What is cancer?
Nasal Cavity and Paranasal Sinuses Cancer
What is cancer?
The body is made up of hundreds of millions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries.
Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.
Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell.
Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, but the cell doesn't die like it should. Instead, this cell goes on making new cells that the body does not need. These new cells will all have the same damaged DNA as the first cell does.
People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in our environment. Sometimes the cause of the DNA damage is something obvious, like cigarette smoking. But often no clear cause is found.
In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow.
Cancer cells often travel to other parts of the body, where they begin to grow and form new tumors that replace normal tissue. This process is called metastasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body.
No matter where a cancer may spread, it is always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer.
Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer.
Not all tumors are cancerous. Tumors that aren't cancer are called benign. Benign tumors can cause problems -- they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.
The nasal cavity
The nose opens into the nasal passageway, or cavity. This cavity runs along the top of the palate (the roof of the mouth, the shelf that separates your nose from your mouth) and turns downward to join the passage from the mouth to the throat.
The paranasal sinuses
Sinuses are cavities or small tunnels. They are called paranasal because they are "around or near the nose." The nasal cavity and paranasal sinuses help filter, warm, and humidify the air you breathe. They also give your voice resonance, lighten the weight of the skull, and provide a bony framework for the face and eyes.
The nasal cavity opens into a network of paired sinuses:
- Maxillary sinuses are in the cheek area, below the eyes, and on either side of the nose.
- Frontal sinuses are above the inner eye and eyebrow area.
- Sphenoid sinuses are situated deep behind the nose, between the eyes.
- Ethmoid sinuses are made up of multiple, sieve-like sinuses formed of thin bone and mucous tissues. They are located above the nose, between the eyes.
Normally, these sinuses are filled with air. When you have a cold or sinus infection they can fill with mucus and pus, often becoming obstructed, and cause discomfort.
The nasal cavity and the paranasal sinuses are lined by a layer of mucous producing tissue called mucosa. The mucosa has multiple types of cells including:
- squamous epithelial cells, which are lining cells and form the majority of the mucosa
- glandular cells such as minor salivary gland cells, which produce mucus and other fluids
- nerve cells which are responsible for sensation and the sense of smell in the nose
- infection-fighting cells (which are part of the immune system), blood vessel cells, and other supporting cells
All of the cells that make up the mucosa can become cancerous and each type behaves or grows differently. The types of tumors formed when these cell types become cancerous include:
Squamous epithelial cells can become squamous cell carcinoma. This is the most common type of cancer in the nasal cavity and paranasal sinuses. It makes up a little over half of cancers of these areas.
- A type of cancer that can also come from mucosa cells is called undifferentiated carcinoma. It makes up about 7% of cancer in the nasal cavity and paranasal sinuses.
- Cells that give the skin color are called melanocytes. These cells give rise to a type of cancer called malignant melanoma. This is an aggressive cancer that comprises about 7% of the nasal and paranasal sinus tumors.
- A cancer that starts in the nerve for the sense of smell (the olfactory nerve) is called esthesioneuroblastoma. This tumor is also known as olfactory neuroblastoma. This type of cancer usually occurs on the roof of the nasal cavity and involves a structure called the cribiform plate. The cribiform plate is a bone deep in the skull, between the eyes, and above the ethmoid sinuses. These tumors make up about 7% of the cancers of the nasal cavity and paranasal sinuses. They can sometimes be mistaken for other types of tumors, like undifferentiated carcinoma (a rapidly growing cancer) or lymphoma.
- Malignant lymphomas (cancer arising from immune system cells called lymphocytes) can also occur in the nasal cavity and paranasal sinuses. One type of lymphoma seen in this area, T-cell/natural killer cell nasal-type lymphoma, was previously called lethal midline granuloma. Information about the diagnosis and treatment of lymphomas can be found in our document, Non-Hodgkin Lymphoma.
- Cancers of muscle, bone, cartilage, and fibrous cells may also occur. These are sarcomas, and make up about 6% of nasal and paranasal sinus cancers. Information about sarcomas can be found in other American Cancer Society documents.
- Papillomas also occur in the nasal cavity and paranasal sinuses. They are growths similar to warts that can destroy healthy tissue. Papillomas are not cancer, but sometimes a squamous cell carcinoma will start in a papilloma. Inverting papilloma is a type of papilloma that is officially a benign tumor, but tends to act more like a cancer. It has a tendency to recur (come back) and can grow into surrounding tissues. The treatment of inverting papilloma often includes the same type of surgery that is used for cancer.
Cancers of the nasal cavity and paranasal sinuses are rare. About 2,000 people in the United States develop cancer of the nasal cavity and paranasal sinus each year. Men are about 50% more likely than women to get this cancer. Nearly 80% of the people who get this cancer are between the ages of 45 and 85. These cancers also occur much more often in certain areas of the world such as Japan and South Africa.
About 30% to 40% of cancers of the nasal cavity and paranasal sinuses occur in the maxillary sinus, 40% to 50% in the nasal cavity, 10% in the ethmoid sinuses, and less than 5% in the frontal and sphenoid sinuses.
A risk factor is anything that changes your chances of getting a disease such as cancer. Different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer. Also, smoking is a risk factor for many different kinds of cancers.
Researchers have found several risk factors that make a person more likely to develop nasal cavity and paranasal sinus cancer, but many people with these cancers have no known risk factors. Even if a patient has one or more risk factors, it is difficult to know whether that factor actually caused the cancer.
Scientists have found that people who work in certain jobs are more likely to develop nasal cavity and paranasal sinus cancer. The increased risk seems to be related to breathing in certain substances while at work, such as:
- wood dusts from carpentry (furniture and cabinet builders), sawmills, and other wood related industries
- dusts from textiles (textile plants)
- leather dusts (shoemaking)
- flour (baking and flour milling)
- nickel and chromium dust
- mustard gas, a poison used in chemical warfare
These workplace exposures have less clear links to nasal and paranasal sinus cancer:
- organic solvents
Smoking increases the risk of nasal cavity cancer.
Most people with nasal cavity and paranasal sinus cancer do not have any relatives with this disease. Family history does not seem to be a risk factor for these cancers.
People with the inherited form of a certain type of eye cancer, retinoblastoma, have an increased risk of nasal cavity cancer. The increase in nasal cavity cancer was only seen in those who had their retinoblastoma treated with radiation.
Scientists have found that these cancers are associated with a number of risk factors, but their exact cause in most cases is not yet known. But researchers think these risk factors probably affect the DNA, the genetic material present in the cells lining the nasal passages and paranasal sinuses.
Researchers have made great progress in understanding how certain changes in a person's DNA can cause cells to become cancerous. DNA is the molecule that carries the instructions for nearly everything our cells do. We usually look like our parents because they are the source of our DNA. However, DNA affects more than our outward appearance. It also determines our risk for developing certain diseases, such as some kinds of cancer.
Some genes (parts of our DNA) contain instructions for controlling when our cells grow and divide. Genes that promote cell division are called oncogenes. Others that slow down cell division or cause cells to die at the appropriate time are called tumor suppressor genes. Cancers can be caused by DNA mutations (defects) that turn on oncogenes or turn off tumor suppressor genes.
