Nasal Cavity and Paranasal Sinuses Cancer

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Treating Nasal Cavity and Paranasal Sinus Cancer TOPICS

Treatment options by type, location, and stage of nasal cavity and paranasal sinus cancer

Most of the time, the treatment of nasal cavity or paranasal sinus cancer is based on its location and its stage — how far it has spread in the body. But other factors, such as a person's overall health, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.

The staging of nasal cavity and paranasal sinus cancer is very complex, and thus far staging systems have only been agreed upon for the most common cancers — maxillary sinus and nasal cavity/ethmoid sinus cancers (see "How are nasal cavity and paranasal sinus cancers staged?"). Treatment choices for less common cancers of the nasal cavity and paranasal sinuses are tailored to suit each patient depending on the tumor type, size, location, and the patient's 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. Surgery to remove lymph nodes in the neck is not needed.

If the cancer was removed completely with negative margins (meaning that there are no cancer cells at the edge of the removed specimen), no other treatment may be needed.

If the tissue removed had cancer cells at the edge (called positive margins), most doctors recommend surgery to remove more tissue. If that isn’t done, radiation treatments are recommended.

For cancers that have a higher chance of coming back later (based on the cancer growing into the area around the nerves, called perineural invasion), the doctor may recommend radiation therapy after surgery. Some doctors may recommend chemotherapy (chemo) or targeted therapy along with the radiation.

Radiation is often recommended for cancers that are the type called adenoid cystic, even if the margins are negative and there is no perineural invasion.

For people in whom surgery to remove the cancer would be risky because of other medical problems, treatment may be radiation therapy alone. Sometimes chemo is given with the radiation.

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, these lymph nodes are removed as well (a neck dissection).

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 if the cancer has spread to a neck lymph node. Chemo (or targeted therapy) may be given along with the radiation therapy. This has more side effects than giving either treatment alone, but it may also reduce the risk that the cancer will grow back after treatment. Sometimes the radiation and chemo are given before the surgery to try 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 main tumor is not resectable (it cannot be removed completely with surgery). Patients with these cancers are usually treated with radiation therapy. They may also receive chemo (or targeted therapy). Surgery is sometimes done before radiation therapy to help relieve sinus blockage, but it is not meant to cure or completely remove the cancer on its own.

Stage IVB also includes some cancers where the main tumor can be removed with surgery (is resectable) but the cancer has spread to lymph nodes, making them larger than 6 cm (about 2 ½ inches, across). These cancers are treated like stage IVA cancers — surgery to remove the tumor and neck lymph nodes, followed by radiation and maybe chemo. Again, sometimes radiation and chemo are given before the operation to try to shrink the tumor and make it easier to remove.

Stage IVC: These cancers have spread to organs beyond the head and neck. Cancers in this stage are extremely hard to cure, so the goal of treatment is usually to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.

Treatment for this stage varies, depending on where the cancer is, the problems it is causing, and a person's general health. Chemo (or targeted therapy) is often the main form of treatment if a person can tolerate it because it reaches all parts of the body. Radiation therapy may be directed at areas of cancer that are causing problems. Because these cancers are hard to treat, clinical trials of newer treatments may be a good option for some people.

Nasal cavity and ethmoid sinus cancer

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.

Stages I and II: Most of these cancers are treated with surgery to remove the tumor. Surgery is typically followed by radiation therapy (sometimes with chemo or targeted therapy). This is to try to kill any tiny bits of cancer cells that couldn't be seen and removed during surgery, which may lower the chance of the cancer coming back later. Sometimes chemo and radiation therapy are given before surgery to shrink the tumor and make it easier to remove.

For some very small cancers that are unlikely to spread, some doctors may recommend surgery only, although not all doctors agree with this.

Radiation therapy instead of surgery may also be an option for some patients. Radiation often results in less change in the facial appearance than surgery.

Stages III and IVA: These cancers are usually treated with surgery as well. If lymph nodes in the neck are enlarged, they will also be removed in an operation called a neck dissection. Surgery is typically followed by radiation therapy (sometimes along with chemo or targeted therapy).

Another option may be to start treatment with radiation therapy and chemo (or targeted therapy). This might be followed by surgery if the tumor shrinks enough.

More advanced cancers: If the tumor is unresectable or if the patient is not eligible for (or does not want) surgery, the first treatment is usually radiation therapy. Sometimes chemo is given with the radiation treatments.

Cancers that have spread to distant parts of the body are extremely hard to cure, so the goal of treatment is usually to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.

Treatment depends on where the cancer is, the problems it is causing, and a person's general health. Chemo (or targeted therapy) is often the main treatment if a person can tolerate it because it reaches all parts of the body. Radiation therapy may be directed at areas of cancer that are causing problems. Because these cancers are hard to treat, clinical trials of newer treatments may be a good option for some people.

Sphenoid sinus cancer

The sphenoid sinuses are very difficult to reach surgically. Cancers in this location are generally treated with radiation therapy. Chemo (or targeted therapy) may be added as well.

Melanomas

Most melanomas of the nasal cavity or paranasal sinuses are treated with surgery to remove the tumor and a surrounding area of normal tissue. Lymph nodes in the neck may also be removed in an operation called a neck dissection. Radiation therapy is usually given after surgery.

For cancers that can't be removed, radiation therapy, chemo, or other treatments (immunotherapy or targeted therapy) may be used. Although a melanoma that forms in the nasal cavity or a paranasal sinus is different in many ways from a melanoma skin cancer, it is often treated the same way when it is advanced. For more information about the treatment of advanced melanomas, see our document, Melanoma Skin Cancer.

Sarcomas

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 chemo 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 chemo. For more information about the treatment of rhabdomyosarcoma, please see our document, Rhabdomyosarcoma.

For other types of sarcoma, please see our document, 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), regional (in nearby lymph nodes), or distant (spread to distant organs such as the lungs). Options for treating recurrences depend on the location and type of cancer, as well as the initial treatment.

For a local recurrence, if radiation was the first treatment for the cancer, surgery may be used. If the first treatment was surgery without radiation, radiation therapy may be tried. Chemo (or targeted therapy) 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 (or targeted therapy).

In a regional recurrence, the cancer comes back in the lymph nodes in the neck. This is often treated with surgery to remove many lymph nodes in the neck (a neck dissection) that are on the same side as the cancer. This may be followed with radiation to the neck, sometimes combined with chemo and/or targeted therapy.

Recurrent melanomas or sarcomas of the nasal cavity or paranasal sinuses are treated by surgery, if possible. Depending on the exact type of cells forming the cancers, chemo or other treatments may also be given.

When a nasal cavity or paranasal sinus cancer comes back in other organs, it is often treated with chemo and/or targeted therapy, although radiation could also be an option if it wasn’t given before.

Treatments for recurrent nasal cavity or paranasal sinus cancer may temporarily shrink cancers and help relieve symptoms, but these cancers are very difficult to cure. If further treatment is recommended, it's important to talk to your doctor so that you understand what the goal of treatment is — whether it is to try to cure the cancer or to keep it under control for as long as possible and relieve symptoms. This can help you weigh the pros and cons of each treatment. Because these cancers are hard to treat, clinical trials of newer treatments could be a good option for some people.


Last Medical Review: 01/10/2013
Last Revised: 01/10/2013