This information explains your surgery for the cancer of the nasal cavity and paranasal sinuses, and what to expect afterward.
The nasal cavity is an empty space within the nose. The paranasal sinuses are hollow spaces in the bones around the nasal cavity. They are filled with air. The nose and the sinuses are coated with a layer of cells that make mucous. These moisturize and help warm the air we inhale and give depth to the sound of our voice when we speak.
There are 4 major sinuses. (See illustration.)
- The frontal sinuses, located over the eyebrows near the center of the forehead
- The ethmoid sinuses, on both sides of the bridge of the nose
- The sphenoid sinus, deep in the nasal cavity, behind the ethmoid sinuses
- The maxillary sinuses, below the eyes and near the cheekbones
Cancer of the Nasal Cavity and Paranasal Sinuses
Cancer of the nasal cavity and paranasal sinuses is rare. It is usually treated with surgery, radiation, chemotherapy or a combination of two or all of these types of treatment. This booklet will concentrate on the surgical treatment for nasal cavity and paranasal sinus cancer.
You may have already had a biopsy to collect tissue from the tumor. If not, it needs to be done to make a diagnosis. It is done in the operating room while you are asleep. A flexible tube called a nasal endoscope is inserted into your nose. Your surgeon looks through it to see the back of your nose, the nasal cavity, and the sinuses. A small piece of tissue is removed from the suspicious area.
A pathologist examines the tissue. If the cells are cancerous, the pathologist will assign a grade to the tumor. The grade is based on how different the cells look compared to normal cells. The grade describes how aggressive the cancer is.
The surgeon will determine the stage of the disease based on the results of your exam and computed tomography (CT) or magnetic resonance imaging (MRI) scan. The stage describes:
- The extent of cancer
- Whether or not it has affected other structures of the body
The cancer may be limited to the area where it started. It can also grow and involve other sinuses. It can destroy the bony structures of the face, the eye socket, or the cheek. It may also spread to the lymph nodes in the neck. Lymph nodes are small oval bodies that are part of the immune system. The stage also indicates how the disease is likely to progress.
There is no staging system for cancers of the sphenoid and frontal sinuses. Cancers of the maxillary and ethmoid sinuses are staged using the TNM system. T describes the size of the tumor and its relation to other structures and bones of the nasal cavity. N describes lymph node involvement. M describes metastasis (spread) to distant organs.
Your doctor will decide the most appropriate treatment for you. It will be based on the stage and grade of the cancer, where the cancer is, and your overall health. If the tumor can be taken out, treatment is usually surgery. You may also need radiation therapy. Even after the diagnosis is made, your doctor may not know the full extent of the cancer until seeing it during the surgery.
If the tumor cannot be removed, you will get chemotherapy, radiation therapy, or both.
Many people will be part of your treatment team. They include:
- Radiation oncologists
- Medical oncologists
- Dentists who specialize in oral prosthetics
- Speech therapists
- Case managers
- Social workers
The goal of surgery is to remove the entire tumor with a margin of healthy tissue. A tumor may require extensive surgery if it is:
- Hard to reach
- Large and has affected surrounding structures
The surgeon will try very hard to get all of the cancer. He or she will try to preserve your appearance and your ability to chew, swallow, and talk. Any of these things can be affected by the surgery. The extent of surgery depends on the size of the tumor and its location. Surgery can take 3 to 10 hours and may involve a team of surgeons. This team may include:
- your head and neck surgeon
- a plastic and reconstructive surgeon
- a dental surgeon
If the tumor is close to your brain, a neurosurgeon will be part of your team. He or she will help protect the brain. Your head and neck surgeon will determine who should be on the team. You will have appointments with all the surgeons who will be involved.
The surgeon may suspect that the cancer has spread or has the potential to spread to the lymph nodes of your neck. If so, some of these nodes may be removed. Your nurse will give you the booklet called Neck Dissection, if necessary.
Dental Evaluation and Prosthetic Management
You may need to have part of your palate or upper gum removed. If so, a dental surgeon will see you before surgery. He or she will take dental impressions. These are used to make a dental obturator. The obturator helps the mouth keep its shape and function. It is placed during surgery. It is modified after surgery.
Reconstructive and Plastic Surgery
You may need reconstructive and plastic surgery. This is both to restore your appearance and function. The head and neck surgeon will remove the tumor. Then the plastic and reconstructive surgery team will take bone, tissue, and skin from another part of your body. This is called the donor area. They use it to reconstruct the areas that have been changed by surgery.
You will be taken to our recovery room, the Post-Anesthesia Care Unit (PACU). You may have one or more of the following:
- A patient-controlled analgesia (PCA) pump. It will deliver medicine into a vein to control pain. This pump also contains a “rescue” button that your nurse will show you how to use if you feel pain.