Some people with cancer have DNA mutations they inherited from a parent, which increase their risk for the disease. But usually DNA mutations occur during life rather than having been inherited. These acquired mutations may result from events such as exposure to radiation or cancer-causing chemicals. Sometimes they occur for no apparent reason.
So far no specific gene changes have been found in these cancers.
The best way to prevent cancer of the nasal cavity and paranasal sinuses is to avoid the known risk factors. Fortunately, working conditions and safety measures have improved and awareness of the risk factors has increased. If you are working with the substances listed in the section of this document on risk factors, it is important for you to find out if you are being protected from harmful exposure.
Cigarette smoking is another avoidable risk factor for cancers of the nasal cavity and sinuses.
Because many people with cancer of the nasal cavity and paranasal sinuses have no known risk factors, there is currently no way to prevent all of these cancers.
Small cancers of the nasal cavity and paranasal sinuses usually do not cause any specific symptoms. Many of the symptoms of nasal cavity and paranasal sinus cancers can also be caused by benign conditions like infections. This is why many of these cancers are not found until they have grown large enough to block the nasal airway or sinuses, or until they have spread to nearby tissues or even to distant areas of the body.
Screening refers to tests and exams used to detect a disease, such as cancer, in people who do not have any symptoms. The American Cancer Society has official recommendations for screening tests to find several types of cancer as early as possible. Cancers of the nasal cavity and paranasal sinuses occur so rarely that routine testing of people without any symptoms is not recommended.
If there are symptoms that give reason to suspect that a person has nasal cavity or paranasal sinus cancer, the doctor will take a complete medical history and perform a physical exam. Additional tests will be done to find out if the disease is really present and to determine its stage (how far the cancer has spread).
symptoms of nasal and paranasal sinus cancers
- nasal congestion and stuffiness that doesn't get better or even worsens
- pain above or below the eyes
- blockage of one side of the nose
- post-nasal drip (nasal drainage in the back of the nose and throat)
- pus draining from the nose
- decreased sense of smell
- numbness or pain in parts of the face
- loosening or numbness of the teeth
- growth or mass of the face, nose, or palate
- watery eyes that persists over time
- bulging of one eye
- visual loss
- pain or pressure in one of the ears
- trouble opening the mouth
- lymph nodes in the neck getting larger
Many of these symptoms are most often caused by benign conditions such as allergies or infections. When the symptoms are caused by cancer, they don't get better over time. People with these symptoms should see a doctor. If a cancer is present, early detection greatly improves the chance that treatment will be successful.
Medical history and physical exam
When your doctor "takes a history," he or she will ask you a series of questions about your symptoms and risk factors. A physical exam will provide other information about signs of nasal cavity and paranasal sinus cancer and other health problems.
During your physical exam, your doctor will pay special attention to the areas of the nose and sinuses that are causing symptoms. He or she will also pay attention to areas of numbness or pain, swelling and firmness in areas of the face or lymph nodes in the neck, changes in the symmetry of the eyes and face, visual changes, and any other associated problem that you may be experiencing. Your doctor may also examine the nasal cavity with a headlight or even look inside your nose with a special instrument called a nasal endoscope (a thin tube designed to allow the doctor to see into cavities of the body).
If your doctors suspects cancer of the nasal cavity or paranasal sinuses, you will be referred to a specialist in ear, nose, and throat (ENT) diseases called an otolaryngologist.
X-rays of the sinuses
These x-ray images may tell if the sinuses are not filled by air as they should be. This would suggest that something is wrong, but it may not be a tumor. Most of the time, an abnormal sinus x-ray means there is an infection. If treatment for infection doesn't work, then other more specialized x-ray tests may be done. Sinus x-rays are not done often any more, as many doctors prefer to order a computed tomography (CT) scan instead. A CT scan provides much more detail about the anatomy of the sinuses and only exposes the patient to the same amount of radiation as sinus x-rays.
This test may be done to find out whether nasal cavity or paranasal sinus cancer has spread to the lungs, which is the most common site of spread other than lymph nodes.
Computed tomography scan
The computed tomography (CT) scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then processes these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied. This test is very useful in identifying cancers of the nasal cavity and paranasal sinuses.
Often after the first set of pictures is taken, you may receive an injection of a "dye" or radiocontrast agent into an intravenous (IV) line. This dye helps better outline structures in your body. A second set of pictures is then taken. The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medication can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays, and you need to lie quietly on a table while they are being done. But just like other computerized devices, they are getting faster, and your stay might be pleasantly short. Also, you might feel a bit confined by the machine you lie within when the pictures are being taken.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected just as with CT scans. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. Because they are better than CT in distinguishing fluid from tumor, sometimes they can help the doctor tell the difference between a benign tumor and a malignant one.
MRI scans take longer than CT scans, often up to an hour. Also, you are placed inside a tube, which is confining and can upset people with claustrophobia or fear of enclosed spaces. The machine gives off a thumping noise, and some facilities provide headphones with music to block out the noise. However the benefits of the test outweigh any discomfort.
Both CT and MRI are helpful in identifying cancers of the nasal cavities and paranasal sinuses and their characteristics. The CT scan can tell if the cancer is growing into bone, but the MRI is better at evaluating the kind and size of the cancer. Both can tell if it has spread to lymph nodes in the neck.
A biopsy removes a sample of tissue to examine under a microscope in order to see if a growth is cancer. If it is a cancer, the biopsy can tell what type of cancer it is and how aggressive it is. This is important to plan the most effective treatment. Often, biopsies are done in the doctor's office or clinic. If the tumor is in an area that is hard to reach, the biopsy will be done in the operating room. Several types of biopsies are used to diagnose nasal cavity or paranasal sinus cancer.
Fine needle biopsy
In this type of biopsy, the doctor places a thin, hollow needle directly into a tumor or lymph node to take out cells and a few drops of fluid. The doctor may repeat this procedure 2 or 3 times during the same appointment to take samples from several areas of the nodule. The cells can then be viewed under a microscope to see if they look cancerous or benign. This type of biopsy is often used in patients with enlarged lymph nodes in the neck. In these patients, fine needle biopsy can be useful in deciding whether the lymph node swelling is from the spread of cancer from somewhere else (such as the sinus), a lymphoma (cancer that begins in lymph nodes), or reactive hyperplasia (lymph node swelling in response to an infection). If someone who has already been diagnosed with nasal cavity or paranasal sinus cancer has enlarged neck lymph nodes, a fine needle biopsy can help determine whether the lymph node swelling is due to the spread of cancer.
In this type of biopsy, the surgeon cuts out a small piece of the tumor. The surgeon may remove small biopsy specimens by using special instruments placed into the nose.
In this type of biopsy, the entire tumor is removed and then sent to the laboratory for analysis.
This type of biopsy is done through an endoscope (a thin, flexible lighted tube).
In some cases, it may necessary to cut through the skin next to the nose and through the underlying bones to reach tumors inside the sinuses. These operations are discussed in greater detail in the section on treatment of nasal cavity or paranasal sinus cancers.
