Nasal and Sinus Cancer - Causes, Signs, Symptoms, Diagnosis, Treatment and Prevention

What Is a Nasal Cavity?

The nose opens into the nasal cavity, which is divided into two nasal passages. The nasal cavity is located above the roof of the mouth and curves down at the back to join the throat. The area inside the nostrils is called a nasal vestibule.

What Are Para Sinuses?

The para sinuses are hollow, air-filled cavities around the nose. They are lined with cells and produce mucus that helps keep the nose moist while breathing.

What Are Nasal Cancer and Sinus Cancer?

Nasal cancer and sinus cancer are diseases in which the cancerous cells are found in the nasal cavity or in the sinuses. There are various types of sinonasal cancers.

They are:

• Squamous cell carcinoma.

• Adenocarcinoma.

• Adenoid cystic carcinoma.

• Olfactory neuroblastoma.

• Sinonasal undifferentiated carcinoma.

What Causes Nasal and Sinus Cancer?

The nasal cavity or sinus cancer may be related to gene mutations or environmental factors. It may be due to damage to the DNA within the cells. However, the health experts are still not aware of the causes, but there can be various factors that contribute to nasal and sinus cancer. They include,

• Age: Those people who are above 40 years of age are more likely to develop nasal and sinus cancers.

• Gender: Nasal and sinus cancers occur twice as often in men as in women.

• Smoking: It increases the risk of developing a number of cancers.

• Alcohol: Excessive and frequent consumption of alcohol is a major risk factor for developing head and neck cancers.

• Workplace: If someone works in an area where they have to constantly breathe substances like dust, chemicals, flour, nickel dust, mustard gas, glue fumes, formaldehyde fumes, or any solvent fumes, they could be at a higher risk of developing nasal and sinus cancers.

• Air Pollution: People being constantly exposed to air pollution can be at higher risk of developing nasal and sinus cancer.

• Human Papillomavirus (HPV): There are HPV (human papillomavirus)-associated nasal and sinus cancers. They are:

  • Squamous cell carcinoma.

  • Small cell carcinoma.

  • HPV-associated multi-phenotypic carcinoma.

  • Nasopharyngeal carcinoma.

  • Sinonasal undifferentiated carcinoma (SNUC).

What Are the Risk Groups for Nasal and Sinus Cancer?

Certain groups are at a heightened risk for nasal and sinus cancer due to various factors:

• Prolonged exposure to specific substances in the workplace, such as wood dust, leather dust, cloth fibers, nickel, chromium, and formaldehyde.

• Smoking, where the risk increases with the amount smoked. This habit elevates the risk not only for nasal and sinus cancer but also for several other types of cancer.

• Human papillomavirus (HPV) is a collection of viruses that impact the skin and moist membranes, like those in the mouth and throat.

What Are the Symptoms and Signs of Nasal and Sinus Cancers?

People with nasal and sinus cancer may experience the following symptoms:

• Nasal congestion or nasal obstruction.

• Frequent headaches.

• Pain in the sinus region.

• Chronic sinus infections which typically do not go away with antibiotic treatment.

• Swelling in the face, eyes, or ears.

• Loss of vision.

• Reduced sense of smell.

• Frequent runny nose.

• Regular nosebleeds.

• Difficulty in opening the mouth.

• Loosening of teeth.

• A lump inside the nose that does not heal with medications.

• Fatigue.

• Weight loss.

There are times when people with nasal and sinus cancer do not show any symptoms, as the early stages of cancer do not show any symptoms. These symptoms can be noticed in the later stages of cancer. When cancer is diagnosed, relieving and easing the symptoms of cancer is a major part of cancer care. It may be palliative care or supportive care.

What Are the Stages Involved in Nasal and Sinus Cancer?

Diagnosis of paranasal sinus and nasal cavity cancer involves tests to determine if cancer cells have spread within these areas or to other parts of the body.

• Maxillary sinus cancer is staged using the following criteria: Stage 0 (Carcinoma in Situ), Stage I, Stage II, Stage III, and Stage IV.

