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.

Melanomas

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.

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 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.

Last Medical Review: 08/13/2009
Last Revised: 08/13/2009