Anesthesia is used for a biopsy, but the type of anesthesia that is used depends on which biopsy method is used. Local anesthesia (numbing medication) is often used for an incisional biopsy or needle biopsy. Local anesthesia can be injected into the skin and nearby tissues or even applied directly onto the inside of the nose to make the area numb for the biopsy. General anesthesia may be required for endoscopic biopsies and is necessary for procedures that cut through the sinus bones.
The prognosis (outlook) for people with cancers of the nasal cavity and paranasal sinuses depends on many factors. These include the type of cancer, the size and location of the cancer, whether the cancer has spread to other areas of the body, and the general health of the patient. Cancers of the nasal cavity and paranasal sinuses first grow or spread locally (to nearby areas) and then spread to the lymph nodes. Lymph nodes are bean-sized glands scattered throughout the head and neck (and the rest of the body) which fight infection and remove cell waste.
Staging is a process that tells the doctor how widespread a cancer may be. It will show whether the cancer has spread and how far. The treatment and outlook for nasal cavity or paranasal sinus cancers depend, to a large extent, on their stage. For early cancer, surgery may be all that is needed. For more advanced cancer, other treatments such as chemotherapy or radiation therapy may be required. Be sure to ask your doctor to explain the stage of your cancer so that you can make the best choice for yourself about your treatment.
Nasal cavity and paranasal sinus cancers are staged using a system that is agreed upon by the American Joint Committee on Cancer (AJCC).The AJCC/TNM System describes the extent of the primary tumor (T), the absence or presence of metastasis to nearby lymph nodes (N), and the absence or presence of distant metastasis (M). Information about the T, N, and M categories is then combined by a process called stage grouping to determine the patient’s stage. This stage is described in Roman numerals from 0 to IV.
T categories for maxillary sinus cancer
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Cancer cells are limited to the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.
T1: Tumor is only in the tissue lining the sinus (the mucosa) and does not invade bone
T2: Tumor begins to grow into some of the bones of the sinus. (Note: If the cancer grows into the bone of the back part of the sinus, it is classified as T3).
T3: Tumor begins to grow into the bone at the back of the sinus (called the posterior wall) or the tumor has grown into the ethmoid sinus, the tissues under the skin, or the eye socket.
T4a: Tumor grows into other structures such as the skin of the cheek, the front part of the eye socket, the bone at the top of the nose (cribiform plate), the sphenoid sinus, the frontal sinus, or certain parts of the face (the pterygoid plates and the infratemporal fossa). This is also known as moderately advanced local disease.
T4b: Tumor has grown into the area between the nasal cavity and the throat (called the nasopharynx), the back of the eye socket, the brain, the tissue covering the brain (the dura), some parts of the skull (middle cranial fossa, the clivus), or certain nerves. This is also known as very advanced local disease.
T categories for nasal cavity and ethmoid sinus cancer
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
Tis: Cancer cells are only in the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.
T1: Tumor is only in the nasal cavity or one of the ethmoid sinuses, although it may have grown into the bones of the sinus.
T2: Tumor has grown into other nasal or paranasal cavities
T3: Tumor has grown into bone of the eye socket, the roof of the mouth (palate), the cribiform plate (the bone that separates the nose from the brain), and/or the maxillary sinus
T4a: Tumor has grown into other structures such as the front part of the eye socket, the skin of the nose or cheek, the sphenoid sinus, the frontal sinus, or certain bones in the face (pterygoid plates). This is also known as moderately advanced local disease. Cancers that areT4a are resectable (meaning they can be removed with surgery)
T4b: Tumor is growing into the back of the eye socket, the brain, the dura (the tissue covering the brain), some parts of the skull (the clivus, the middle cranial fossa), certain nerves, or the nasopharynx (the area between the nasal cavity and the throat). This is also known as very advanced local disease. Tumors are called T4b when they are not resectable (they cannot be removed with surgery)
NX: Nearby (regional) lymph nodes cannot be assessed
N0: Cancer has not spread into the lymph nodes
N1: Cancer has spread to a single lymph node that is on the same side as the tumor and is no larger than 3 cm (slightly larger than 1 inch)
N2: Cancer has spread to a lymph node that is larger than 3 cm (slightly larger than one inch) but smaller than 6 centimeters (slightly larger than 2 inches); or cancer has spread to more than one lymph node which are smaller than 6 cm; or cancer is in a lymph node that is not on the same side as the tumor (and the lymph node is smaller than 6 cm).
N3: Cancer has spread to at least one nearby lymph node that is larger than 6 cm (slightly larger than 2 inches)
M0: No cancer spread (metastasis) distant organs or tissues
M1: The cancer has spread to distant organs such as the lung, brain, or liver.
T1 or T2
N0 or N1
T1, T2, or T3
N0, N1, or N2
Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about the survival statistics below for nasal and paranasal sinus cancer is up to you.
The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).
Five-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to describe the impact on survival for a particular type and stage of cancer.
In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with nasal and paranasal sinus cancer.
Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors may affect a person's outlook, such as their general state of health, the type of cancer, and how well the cancer responds to treatment Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.
The following statistics come from the National Cancer Institute's SEER database and are based on cancers diagnosed between 1988 and 2001. This database does not list these cancers by AJCC stage, but instead groups them into local, regional and distant stages. Local stage means that there is no sign that the cancer has spread outside of the nose or sinus (where it started). This corresponds to AJCC stages I and II. Regional means that the cancer has started growing into nearby structure or lymph nodes. This corresponds to stages III, IVA, and IVB. Distant means that the cancer has spread to distant sites, such as the lung or liver. This corresponds to stage IVC.
For all nasal cavity and paranasal sinus cancers combined, the relative 5-year survival is 54%. Survival tends to worsen as the stage increases:
5-year relative survival
For nasal cavity cancers, survival is slightly better:
5-year relative survival
How are nasal cavity and paranasal sinus cancers treated?
In recent years, progress has been made in treating nasal cavity and paranasal sinus cancer with surgery, radiation therapy, and chemotherapy. Surgery has improved, and more is known about the best way to combine drugs to treat different types of cancer.
After the disease is found and staged, the cancer care team will recommend a treatment plan. This is an important decision, but it is also important to take time and think about all of the choices. In choosing a treatment plan, factors to consider include the patient's overall physical health, the nature of the disease, and anything else that makes that person unique.
It is often a good idea to seek a second opinion. A second opinion can provide more information and help the patient feel good about the treatment plan that is chosen. It is important to remember that these are uncommon cancers and not all hospitals and doctors have enough experience in treating them. Some insurance companies require a second opinion before they will agree to pay for treatments.
For most nasal cavity or paranasal sinus cancers, surgery to remove the cancer (and some of the surrounding bone or other nearby tissues) is an essential part of treatment. If the cancer has spread to the lymph nodes of the neck, the surgeon may also remove lymph nodes by an operation called a neck dissection. Often, surgery is combined with radiation to get the best result. The role of chemotherapy is being studied.
The anatomy of the nasal cavity and paranasal sinuses is extremely complex. Many important nerves, blood vessels, and other structures are located in and around the nasal cavity and paranasal sinuses.
