherapy combined with radiation therapy. If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive radiation therapy. If the cancer is a melanoma or sarcoma, treatment will probably be surgery, if possible. Radiation therapy or chemotherapy may be given if the cancer cannot be removed with surgery. If the cancer is a midline granuloma, treatment will probably be radiation therapy. If the cancer is in the nose (nasal vestibule), treatment may be one of the following: 1. External beam and/or internal radiation therapy. 2. Surgery if the cancer comes back following treatment. 3. A clinical trial of chemotherapy before surgery or radiation therapy. 4. A clinical trial of chemotherapy following surgery with or without radiation therapy. 5. A clinical trial of chemotherapy combined with radiation therapy. Recurrent Paranasal Sinus and Nasal Cavity Cancer Treatment depends on the type of cancer, where the cancer is found, and the type of treatment the patient received before. If cancer is in the maxillary sinus, treatment will probably be one of the following: 1. If surgery was done before, more extensive surgery followed by radiation therapy or radiation therapy alone. 2. If radiation therapy was given before, surgery. 3. Chemotherapy. Clinical trials are testing new chemotherapy drugs. If cancer is in the ethmoid sinus, treatment may be one of the following: 1. If limited surgery was done before, more extensive surgery followed by radiation therapy or radiation therapy alone. 2. If radiation therapy was given before, surgery. 3. Chemotherapy. Clinical trials are testing new chemotherapy drugs. If cancer is in the sphenoid sinus, treatment will probably be radiation therapy. Chemotherapy is given if radiation therapy does not work. If cancer is in the nasal cavity, treatment may be one of the following: 1. If limited surgery was done before, radiation therapy alone or more extensive surgery followed by radiation therapy. 2. If radiation therapy was given before, surgery. 3. Chemotherapy. Clinical trials are testing new chemotherapy drugs. If the cancer is an inverting papilloma, treatment will probably be surgery. If the cancer comes back after surgery, patients may receive more surgery or radiation therapy. If the cancer is a melanoma or sarcoma, treatment may be surgery or chemotherapy. If the cancer is a midline granuloma, treatment will probably be radiation therapy. If the cancer is in the nose (nasal vestibule), treatment may be one of the following: 1. If radiation therapy was given before, surgery. 2. If surgery was done before, radiation therapy alone or more extensive surgery followed by radiation therapy. 3. Chemotherapy. Clinical trials are testing new chemotherapy drugs. The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals. The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation. The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. 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