- A nasogastric (NG) tube. It provides temporary nutrition if necessary.
- Drainage tubes to help drain fluid from your surgical wound.
- A catheter (a small flexible tube) to drain urine from your bladder.
- A facemask and humidifier to keep your airways moist.
While you are in the PACU, you will begin to do the coughing and deep breathing exercises your nurse taught you. These help to prevent pneumonia. You may remain in the PACU 6 - 12 hours or overnight. You will then be taken to your room on the inpatient unit. You will continue the coughing and deep breathing exercises. You will also be helped out of bed to a chair the first day after surgery.
You will begin to get pain medicine by mouth on or about the second day after the operation. The PCA will be discontinued. You will begin to walk around the unit. If you have an NG tube, it will be removed during the third to fifth day. You will then begin to eat soft foods. Your nurse will teach you how to do oral irrigations. These help keep your mouth clean, moist, and comfortable. The nurse will also begin to spray your mouth with salt water daily. Your nurse will teach you how to care for your surgical incision(s). If you had a skin graft or reconstruction, you will also learn how to care for your donor site.
Discharge and Self-Care
A team of professionals will prepare you for a smooth discharge. Your doctor will give you a prescription for pain medicine. Your nurse will teach you the self-care you will need to continue at home. This will involve irrigating your mouth and nose if necessary. You will also learn exercises to prevent trismus. This is the inability to open your jaw. It can occur because of soft tissue scarring or changes in the muscles around the jaw. Your nurse will give you the “Trismus” booklet to review.
You will slowly go from a puréed diet to a mechanical-soft one. Your dietitian will give you a booklet describing the diet you will go home on. You may gradually resume your normal activities.
Your doctor will discuss your long-term follow-up care with you. If you had surgery, your first post-operative visit will be in about 1 week.
The dental and prosthetic team will follow you after surgery. They will adjust the obturator as needed to help restore your ability to chew, swallow, and speak. A facial prosthesis will be made, if needed. It is made to restore your appearance.
If necessary, a speech pathologist from the Speech and Hearing Center will work with you. He or she treats:
- Voice loss
- Swallowing disorders
- Impaired speech
The speech pathologist will help you regain as much of your speech and swallowing as possible.
Your Emotional Well-Being
The diagnosis and treatment of cancer can be a very stressful event. For many, it can be overwhelming at times. Each person who receives a diagnosis of cancer copes in his or her own way. You and your family will almost certainly have ups and downs. Many say it helps to concentrate on the small improvements you will see as the days and weeks go by.
Your treatment may alter your appearance. This can be especially upsetting. There are many resources to help you and your family during your recovery. Some are here at Memorial and others are in your community. Ask your doctor, nurse, or social worker about options. You might wish to speak with a head and neck cancer survivor. This can be arranged through our patient-to-patient volunteer program. Most people find it very reassuring to see someone who has been through what they are facing.
The Post-Treatment Resource Program (PTRP) at Memorial provides support and education for people who are finished with treatment. PTRP programs address a variety of issues. To learn more about this group and the programs they offer, call (646) 888-4740.
Depression can occur at any time when you have a serious illness. It is important to recognize the symptoms. Help is available to treat and manage it. Signs of depression are:
- Prolonged feelings of helplessness and sadness
- Inability or difficulty to concentrate and/or carry out normal activities
- Change in mood
- Change in sleep pattern
- Change in appetite
If you have any of these symptoms and they last more than two weeks, tell your doctor or nurse.
Learning about your treatment plan may decrease a fear of the unknown. By making a list of your questions and concerns, you can focus on them. Be sure to discuss them with your doctors and nurses. The teams caring for you expect you to have questions. They want to answer them so that you can be actively involved in your care.
Share Your Feelings and Thoughts
Share your feelings and thoughts with family and friends. It can be a burden to hold it all in. Sometimes this is difficult because you do not want your family and friends to worry. However, not knowing how you feel or how to help may cause your loved ones to worry. Engaging with others can bring people together during a time of stress. Talk with your close friends. Ask your social worker about a support group or the Post-Treatment Resource Program. Your social worker can also provide individual counseling for you and your family. If you want, staff can also arrange an appointment with a therapist from the MSKCC Counseling Center.
- Former patients
- If you want to speak with a patient who has had a similar diagnosis, contact the Patient-To-Patient Program in the Volunteer Office at (212) 639-5980.
- Outside resources
- You may also find helpful information at www.spohnc.org. It is the website of Support for People with Oral and Head and Neck Cancers (SPOHNC). Or you may call SPOHNC at 1-800-377-0928.