Closeness to the brain, eyes, mouth, and carotid arteries (arteries that supply blood to the brain) makes surgical planning and surgery itself difficult. Also, how the face looks and functions after surgery must be taken into account. The goal of surgery in these areas is to remove the entire tumor and a small amount of normal tissue around it while keeping appearance and function (such as breathing, speech, chewing, and swallowing) as normal as possible.
Unfortunately, these cancers often involve the eye or orbit (the bone and tissue surrounding the eye) by the time they are noticed or cause symptoms. Most of the time the eye can be saved, but occasionally the entire orbit and eye may need to be removed to give the best chance for cure.
Nasal cavity cancers
Nasal cavity cancers are often removed by a procedure called wide local excision. This means removing the tumor plus an area of normal tissue surrounding it. The goal is to remove enough tissue so that no cancer cells remain. If the tumor involves the middle dividing wall of the nasal cavity (the nasal septum), sometimes the entire septum or a large portion of it will be removed.
If the tumor involves the lateral (side) wall of the nasal cavity, often this wall must be removed by a procedure called a medial maxillectomy. For this operation, the surgeon will usually cut through the skin along the side or edge of the nose and fold the external nose toward the opposite side to see and work on the tumor. Then the side of the nose can be removed by cutting the bone and soft tissue as needed. Sometimes, if the cancer is in a certain position, the surgeon can reach the tumor by cutting under the upper lip. This approach has the advantage of avoiding any skin incisions.
Discuss which approach or incision you may need with your head and neck surgeon. If the cancer involves the skin or deeply invades the tissue of the external nose, part (or all) of the nose may need to be removed. There are many ways to rebuild the nose with surrounding facial tissues. Or a cosmetic prosthesis (artificial materials) may be used to make a new nose.
Paranasal sinus cancers
Operations for paranasal sinus tumors vary, depending on the tumor's specific type, location, size, and involvement with other structures.
If the tumor is very small and/or benign and is located within the ethmoid sinuses only, an external ethmoidectomy may be performed. The surgeon performing this operation will cut through the skin on the upper side of the nose next to the upper eyelid. Bone on the inner side of orbit (eye socket) and nose will be removed to reach tumors inside the ethmoid sinuses.
If the tumor also involves the maxillary sinus, a maxillectomy may be performed. There are several types of maxillectomies that may be performed depending on exactly where the tumor is and whether it also involves nearby tissues. These procedures may involve an incision along the side of the nose from the eyebrow or upper eyelid down to or through the upper lip. Or the incision may be made under the upper lip as discussed above. The bones around the maxillary sinus are cut so that the entire tumor and some surrounding tissue can be removed in one piece. This operation may remove bone from the hard palate (the roof-of the mouth), upper teeth on one side of the mouth, part or all of the orbit (eye socket), part of the cheekbone, and/or the bony part of the upper nose.
If the cancer involves the ethmoid sinuses, frontal sinuses, and/or the sphenoid sinuses, an operation called a craniofacial resection may be performed. This operation is similar to a maxillectomy except that the operation may also remove upper parts of the eye socket and the front of the skull base. This procedure is extensive and usually involves a surgical team including an otolaryngologist (head and neck surgeon) and a neurosurgeon.
In endoscopic surgery, the surgeon uses an endoscope (a thin, flexible lighted tube inserted into the nasal cavity or sinus) to see and remove the tumor. That way, the surgeon does not have to cut through bone to open up the whole cavity. This reduces the actual amount of normal tissue destroyed. Endoscopic surgery is most often used for smaller tumors. For larger tumors, it may be used to help treat people who are not healthy enough for a bigger operation. Usually it is combined with radiation treatment. Endoscopic approaches to remove nasal and sinus cancers are being used more commonly as an increasing number of surgeons are trained in these techniques. Some medical centers have more experience with endoscopic surgery for nasal and sinus cancers.
Cancers of the nasal cavity or paranasal sinuses sometimes spread to the lymph nodes in the neck. Depending on the stage and exact location of the cancer, it may be necessary to remove these lymph nodes by an operation called a neck dissection. There are several types of neck dissection procedures and they differ in the amount of tissue removed from the neck. Their goals are to remove lymph nodes proven or likely to contain metastatic cancer. The amount of tissue removed depends on the primary cancer's size and extent of spread to lymph nodes.
- A partial or selective neck dissection removes only a few lymph nodes.
- A modified radical neck dissection removes most lymph nodes on one side of the neck between the jawbone and collarbone, as well as some muscle and nerve tissue.
- A radical neck dissection removes nearly all nodes on one side as well as even more muscles, nerves, and veins.
The most common side effects of any neck dissection are numbness of the ear (caused by injury to the greater auricular nerve), weakness in raising the arm above the head (caused by injury to the spinal accessory nerve), and weakness of the lower lip (caused by injury to lower branches of the facial nerve). After a selective neck dissection, the weakness of the arm and lower lip usually resolve after a few months. But if either nerve is removed as part of a radical neck dissection or because of tumor spread then the weakness will be permanent. After any neck dissection procedure, physical therapists can teach the patient exercises to improve neck and shoulder movement.
Radiation therapy uses high-energy radiation to kill cancer cells. It can be used as the main (primary) treatment of nasal cavity and paranasal sinus cancer in some cases. Patients with small nasal cavity tumors can often be cured with radiation alone with less change in their facial appearance than if they had surgery. Patients whose general health is too poor to undergo surgery may receive radiation therapy as their only treatment.
Often, after surgery, radiation therapy will be used to kill very small deposits of cancer that cannot be seen and removed during surgery. This is called adjuvant treatment. It also may be given before surgery to shrink the tumor so it is easier to remove. This is called neoadjuvant treatment. Radiation therapy can also be used to help with symptoms like pain, bleeding, and difficulty swallowing. This is known as palliative treatment. It is also used when the cancer has spread to the brain or spinal cord. There are 2 major types of radiation therapy -- external beam radiation therapy and brachytherapy.
External beam radiation therapy
The most common way to deliver radiation to a paranasal or nasal tumor is to carefully focus a beam of radiation from a machine outside of the body. This is known as external beam radiation. To reduce the risk of side effects, doctors carefully figure out the exact dose you need and aim the beam as accurately as they can to hit the target area. External beam radiation therapy usually means having treatments 5 days a week for a period of about 6 to 7 weeks. Intensity modulated radiation therapy (IMRT) is a form of external beam radiation therapy in which the radiation beam is focused so that it is better shaped to the contours of the tumor. This reduces the dose of radiation to the surrounding normal tissue, decreasing some side effects.
Another method of delivering radiation is to insert (implant) very thin metal rods containing radioactive materials in or near the cancer. This method is called internal radiation, interstitial (in the tissue) radiation, or brachytherapy. This is sometimes done if the cancer comes back after external beam radiation therapy.
The implant is usually left in place for several days while the patient stays in a private hospital room. The length of time that visitors, nurses, and other caregivers can spend with the patient may be limited because of potential radiation exposure, but this depends on the type of radiation. The implants are removed before the patient goes home. Sometimes, both internal and external beam radiation therapy are used together.
