Nasal cavity and sinus cancers are a rare group of malignancies that develop in and around the passageway within the nose. This includes the nasal cavity (a large, hollow, air-filled space behind the nose) and paranasal sinuses (small, air-filled spaces in the bones at the front of the skull and surrounding the nose).
The nasal cavity is divided into two main sections (called nasal passages) by a thin wall of bone and cartilage at the centre of the nose called the septum. In the roof of each of these passages are small groups of cellsthe basic structural and functional unit of all living things called olfactory receptors, which are responsible for our sense of smell. The nasal cavity is also responsible for warming and humidifying the air that we breathe to filter out dust and other harmful particles.
Paranasal sinuses influence the sound and tone and clarity of your voice, and help lighten the weight of your skull. During illness, these cavities become filled with mucus and become blocked which can cause a change in the voice as well as pain and discomfort. There are four pairs of paranasal sinuses that are named for the bones they are found in. Maxillary sinuses are the biggest, and are found in the maxillary bone under the eyes and in the cheek area on either side of the nose. Paranasal sinus cancers are most commonly found here. Frontal sinuses are found in the frontal bone in the lower forehead above the nose. Ethmoid sinuses are found in the ethmoid bone at the roof of the nasal cavity in-between the eyes. Sphenoid sinuses are found in the sphenoid bone behind the nasal cavity in the middle of the skull.
Nasal cavity and paranasal sinus cancers are generally more common in men, and tend to be diagnosed between the ages of 50-60. However, anyone can develop these diseases.
Types of Nasal Cavity and Paranasal Sinus Cancers
There are several different types of nasal cavity and paranasal sinus cancers, which are categorised by the types of cells they develop from and their location.
Sinonasal Carcinoma
Sinonasal carcinomas are a rare group of malignancies that develop in the nasal cavity, nasopharynx (located at the uppermost portion of the throat, behind the nose and above the soft palate), or paranasal sinuses. For more information on sinonasal carcinomas, please refer to the Rare Cancers Australia Sinonasal Carcinoma page.
Sinonasal Adenocarcinoma
Sinonasal adenocarcinomas are the second most common type of sinonasal carcinomacancer arising from tissues that line organs, and develops from the mucus-producing cells in the nasal cavity and paranasal sinuses. They can be further categorised into:
- Salivary type (develop from seromucinous glands and surface epithelium and are similar to those found in salivary gland cancers).
- Non-salivary type (develop from surface epithelium alone), which is further subdivided into:
- Intestinal type (cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs cells resemble carcinomas or adenomas of the intestinesportion of the digestive system that digests food (small intestine) and absorbs salts and water (large intestine), also called bowel).
- Non-intestinal type (cancer cells don’t resemble salivary type adenocarcinomas or intestinal type adenocarcinomas).
This type of cancer is often aggressive and can have a high recurrenceto occur or happen again rate, however they can have an improved prognosisto predict how a disease/condition may progress and what the outcome might be when caught early.
Esthesioneuroblastoma/ Olfactory Neuroblastomas
Esthesioneuroblastoma, also known as olfactory neuroblastoma (cancer that develops in immature nerve cells), is a rare type of cancer that develops in the upper portion of the nasal cavity. More specifically, it develops in the olfactory epithelium and nerve endings, which is near the bone separating the nasal cavity from the brain. For more information on esthesioneuroblastomas, please refer to the Rare Cancers Australia Esthesioneuroblastoma page.
Rare types of Nasal Cavity and Paranasal Sinus Cancers
These types of nasal cavity and paranasal sinus cancers are considered rare:
- Adenoid cystic cancers (generally found in maxillary sinus).
- Melanomaa type of cancer that develops from melanocytes, which are the cells that produce pigment generally in the skin (but can develop in other areas of the body).
- Lymphomacancers of the lymphatic system.
- Sarcomacancer arising from bones and/or soft tissue.
- Plasmacytoma.
- Neuroendocrine carcinoma.
Treatment
If a nasal cavity and paranasal sinus cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for nasal and paranasal sinus cancers may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence to remove as much of the tumour as possible.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of nasal and paranasal sinus cancers remains unknown, the following factors may increase the likelihood of developing the disease:
- Being exposed to certain workplace substances and chemicals, potentially including:
- Leather dust.
- Glues.
- Formaldehyde.
- Chrome.
- Nickel.
- Flour.
- Textiles.
- Organic solvents.
- Having a history of smoking.
- Being infected with the human papillomavirus (HPV).
- Having nasal polyposis.
- Having an inverted sinonasal papilloma.
- Having chronica long-lasting disease that changes slowly over time sinusitis.
Not everyone with these riskthe possibility that something bad will happen factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Symptoms of nasal cavity and paranasal sinus cancers may include:
- Decreased or lost sense of smell.
- Persistent blocked sinuses.
- Sinus pressure.
- Headaches.
- Pain in the sinus area.
- Runny nose.
- Nosebleeds.
- A lump or sore inside of the nose that does not heal.
- A lump on the face or roof of the mouth.
- Numbness and/or tingling in the face.
- Swelling or difficulties with the eyes, potentially including:
- Diplopiaseeing two images of a single object, also known as double vision.
- Blurriness.
- Eyes pointing in different directions.
- Pain in the upper teeth and/or loose teeth.
- Pain and/or pressure in the ear.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a nasal cavity or paranasal sinus cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body .
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Nasoendoscopyexamination of the lining of the nasal passages and the nasopharynx with a small, flexible instrument known as a nasoendoscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
