Nasal Cavity and Sinus Cancers
Overview
The nasal cavity and the paranasal sinuses
The nasal cavity is a large space filled with air. It’s above and behind your nose, in the middle of your face. The 2 openings, your nostrils, warm the air you breathe in and make it moist.
Your nose and sinuses are covered with a layer of cells that make mucus and warm the air you breathe. They also affect how your voice sounds when you speak.
Inside your nasal cavity, you have 4 types of paranasal sinuses. Your sinuses are a group of hollow spaces filled with air that surround your nasal cavity.
Your sinuses include:
- Frontal sinuses, which are above your eyes.
- Ethmoid sinuses, which are between your eyes.
- Sphenoid sinuses, which are deep in your nasal cavity, behind your ethmoid sinuses.
- Maxillary sinuses, which are on the sides of your nose.
The location of your paranasal sinuses, including frontal, ethmoidal, sphenoidal, and maxillary.
Symptoms and diagnosis of nasal cavity and sinus cancers
Nasal cavity and sinus tumors rarely cause symptoms at their earliest stages. Most people only notice symptoms when the tumor is so large it blocks the nasal cavity or affects vision.
These are some common signs of nasal cavity or paranasal cancer:
- Nasal congestion (stuffy nose) that does not go away.
- Runny nose.
- You often get sinus infections that do not respond to antibiotics.
- You often get headaches.
- Pain in your face.
- Nosebleeds.
- Swelling around your eyes.
- Your sense of smell is not as good as it used to be.
- Loose teeth.
- Numbness around the cheek and upper lip.
- Double vision or change in vision.
- Swelling in the mouth, jaw, or neck.
Risk factors for nasal cavity and sinus cancers
A risk factor is anything that raises your chances of getting a disease, such as cancer. There are some risk factors that you cannot change, such as your age or genes (DNA).
There are some steps you can take to lower your risk for nasal cavity and sinus cancers. You can have healthier habits, like quitting tobacco.
Tobacco use is a risk factor for nasal cavity and sinus cancers.
You’re also at risk for cancer if you do not treat a benign (not cancer) tumor called an inverted papilloma. The tumor is in your nasal passages or sinuses. Researchers think about 1 out of every 10 inverted papillomas turn into cancer if they’re not treated.
Nasal cavity and sinus cancers are also more common if you were exposed a lot to:
- Wood dust.
- Nickel.
- Chemicals used in leather processing.
How nasal cavity cancer and sinus cancer are diagnosed
- Biopsy: A biopsy is the first step in diagnosing nasal cavity cancer or sinus cancer. This is a procedure to take a small piece of tissue from the tumor. They’ll send the tissue sample to a pathologist. A pathologist is a doctor who uses a microscope to diagnose disease. They’ll examine the sample to see if it has cancer cells.
- Imaging tests: To get a clearer picture, your doctor may also order imaging tests. They can show how deep the cancer is, or if it has spread. Tests can include a computed tomography (CT) scan, a magnetic resonance imaging (MRI), or PET/CT scans.
The information from your biopsy and imaging scans tells your doctor the stage of the cancer. The stage tells us how advanced the cancer is and how far it spread. The stage guides which treatment is best for you.
Treatments for nasal cavity and sinus cancer
Surgery is the most common treatment for nasal cavity and sinus cancers. Surgery often is the only treatment for benign (not cancer) tumors and early-stage cancers.
The main goal of surgery is to remove the whole tumor and a small amount of normal tissue around it.
Your nasal cavity and sinuses are small areas that have many muscles, nerves, blood vessels, and other important parts. If your surgeon must remove any of these things, there’s a chance it can affect how you look or function.
We try to use treatments that take care of the cancer, but with less effect on your quality of life.
For more advanced cancer, you may have radiation, chemotherapy, or both. You may have treatment before or after surgery. This can shrink the tumor and lower the chance cancer will come back.
Proton therapy to treat nasal cavity and sinus cancers
MSK uses proton therapy, also called proton beam therapy, to treat nasal cavity and sinus tumors.
This type of radiation therapy uses charged particles called protons to kill cancer cells. A device called a cyclotron sends tiny, high-energy beams of protons to the tumor.
With proton therapy, the beams do not go past the tumor. It can cause fewer side effects because healthy tissue near the tumor is less likely to get radiation.
Proton therapy works well on nasal cavity and sinus tumors. It delivers radiation right to the tumor. That’s important because the optic nerves and brain stem are very near the nasal cavity and sinuses. Proton therapy is less likely to harm nearby healthy tissue of the eyes, the optic nerves, and the brain.
MSK is among the few cancer centers that offers proton therapy.
Our surgeons use MRIs during surgery to remove sinus and skull-base tumors. The MRI images confirm they removed all of the tumor while keeping healthy tissue safe. MRI-guided surgeries help prevent complications (problems) after surgery. This method also makes it less likely you’ll need another surgery.