Side effects of radiation therapy
Common side effects include:
- loss of appetite
- feeling tired or weak
- mouth/throat pain, sores in the mouth, and trouble swallowing (called mucositis)
- problems with taste
- bone pain
- bone damage
Problems with mucositis can be severe enough that patients have trouble eating and drinking. This can lead to weight loss and malnutrition. Some people need to rely on tube feedings during treatment to keep up their strength. With tube feedings, a liquid food is given through a tube that is placed directly into the stomach.
Most of these symptoms will go away a short while after the radiation is finished, but some side effects can be permanent. For example, if an eye lies in the path of the radiation beam, the vision may be damaged. Also, radiation therapy to the head or neck area often damages the salivary (spit) glands, causing the mouth to become very dry. This can lead to problems with eating and swallowing and also cause tooth problems. This is a very common side effect of radiation therapy to the head and neck areas, and is often permanent. This side effect can be lessened if a drug called amifostine (Ethyol®) is given before each radiation treatment. There are also fewer problems with dry mouth if IMRT is used. Also, if the pituitary or thyroid glands are exposed to radiation (irradiated), their production of hormones may decrease over time. This can lead to problems with metabolism that may need to be corrected with medicine. Sometimes chemotherapy is given with radiation to help it work better. This is called chemoradiation, and it has more severe side effects than when radiation is given by itself. However, there are ways to relieve many of the side effects caused by radiation, so it is important to discuss these symptoms with your cancer care team.
Systemic chemotherapy (chemo) uses anticancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread or metastasized to organs beyond the nasal cavity and paranasal sinuses. Chemo may also be given to shrink the tumor before surgery (called neoadjuvant), or it may be given after surgery to help prevent the cancer from coming back later (called adjuvant). When chemotherapy is given before or after surgery, it is often combined with radiation therapy (chemoradiation). Chemo for nasal cavity and paranasal sinus cancer may include a combination of several anticancer drugs. Because nasal and paranasal sinus cancers are so rare, there aren't many studies to decide the best way to treat them. Often, doctors treat them with the same drugs that are used for other, more common, cancers of the head and neck.
The most common types of nasal cavity and paranasal sinus cancers, squamous cell carcinoma, adenocarcinoma, and adenoid cystic carcinoma, can be grouped together as carcinomas. Some of the chemo drugs commonly used to treat carcinomas include carboplatin, cisplatin, 5-fluorouracil (5-FU), docetaxel (Taxotere), and paclitaxel (Taxol). Cisplatin (sometimes combined with 5-FU) is the drug most often given with radiation. Recent studies have shown that giving docetaxel with these 2 drugs may work even better. Other drugs that can be helpful to treat these cancers include bleomycin, cyclophosphamide, vinblastine, and methotrexate. Chemo drugs may be used alone, but more often they are used in combination with one another. New chemotherapy drugs and combination treatments are currently being studied.
Different chemo drugs are used for sarcoma and melanoma. Information about chemotherapy for sarcomas may be found in our document, Sarcoma -- Adult Soft Tissue Cancer. Drug therapy for melanoma is covered in our document, Melanoma Skin Cancer.
Chemotherapy drugs kill cancer cells but can also damage some normal cells, leading to some side effects. The side effects seen depend on the type of drugs given, the amount taken, and the length of treatment. Common temporary side effects of chemo include:
- nausea and vomiting
- loss of appetite
- loss of hair
- hand and foot rashes
- mouth sores
- low blood counts
Chemo can damage the blood-producing cells of the bone marrow, so patients may have low blood cell counts. This can result in an increased chance of infection (due to a shortage of white blood cells), bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets), and fatigue (due to low red blood cell counts). If the blood counts get too low, treatment may need to be delayed for a time so that they return to a safe level.
Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, though it may look different. There are remedies for many of the temporary side effects of chemotherapy. For example, there are very good drugs to prevent or reduce nausea and vomiting.
Some side effects can continue long after treatment is stopped. For example, cisplatin can cause nerve damage leading to numbness of the hands and feet (this is called neuropathy). It can also cause hearing loss. These symptoms usually improve after the drug is stopped, but may not go away completely. It is important to talk with your doctor about the chemotherapy drugs that will be used and their possible side effects.
Many doctors are treating more advanced nasal and paranasal cancers with a combination of treatments that often includes chemotherapy. Often this is given at the same time as radiation therapy. Cisplatin and carboplatin are chemotherapy drugs that are often given with radiation. Some doctors give the drugs directly into arteries leading to the tumor. This concentrates the chemotherapy into the area that needs it to try to reduce side effects.
A drug called cetuximab (Erbitux®) can also be helpful in treating these cancers. It is considered a type of targeted therapy because it blocks the receptor for a certain hormone-like substance. This receptor is found in high amounts on the surface of the cells of head and neck cancers. Cetuximab belongs to a class of drugs called EGFR inhibitors. It blocks the activity of a certain hormone-like substance called epidermal growth factor that signals cells to grow and divide. It doesn't have the same side effects as regular chemo drugs. The most common side effect is a rash similar to acne. This rash can be severe, and can cause patients to stop treatment. Also, this drug is given as an infusion into a vein (IV) and sometimes allergic reactions occur during the infusion. Other side effects include diarrhea, headaches, and feeling itchy. Cetuximab is commonly given with radiation to treat cancers that cannot be removed with surgery. It can also be given alone or even with standard chemo drugs to help them work better.
Most of this document discusses ways to remove or to destroy cancer cells or to slow their growth. But it is important to realize that maintaining a patient's quality of life is another important goal.
Pain is a significant concern for many patients with cancer. This symptom can be effectively treated with morphine or morphine-like drugs. These are the best drugs to treat pain. Taking them does not mean a person will become addicted. Many studies have shown that people with cancer who take morphine for pain as their doctor directed do not become addicted.
There are many other ways your doctor can help maintain your quality of life and control your symptoms. This means though, that you have to tell your doctor how you are feeling and what symptoms you are having. Some patients don't like to disappoint their doctors by telling them they are not feeling well. This does no one any good. Your doctor wants to know how you really feel. Talking about the symptoms you are having allows your doctor to give treatments that can relieve the symptoms. Getting effective treatment can help you feel better and allow you to concentrate on the things that are important in your life.
You may have had to make a lot of decisions since you've been told you have cancer. One of the most important decisions you will make is choosing which treatment is best for you. You may have heard about clinical trials being done for your type of cancer. Or maybe someone on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. They are done to get a closer look at promising new treatments or procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if your clinic or hospital conducts clinical trials. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs. You can reach this service at 1-800-303-5691 or on our Web site at http://clinicaltrials.cancer.org. You can also get a list of current clinical trials by calling the National Cancer Institute's Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.
There are requirements you must meet to take part in any clinical trial. If you do qualify for a clinical trial, it is up to you whether or not to enter (enroll in) it.
Clinical trials are one way to get state-of-the art cancer treatment. They are the only way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
You can get a lot more information on clinical trials in our document called Clinical Trials: What You Need to Know. You can read it on our Web site or call our toll-free number (1-8800-227-2345) and have it sent to you.
When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet groups and Web sites offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
What exactly are complementary and alternative therapies?
Not everyone uses these terms the same way, and they are used to refer to many different methods, so it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor's medical treatment.
Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not be helpful, and a few have even been found harmful.
Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.
Finding out more
It is easy to see why people with cancer think about alternative methods. You want to do all you can to fight the cancer, and the idea of a treatment with no side effects sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or they may no longer be working. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer.
As you consider your options, here are 3 important steps you can take:
- Look for "red flags" that suggest fraud. Does the method promise to cure all or most cancers? Are you told not to have regular medical treatments? Is the treatment a "secret" that requires you to visit certain providers or travel to another country?
- Talk to your doctor or nurse about any method you are thinking about using.
- Contact us at 1-800-227-2345 to learn more about complementary and alternative methods in general and to find out about the specific methods you are looking at.
The choice is yours
Decisions about how to treat or manage your cancer are always yours to make. If you want to use a non-standard treatment, learn all you can about the method and talk to your doctor about it. With good information and the support of your health care team, you may be able to safely use the methods that can help you while avoiding those that could be harmful.
Treatment options by type, location, and stage of nasal cavity and paranasal sinus cancer
Clinical staging of nasal cavity and paranasal sinus cancer is extremely complex and thus far only maxillary sinus and nasal cavity/ethmoid sinus cancer staging systems have been agreed upon by the American Joint Committee on Cancer. Treatment choices for other cancers of the nasal cavity and paranasal sinuses are tailored to suit each individual patient depending on the patient's tumor type, size, location, general medical condition, and desires.
Maxillary sinus cancer
Stages I and II: The first step in treating most stage I or II maxillary sinus cancers is surgery to remove the cancer. Usually a maxillectomy (removal of bone and mucosa of the maxillary sinus) is done. When a tumor is completely removed with negative margins (meaning that there are no signs of any cancer left behind), often no other treatment is needed. If the cancer has grown into the area around the nerves (called perineural invasion), the doctor may recommend radiation therapy after surgery. Radiation can also be helpful if the cancer is the type called "adenoid cystic." If cancer cells are close to the surgical margin (only a small amount of normal tissue around the tumor is removed) radiation after surgery may also be considered.
In some patients, having surgery to remove the cancer can be very risky because they have other medical problems. Those people may have their stage I or stage II maxillary sinus cancer treated with radiation therapy alone.
Stages III and IVA: People with these stages of maxillary sinus cancer are also treated with surgery to remove the tumor. If there are signs that the cancer has spread to the lymph nodes in the neck, a neck dissection will be done as well.
After surgery, the area where the tumor had been is treated with radiation therapy. Sometimes, the lymph nodes in the neck are also treated with radiation. This is more likely to occur if the cancer has spread to a neck lymph node. Chemotherapy may be given along with the radiation therapy. Giving chemotherapy with radiation has more side effects than giving either treatment alone, but it also reduces the risk that the cancer will grow back after treatment. Sometimes the radiation and chemotherapy are given before the surgery to shrink the tumor so that it can be more easily or more completely removed.
Stage IVB: Some cancers are in this stage because the tumor is T4b -- which means that the cancer is not resectable (it cannot be removed completely with surgery). Patients with T4b cancers are usually treated with radiation therapy. They may also receive chemotherapy. Surgery is sometimes done before radiation therapy to help relieve sinus blockage, but it is not meant to cure or completely remove the cancer.
Stage IVB also includes cancers that can be removed with surgery (resectable) when the cancer has spread to lymph nodes causing them to be large (more than 6 cm or about 2 1/2 inches). These cancers are treated like stage IVA cancers -- surgery to remove the tumor and neck lymph nodes, followed by radiation and maybe chemotherapy. Again, sometimes radiation and chemotherapy are given before the operation to shrink the tumor and make it easier to remove.
Stage IVC: If the cancer has spread (metastasized) to organs outside of the head and neck area, it is considered stage IVC. Cancers in this stage are not considered curable. Treatment for this stage varies, depending on where the cancer is, the problems that the cancer is causing, and the general health of the patient. Options include radiation treatment and chemotherapy.
Nasal cavity and ethmoid sinus cancer
Most stages of ethmoid sinus or nasal cavity cancer are treated with surgery to remove the tumor. A patient with a T1 or T2 tumor of the ethmoid sinus or nasal cavity cancer may be given the option of treating the tumor with radiation instead of surgery. Radiation often results in less change in the facial appearance than surgery. Because the ethmoid sinuses are close to the eye sockets and the skull base, operations for cancers in this area are generally more difficult and more extensive than operations for maxillary sinus cancers. If lymph nodes in the neck are enlarged, they will also be removed in an operation called a neck dissection. Treatment after surgery usually includes radiation therapy (which is sometimes given with chemotherapy). This is to kill any tiny bits of cancer cells that couldn't be seen and removed during surgery. This treatment lowers the chance of the cancer coming back later. Sometimes chemotherapy and radiation therapy are given before surgery to shrink the tumor and make it easier to remove.
If the tumor is unresectable (T4b), the first treatment is usually radiation therapy. Sometimes chemotherapy is given with the radiation treatments.
Sphenoid sinus cancer
The sphenoid sinuses are very difficult to reach surgically. Cancers in this location are generally treated with radiation therapy.
Most melanomas of the nasal cavity or paranasal sinuses are treated with surgery to remove all of the tumor and a surrounding area of normal tissue.
Like other cancers of the nasal cavity and the paranasal sinuses, the main treatment for most types of sarcoma is surgery. In some cases radiation and/or chemotherapy may also be used. Rhabdomyosarcoma is a type of sarcoma that is most common among infants and young children. It is usually treated with a combination of surgery, radiation therapy, and chemotherapy. For more information about the treatment of rhabdomyosarcoma, please see our document, Rhabdomyosarcoma. For other types of sarcoma, please see ourdocument, Sarcoma -- Adult Soft Tissue Cancer.
Recurrent nasal cavity or paranasal sinus cancer
Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to distant organs such as the lungs or liver).Options for treating recurrences depend on the location and type of cancer, as well as the initial therapy.
If radiation is the first treatment for the cancer, craniofacial surgery may be used to treat a local recurrence. If the first treatment is surgery without radiation, a local recurrence can be treated with radiation therapy. Chemotherapy may be used with radiation, or it may be used by itself to treat recurrences that are not controlled by radiation therapy or surgery.
Recurrences of sphenoid sinus cancer are usually treated with chemotherapy.
Recurrent melanomas or sarcomas of the nasal cavity or paranasal sinuses are treated by surgery, when feasible. Depending on the exact type of cells forming the cancers, chemotherapy may also be given.
Treatments for recurrent nasal cavity or paranasal sinus cancer may temporarily shrink cancers and help relieve symptoms, but a cure is usually not possible.
For more details on treatment options -- including some that may not be addressed in this document -- the National Comprehensive Cancer Network (NCCN) and the National Cancer Institute (NCI) are good sources of information.
The NCCN, made up of experts from many of the nation's leading cancer centers, develops cancer treatment guidelines for doctors to use when treating patients. Those are available on the NCCN Web site (www.nccn.org).
The NCI provides treatment guidelines via its telephone information center (1-800-4-CANCER) and its Web site (www.cancer.gov). Detailed guidelines intended for use by cancer care professionals are also available on www.cancer.gov.
