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Head and Neck Cancers

Sinonasal Cancer

The nasal cavity is just behind the nose. Air passes through it on its way to the throat during breathing. Located behind and sides of the nose are 4 groups of air-filled spaces starting with maxillary, ethmoid, frontal and sphenoid sinuses. They have several functions, one is to keeping the nose from drying out by humidifying and heating inhaled air. They function as echo chambers that allow the voice to resonate when a person is talking or singing. In addition, they protect vital structures including the brain during a trauma to the face by acting as a crumpling zone.

These air-filled spaces (paranasal sinuses) around the nose rarely develop tumors or cancers. In general, these tumors are rare, making up only about three percent of tumors in the upper respiratory tract. Some of them are slow growing tumors that stay close to where they started (inverted papilloma) and others are aggressive cancer (SNUC: sinonasal undifferentiated carcinoma) that grows rapidly and has a tendency to spread into other tissues nearby and to more distant parts of the body (metastasis).

Many different types of tumors can develop in the nose or sinuses. Some of these are listed below:

  • Inverted papillomas
  • Squamous cell carcinoma
  • Transitional cell carcinoma
  • Adenocarcinoma
  • Adenoid cystic carcinoma
  • Melanoma
  • Neuroblastoma
  • Sarcomas
  • Lymphoma
  • Plasmacytoma
  • Giant cell tumor
  • Metastatic carcinoma
  • Sinonasal undifferentiated carcinoma (SNUC)

Inverted papillomas are benign tumors by definition, but can cause problems when they expand and apply pressure on nearby bone and cause changes. Five to twenty percent of these benign tumors may also transform to a malignant type if not treated. In general, squamous cell carcinomas are the most common malignant type of tumor, followed by adenoid cystic carcinoma and adenocarcinoma. Most of the tumors originate from the maxillary sinuses. Less commonly, it stems from the nasal cavity, ethmoid sinuses or even more rarely, from the frontal or sphenoid sinuses.

Otolaryngology surgeons at Brigham and Women’s Division of Otolaryngology at Brigham and Women's Faulkner Hospital specialize in surgical techniques for head and neck cancer including sinonasal cancer. We offer the most current diagnostic methods and proven treatments, including minimally invasive surgical approaches aided by endoscopic technology. We are part of the surgical team for Dana-Farber Brigham Cancer Center, an exceptional collaboration between two world-class medical centers.

Sinonasal Cancer Topics

Causes of Sinonasal Cancer

There are several identified causes for sinonasal malignancies. Exposure to industrial environmental fumes from nickel refining process, chromium compounds, wood dust, leather tanning can cause certain types of sinonasal cancers. Tobacco smoke also can cause nasal cancers. Certain Human Papilloma Viruses (HPV) are associated with various types of benign and malignant tumors of the sinonasal cavity. Prior irradiation for other cancers has also been associated with the development of a sinonasal cancer.

Symptoms of Sinonasal Cancer

Sinonasal cancer often presents with symptoms similar to other inflammatory or infectious diseases of the sinus cavity:

  • Nasal obstruction or congestion
  • Bloody nose
  • Runny nose
  • Double vision
  • Bulging eye
  • Headache or facial pain
  • Chronic infections and nasal obstruction

Some patients (~12%) do not have any symptoms at all.

Risk Factors for Sinonasal Cancer

Sinonasal tumors are rare, making up only about three percent of tumors in the upper respiratory tract. They are more common in whites and twice more common in males than in females. Exposure to industrial fumes, tobacco, and radiation exposure can all increase ones risk of getting sinonasal cancers.

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity—such as smoking or diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Diagnosis of Sinonasal Cancer

A complete medical history, physical examination including an office endoscopy can help a clinician narrow the diagnosis. In addition one or more of the following procedures or imaging can help with obtaining a definite diagnosis.

  • Biopsy is a procedure in which tissue samples are removed from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
    • Fine needle aspiration (FNA) biopsy is the removal of tissue or fluid using a thin needle. An FNA is the most common type of biopsy used for salivary gland cancer.
    • Incisional biopsy is the removal of part of a lump or a sample of tissue that doesn’t look normal.
    • Surgery is indicated if cancer cannot be diagnosed from the sample of tissue removed during a FNA biopsy or an incisional biopsy, the mass may be removed and checked for signs of cancer.
  • Computed tomography (CT-scan) is a noninvasive procedure that takes horizontal, or axial, images of the face and sinuses to detect any abnormalities that may not be obvious on an endoscopy of physical examination. This study is very good to characterize the bones of the face and sinuses.
  • Ultrasonography is a diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. This is rarely used for sinonasal malignancies.
  • Magnetic resonance imaging (MRI) is a noninvasive procedure that uses magnetic fields and radio waves to form two-dimensional image of the body. This is a very good imaging modality for soft tissue (skin, muscle, nerves).
  • PET scan (positron emission tomography scan) is an imaging modality that uses a small amount of radioactive glucose (sugar) injected into a vein to produce a three-dimensional image. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Because sinonasal cancer can be hard to diagnose, patients should ask to have the tissue samples checked by a pathologist who has experience in diagnosing sinonasal cancer. Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.

Treatment for Sinonasal Cancer

Patients with sinonasal cancer should have their treatment planned by a team of experts in treating head and neck cancer including Brigham and Women’s Hospital head and neck surgeons and radiation oncologists and Dana-Farber Brigham Cancer Center (DFBCC) medical oncologists.

Treatment may include:

  • Surgery is the main treatment for sinonasal tumors. The surgeon will remove the cancer and some of the healthy tissue around the cancer. The type of surgery will depend on the size and spread of the tumor and surgeon preference. Approaches can be external or endoscopic. In some instances, removal of sinonasal tumors can leave patients with facial disfigurement and speech and swallowing difficulties. Reconstructive surgery is often done to help with these problems, usually using tissue from elsewhere in the body.
  • Radiation therapy uses high-energy rays that damage cancer cells and halts the spread of cancer. Radiation therapy is very localized, aimed at only the area where the cancer is present. Radiation therapy may be administered externally with a machine, or internally with radioactive materials.
  • Chemotherapy uses medications that go throughout the entire body to kill cancer cells. Chemotherapy has the ability to interfere with the cancer cell's replication. Chemotherapy may be used in combination with surgery and radiation therapy.
What You Should Expect

A Brigham and Women’s Hospital otolaryngologist will begin with a complete evaluation and assessment of your specific condition. As part of the assessment, we will establish which treatment is indicated. A customized treatment plan will be established and you will work with the appropriate services.

Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

If surgery is needed, you will be taken care of in the operating room by an experienced otolaryngology surgeon. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.

Multidisciplinary Care

Brigham and Women’s Faulkner Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to Brigham and Women's Hospital's world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our otolaryngologists are faculty members at Harvard Medical School and active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the ear, nose and throat.

Brigham and Women's Faulkner Hospital

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