Minimally invasive nasal cavity or sinus tumor surgery
In a traditional open surgery, you’ll have 1 or more incisions (cuts).
MSK surgeons also are experts in surgery that does less harm to your body. Minimally invasive surgery can be done by MSK surgeons with no incisions at all.
Your surgeon will use an endoscope, a thin lighted tube with a camera at its tip. They’ll put the device through the nasal passage. This magnified view of the tumor is very clear. It lets your surgeon see well enough to remove all of the tumor and keep nearby healthy tissue safe.
In general, you’ll have open or minimally invasive surgery based on the tumor’s location and size.
Benefits of minimally invasive surgery include:
- Less loss of blood.
- A shorter hospital stay.
- A faster recovery.
- Less scarring or no scarring.
- Less risk of infection.
- Fewer complications (problems) during and after surgery.
Types of surgery for nasal cavity and sinus cancers
Wide local excision: Can remove some nasal cavity tumors or tumors on the outside of the nose. It also takes off a small amount of normal tissue around it.
Medial maxillectomy: Removes tumors that are on your nasal turbinates or a part of the maxillary sinus.
Maxillectomy: Removes tumors that grew into your maxillary sinus. How much your surgeon removes depends on where the tumor is, and if it involves nearby tissue and structures. During a maxillectomy, your surgeon may remove part or all of these areas:
- Bone around your maxillary sinus.
- Bone of your hard palate (roof of your mouth).
- Upper teeth on one side of your mouth.
- Part of or your entire orbit (eye socket).
- Part of your cheekbone.
- Part of the bony part of your upper nose.
Sometimes nasal cavity or sinus tumors grow along the base of the skull. The bone in the skull base also forms the top of the nasal cavity and some of the paranasal sinuses.
Your surgeon may be able to do endoscopic (en-doh-SKAH-pik) skull-base surgery on these tumors. They’ll use an endoscope, a thin lighted tube with a camera at its tip.
They’ll put the device through the nasal passage. This magnified view of the skull base tumor is very clear. It lets your surgeon see well enough to remove all of the tumor and keep nearby healthy tissue safe.
This surgery is very complex, and your care team will be very experienced. You’ll have a head and neck surgeon, a neurosurgeon, and sometimes a plastic surgeon working together on your surgery team.
Rhinectomy is a procedure that removes all or part of the nose. This surgery in general is only for people with very high-risk cancer.
MSK’s plastic and reconstructive surgeons are experts in caring for people who need a rhinectomy. We’ll carefully explain your options for rebuilding your nose.
Open craniofacial resection surgery removes tumors in your ethmoid, frontal, or sphenoid sinuses. This surgery removes the tumor through incisions (surgical cuts) on your face and skull.
Surgeons operate on the tumor in 2 directions, from both above and below. This gives them a better chance of removing the entire tumor. It also helps lower the chances of harming your brain, nerves, and other important areas.
This surgery is very complex, and your care team will be very experienced. You’ll have a head and neck surgeon, plastic surgeon, and neurosurgeon working together on your surgery team.
Nasal cavity and sinus cancers can spread to lymph nodes in your neck. Lymph nodes are small oval or round glands along your lymphatic system. You may have a neck dissection to remove these lymph nodes if there’s a high risk of cancer spreading to them.
Your surgeon may do a neck dissection and surgery to remove the nasal cavity or sinus cancer at the same time.
There are a few types of neck dissections. They’re based on the cancer’s location, and whether it spread to your lymph nodes or other parts in your neck. Sometimes your surgeon can tell which lymph nodes are affected by examining you. If not, you may need a CT scan or ultrasound so your surgeon can see the neck area better.
Common questions
MSK’s plastic and reconstructive surgeons are very experienced in caring for people with nasal cavity and sinus cancers.
Sometimes they can rebuild bones and other structures as part of the surgery to remove a tumor. You can avoid having a second surgery to restore how you look.
Our head and neck cancer plastic and reconstructive surgeons are experts in microsurgery. If you need a tissue transplant, they can reconnect tiny blood vessels in the tissue.
Our surgeons also use special methods to keep your appearance after surgery.
Supportive care is an important part of how we improve your quality of life during and after treatment. These therapies can help with side effects that happen months or years later.
Supportive care can also improve your emotional and spiritual health. MSK’s supportive care experts work with all members of your care team. They make a personal plan for you based on your goals and values. Supportive care can help you with:
- Pain
- Fatigue (feeling very tired)
- Insomnia (trouble falling and staying asleep)
- Nausea (feeling like throwing up)
- Anxiety
We know care needs to be as convenient as possible. MSK has treatment locations in New York City, Westchester, on Long Island, and in New Jersey. If you need surgery, you’ll have it at MSK in Manhattan.
At our locations, you can meet with your care team and get treatment. MSK brings its expert care closer to you so you can get back home to what matters most.