As noted earlier, it is important to have frank, open discussions with your cancer care team. They want to answer all of your questions, no matter how trivial they might seem.
For instance, consider these questions:
- What kind of nasal cavity or paranasal sinus cancer do I have?
- Has my cancer spread beyond the primary site?
- What is the stage of my cancer and what does that mean in my case?
- What treatment choices do I have?
- What do you recommend and why?
- What is my expected survival rate, based on my cancer as you view it?
- What risks or side effects are there to the treatments you suggest?
- What are the chances of recurrence of my cancer with these treatment plans?
- What should I do to be ready for treatment?
- What options for reconstruction of the defects do I have?
- Should I follow a special diet?
In addition to these sample questions, be sure to write down some of your own. For instance, you might want more information about recovery times so you can plan your work schedule. Or, you may want to ask about second opinions or about clinical trials for which you may qualify.
Completing treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer.
It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. You can learn more about what to look for and how to learn to live with the possibility of cancer coming back in our document, Living with Uncertainty: The Fear of Cancer Recurrence, available at 1-800-227-2345.
For years after treatment ends, regular follow-up exams will be very important for you. These can detect recurrence, that is, the cancer coming back. Be sure to report any new or persistent symptoms to your doctor right away. Experts recommend a doctor's exam at least every 3 months for the first year after treatment. After a year, the exams can occur less often. For someone who was treated with radiation to the neck, blood tests to look at thyroid function may be needed.
The cancer care team will recommend which other tests should be done and how often. Chest x-rays, CT scans and other imaging studies may be ordered if new symptoms develop to check for a recurrence, metastasis, or for a new tumor.
Seeing a new doctor
At some point after your cancer diagnosis and treatment, you may find yourself in the office of a new doctor. Your original doctor may have moved or retired, or you may have moved or changed doctors for some reason. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. Make sure you have the following information handy:
- a copy of your pathology report(s) from any biopsy or surgery
- copies of any X-rays, CT scans, and MRIs (these often can be put on a DVD)
- if you had surgery, a copy of your operative report(s)
- if you were hospitalized, a copy of the discharge summary that doctors must prepare when patients are sent home
- if you had radiation therapy, a summary of the type and dose of radiation and when and where it was given
- if you had chemotherapy, a list of your drugs, drug doses, and when you took them
It is also important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment. Should your cancer come back the American Cancer Society document, When Your Cancer Comes Back: Cancer Recurrence gives you information on how to manage and cope with this phase of your treatment. You can get this document by calling 1-800-227-2345.
Having cancer and dealing with treatment can be time-consuming and emotionally draining, but it can also be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even begin this process during cancer treatment.
Make healthier choices
Think about your life before you learned you had cancer. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol, or ate more than you needed, or smoked, or didn't exercise very often. Emotionally, maybe you kept your feelings bottled up, or maybe you let stressful situations go on too long.
Now is not the time to feel guilty or to blame yourself. However, you can start making changes today that can have positive effects for the rest of your life. Not only will you feel better but you will also be healthier. What better time than now to take advantage of the motivation you have as a result of going through a life-changing experience like having cancer?
You can start by working on those things that you feel most concerned about. Get help with those that are harder for you. For instance, if you are thinking about quitting smoking and need help, call the American Cancer Society at 1-800-227-2345.
Diet and nutrition
Eating right can be a challenge for anyone, but it can get even tougher during and after cancer treatment. For instance, treatment often may change your sense of taste. Nausea can be a problem. You may lose your appetite for a while and lose weight when you don't want to. On the other hand, some people gain weight even without eating more. This can be frustrating, too.
If you are losing weight or have taste problems during treatment, do the best you can with eating and remember that these problems usually improve over time. You may want to ask your cancer team for a referral to a dietitian, an expert in nutrition who can give you ideas on how to fight some of the side effects of your treatment. You may also find it helps to eat small portions every 2 to 3 hours until you feel better and can go back to a more normal schedule.
One of the best things you can do after treatment is to put healthy eating habits into place. You will be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Try to eat 5 or more servings of vegetables and fruits each day. Choose whole grain foods instead of white flour and sugars. Try to limit meats that are high in fat. Cut back on processed meats like hot dogs, bologna, and bacon. Get rid of them altogether if you can. If you drink alcohol, limit yourself to 1 or 2 drinks a day at the most. And don't forget to get some type of regular exercise. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic.
Rest, fatigue, work, and exercise
Fatigue is a very common symptom in people being treated for cancer. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some, this fatigue lasts a long time after treatment, and can discourage them from physical activity.
However, exercise can actually help you reduce fatigue. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better.
If you are ill and need to be on bed rest during treatment, it is normal to expect your fitness, endurance, and muscle strength to decline some. Physical therapy can help you maintain strength and range of motion in your muscles, which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired.
Any program of physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. If you haven’t exercised in a few years but can still get around, you may want to think about taking short walks.
Talk with your health care team before starting, and get their opinion about your exercise plans. Then, try to get an exercise buddy so that you're not doing it alone. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn’t there.
If you are very tired, though, you will need to balance activity with rest. It is okay to rest when you need to. It is really hard for some people to allow themselves to do that when they are used to working all day or taking care of a household. (For more information about fatigue, please see our documents Fatigue in People With Cancer and Anemia in People With Cancer.)
Exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- It strengthens your muscles.
- It reduces fatigue.
- It lowers anxiety and depression.
- It makes you feel generally happier.
- It helps you feel better about yourself.
Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of people. You may have been going through so much during treatment that you could only focus on getting through your treatment.
Now you may find that you think about the potential of your own death, or the effect of your cancer on your family, friends, and career. You may also begin to re-evaluate your relationship with your spouse or partner. Unexpected issues may also cause concern -- for instance, as you become healthier and have fewer doctor visits, you will see your health care team less often. That can be a source of anxiety for some.
This is an ideal time to seek out emotional and social support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support communities, or individual counselors.
Almost everyone who has been through cancer can benefit from getting some type of support. What's best for you depends on your situation and personality. Some people feel safe in peer-support groups or education groups. Others would rather talk in an informal setting, such as church. Others may feel more at ease talking one-on-one with a trusted friend or counselor. Whatever your source of strength or comfort, make sure you have a place to go with your concerns.
The cancer journey can feel very lonely. It is not necessary or realistic to go it all by yourself. And your friends and family may feel shut out if you decide not include them. Let them in -- and let in anyone else who you feel may help. If you aren't sure who can help, call your American Cancer Society at 1-800-227-2345 and we can put you in touch with an appropriate group or resource.
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making healthy choices and feeling as well as possible, physically and emotionally.
If cancer continues to grow after one kind of treatment, or if it returns, it is often possible to try another treatment plan that might still cure the cancer, or at least shrink the tumors enough to help you live longer and feel better. On the other hand, when a person has received several different medical treatments and the cancer has not been cured, over time the cancer tends to become resistant to all treatment. At this time it’s important to weigh the possible limited benefit of a new treatment against the possible downsides, including continued doctor visits and treatment side effects.
