Paranasal sinuses and nasal cavity cancer
What is paranasal sinuses and nasal cavity cancer?
In this type of cancer the tumorous cells are located on the paranasal sinuses tissues and the nasal cavitiy tissues. The paranasal sinuses are little hollow spaces around the nose, coated with mucous, which contain mucus producing cells and amplify the voice. The nasal cavity is the nose passage through which the air reaches the throat when one breathes.
There are various paranasal sinuses: frontal sinuses, maxillary sinuses, ethmoid sinuses and sphenoid sinuses.
Which are its symptoms?
It is necessary to visit a doctor if the paranasal sinuses are blocked (which cause a feeling of pressure on regions of the face), if the patient has a sinus infection, if there is nose bleeding, a wound that doesn't heal inside the nose, frequent headaches, pain in the paranasal sinus region, swollen eyes or any other difficulty in eye movement, pain in the upper teeth or teeth problems.
How is it diagnosed?
If the patient has the symptoms, the doctor must examine the nose with a rhinoscope or nasoscope in order to see inside the nose. If there is abnormal tissue, the specialist must practise a biopsy so that the pathologist may examine it under the microscope and confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.
Once the cancer is diagnosed, more tests will be performed in order to determine whether the cancerous cells have spread, i.e, in which stage the cancer is. Knowing its stage is needed to plan an adequate treatment. There is not a system to classify nasal cavity cancer and some less common paranasal sinuses cancers. The one used with maxillary sinus caner (the most common) is the following:
Stage I: The cancer is only on the sinus and has not spread towards any other osseous part of the sinus. The cancer has not spread towards any lymphatic ganglion.
Stage II: the cancer has begun to destroy the boned of the paranasal sinus walls, but hasn’t reached any lymphatic ganglion.
Stage III: Any of the following situations:
- The cancer has spread beyond the bones around the paranasal sinus and to on lymphatic ganglion of the same side of the neck as the cancer and it is smaller than 3 cm.
- The cancer has spread to the tissues surrounding the sinus either with or without affecting a ganglion.
Stage IV: Any of the following situations:
- The cancer has reached the surrounding tissues, other paranasal sinuses. It may or may not have reached the lymphatic ganglions.
- There is cancer only on the paranasal sinuses, but it has reached more than one lymphatic ganglion of one or both sides of the neck or any lymphatic ganglion bigger than 6 cm.
- The cancer has reached other parts of the body.
Recurrent: the cancer has reappeared after being treated. It can reappear on the paranasal sinuses, the nasal cavity or any other part of the body.
Which are the treatments?
Three types of treatment are used:
- Radiotherapy (using elevated doses of X rays or other high energy radiations to destroy the tumours)
- Chemotherapy (using drugs to destroy the cancerous cells)
Surgery is usually used with paranasal sinus cancer or nasal cavity cancer. Depending on the placement and extension the doctor may have to cut part of the bone or tissue surrounding the cancer. If it has spread to the neck lymphatic ganglions, those lymphatic ganglions can be extracted (lymphatic ganglion dissection).
Radiotherapy is also a common paranasal sinus and nasal cavity cancer treatment. It consists in using elevated doses of X rays or other high energy radiations to reduce the tumours.
Chemotherapy consists on the use of drugs to destroy tumoral cells. Such drugs can be administrated orally, intramuscularly or intravenously. Chemotherapy is considered a systemic treatment since the drugs are introduced into the bloodstream and travel through all the body, thus it destroys the cancerous cells located anywhere in the body.
The most chosen treatment is surgery (as long as it allows the resection of the whole tumour) followed by simultaneous radiotherapy and chemotherapy. If the tumour cannot be seared, radio-chemoherapy will be used in the first place. When the cancer is diagnosed early, the tumour is affecting only the nasal cavity and has not invaded cranial structures, it can be removed by endoscopic surgery (through the nose). If the tumour has invaded the base of the cranium it may be needed acollaboration between the neurosurgeon and the othorhinolaryngologist (craniofacial approach).
What does the patient have to do one the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
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