Everyone has his or her own way of looking at this. Some people may want to focus on remaining comfortable during their limited time left.
This is likely to be the most difficult time in your battle with cancer -- when you have tried everything medically within reason and it's just not working anymore. Although your doctor may offer you new treatment, you need to consider that at some point, continuing treatment is not likely to improve your health or change your prognosis or survival.
If you want to continue treatment to fight your cancer as long as you can, you still need to consider the odds of more treatment having any benefit. In many cases, your doctor can estimate the response rate for the treatment you are considering. Some people are tempted to try more chemotherapy or radiation, for example, even when their doctors say that the odds of benefit are less than 1%. In this situation, you need to think about and understand your reasons for choosing this plan.
No matter what you decide to do, it is important that you be as comfortable as possible. Make sure you are asking for and getting treatment for any symptoms you might have, such as pain. This type of treatment is called "palliative" treatment.
Palliative treatment helps relieve these symptoms, but is not expected to cure the disease; its main purpose is to improve your quality of life. Sometimes, the treatments you get to control your symptoms are similar to the treatments used to treat cancer. For example, radiation therapy might be given to help relieve bone pain from bone metastasis. Or chemotherapy might be given to help shrink a tumor and keep it from causing a bowel obstruction. But this is not the same as receiving treatment to try to cure the cancer.
At some point, you may benefit from hospice care. Most of the time, this can be given at home. Your cancer may be causing symptoms or problems that need attention, and hospice focuses on your comfort. You should know that receiving hospice care doesn't mean you can’t have treatment for the problems caused by your cancer or other health conditions. It just means that the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult stage of your cancer.
Remember also that maintaining hope is important. Your hope for a cure may not be as bright, but there is still hope for good times with family and friends -- times that are filled with happiness and meaning. In a way, pausing at this time in your cancer treatment is an opportunity to refocus on the most important things in your life. This is the time to do some things you’ve always wanted to do and to stop doing the things you no longer want to do.
There is always research going on in the area of nasal cavity and paranasal sinus cancers. Scientists are looking for causes and ways to prevent nasal cavity and paranasal sinus cancers. Research on better treatment for nasal cavity and paranasal sinus cancer is now being done at many medical centers, university hospitals, and other institutions across the nation. Doctors and patients are urged to contact the nearest cancer center to find out what clinical trials are going on in their community.
We don't know of any inherited tendencies for nasal cavity and paranasal sinus cancer, but scientists are discovering changes in the genes in these cancers that occur during the patient's lifetime. These changes are what transform normal cells into cancer cells.
Understanding these genetic changes will help doctors develop better methods of diagnosing this disease as well as treatments that are more effective and have fewer side effects than ones currently available.
For example, researchers have found that many head and neck cancers have mutations (genetic changes) of the p53 tumor suppressor gene. These changes lead to additional mutations of other genes, which make the cells better able to grow and spread. Scientists are studying several gene therapies that target this gene.
Researchers have found signs that infection with the human papilloma virus (HPV) may be part of the cause of some head and neck cancers. So far, there is no evidence that HPV infection contributes to cancers of the nose or sinuses.
Doctors are learning how to make the immune system of patients reacts against their cancers. For example, researchers are testing the effectiveness of immunotherapy that stimulates immune system cells to destroy cancer cells that contain certain substances. Because nasal cavity and paranasal sinus cancers are rare, this approach has not yet been tested much for these tumors. As new tumor antigens (substances that stimulate an immune response) are discovered and new ways to stimulate the immune system are developed, immunotherapy may assume a more prominent role in treating people with nasal cavity and paranasal sinus cancer.
Clinical trials currently in progress are studying ways to make radiation therapy more effective by using radiosensitizers. These drugs make cancer cells more sensitive to radiation therapy. Other studies are testing radioprotective agents. These drugs protect normal cells from damage by radiation and thereby reduce side effects of radiation therapy. Reducing side effects improves patients’ quality of life as well as helping them tolerate higher radiation doses that can kill more cancer cells.
More information from your American Cancer Society
We have selected some related information that may also be helpful to you. These materials can be ordered from our toll-free number 1-800-227-2345.
After Diagnosis: A Guide for Patients and Families (also available in Spanish)
Caring for the Patient With Cancer at Home (also available in Spanish)
Guide to Quitting Smoking (also available in Spanish)
Nutrition for the Person With Cancer: A Guide for Patients and Families (also available in Spanish)
Pain Control: A Guide for Patients and Families (also available in Spanish)
Questions About Smoking, Tobacco, and Health (also available in Spanish)
Surgery (also available in Spanish)
Understanding Radiation Therapy (also available in Spanish)
Understanding Chemotherapy (also available in Spanish)
Non-Hodgkin Lymphoma (also available in Spanish)
Melanoma Skin Cancer (also available in Spanish)
Sarcoma -- Adult Soft Tissue Cancer (also available in Spanish)
The following books are available from the American Cancer Society. Call us at 1-800-227-2345 to ask about costs or to place your order.
American Cancer Society's Guide to Pain Control
Cancer in the Family: Helping Children Cope With a Parent's Illness
Caregiving: A Step-By-Step Resource for Caring for the Person With Cancer at Home
National organizations and Web sites*
The following organizations can also provide additional information and resources:
National Cancer Institute
Toll-free number 1-800-4-CANCER
Web site: www.cancer.gov
National Coalition for Cancer Survivorship
Toll-free number: 1-888-YES-NCCS (888-937-6227)
Web site: www.canceradvocacy.org
Let's Face It
Web site: www.dent.umich.edu/faceit
Support for People with Oral and Head, Neck Cancer, Inc. (SPOHNC)
Web site: www.spohnc.org
*Inclusion on this list does not imply endorsement by the American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit cancer.org.
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Diaz EM, Sturges EM, Laramore GE, et al. Cancer Medicine 6. Hamilton, Ontario: BC Decker; 2003: 1325-1372.
Dulguerov P, Jacobsen MS, Allal AS, et al. Nasal and paranasal sinus carcinoma: Are we making progress? Cancer. 2001;92:3012-3029.
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Salama JK, Seiwert TY, and Vokes EE. Chemotherapy for locally advanced head and neck cancer. Journal of Clinical Oncology. 2007;25:4118-4126.
Stebbings JH. Health risks from radium in workplaces: an unfinished story. Occup Med. 2001.;16:259-270.
Vermorken JB, Mesia R, Rivera F,
et al. Platinum-based
chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008;
Wong RJ, Kraus DH. Cancer of the nasal cavity and paranasal sinuses. In: Shah JP, Patel SG. American Cancer Society Atlas of Clinical Oncology, Cancer of the Head and Neck. Hamilton Ont. BC Decker 2001: 204-224.
Last Medical Review: 08/13/2009
Last Revised: 08/13/2009
- What Is Nasal Cavity and Paranasal Sinus Cancer?
- Causes, Risk Factors, and Prevention
- Early Detection, Diagnosis, and Staging
- Treating Nasal Cavity and Paranasal Sinus Cancer
- Talking With Your Doctor
- After Treatment
- What`s New in Nasal Cavity and Paranasal Sinus Cancer Research?
- Other Resources and References