• Nasal cavity and ethmoid sinus cancer are also staged similarly: Stage 0 (Carcinoma in Situ), Stage I, Stage II, Stage III, and Stage IV.

• There is no standardized staging system for cancer of the sphenoid and frontal sinuses.

Surgery may alter the cancer's stage, necessitating additional treatment. There is a risk of cancer recurrence even after treatment for paranasal sinus and nasal cavity cancer.

What Are the Different Types of Nasal Cavity and Sinus Cancers?

The type of tumor affecting the nasal cavity or sinuses is identified by examining cells taken from the tumor under a microscope, typically obtained through a biopsy.

Cancerous Tumors -

• The most prevalent form of nasal cavity or sinus cancer is squamous cell carcinoma, characterized by the presence of thin, flat squamous cells lining these passages.

• Additional examples of malignant tumor types comprise salivary gland cancer, esthesioneuroblastoma, lymphoma, sarcoma, sinonasal undifferentiated carcinoma, and melanoma.

Noncancerous Type -

Noncancerous growth in the nasal cavity and sinuses may include squamous papilloma, inverted papilloma, and adenoma.

This classification aids doctors in predicting the tumor's response to specific treatments, facilitating personalized care.

How to Diagnose Nasal and Sinus Cancer?

Early diagnosis of nasal and sinus cancer is one of the best successful treatment options. Some cancers in the early stages may show some symptoms, but this is not the case in all types of cancers.

1. Screening:

Screening is a method that refers to tests and examinations to find out the disease, like cancer or precancer, in people who do not show any symptoms. Screening is used to detect cancer at the early stages. However, nasal and sinus cancers are rare, so there is no simple screening that can find nasal and sinus cancers early. Imaging tests such as X-rays, CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, PET (positron emission tomography) scans, and bone scans can be used to detect nasal and sinus cancer.

2. Biopsy:

In a biopsy, a sample is taken from the suspected area and sent to the laboratory for examination. It is the only way to know if one has nasal or sinus cancer. If cancer is diagnosed, it also helps to determine what kind of cancer it is and how severe it is. This helps in planning the treatment plan. Different types of biopsies employed are:

• Fine needle aspiration biopsy (FNAC).

• Incisional and excisional biopsy.

• Endoscopic biopsy.

3. There are also a few pretreatment tests like:

• Blood tests.

• Dental examination.

• Hearing test.

• Nutrition and speech tests.

What Is the Treatment for Nasal and Sinus Cancer?

There are different treatment options depending on the stage and severity of cancer.

This includes,

• Surgery.

• Radiotherapy.

• Chemotherapy.

1. Surgery: Surgery of nasal cavity cancers includes;

• Wide local excision.

• Open medial maxillectomy.

• Reconstructive surgery.

Surgery for sinus cancers are:

• Open external ethmoidectomy.

• Open maxillectomy.

• Open craniofacial resection.

• Reconstructive surgery.

Side Effects of Nasal and Sinus Surgery -

All surgeries pose some kinds of risks and complications. Similarly, nasal and sinus surgery has some risks, such as:

• Pain.

• Eye changes.

There are some severe complications, like:

• Blindness.

• Leakage of the cerebral spinal fluid.

• Meningitis.

• Weakness or numbness of the middle part of the face.

• Spasm of the jaw muscles.

2. Radiation Therapy: The types of radiation therapy that are used to treat nasal and sinus cancer are:

• External beam radiation therapy (EBRT).

• Brachytherapy.

Side Effects of Radiation Therapy - The common side effects of radiation therapy are:

• Skin problems.

• Nausea.

• Loss of appetite.

• Feeling tired.

• Dry eyes.

• Bone pain.

• Bone damage.

• Brain damage.

3. Chemotherapy: Chemotherapy is the treatment with anticancer drugs, which is either administered into the vein or given orally. These drugs reach the bloodstream and reach the various parts of the body.

How to Prevent Nasal and Sinus Cancer?

There are different factors causing different types of cancer. There is no proven strategy to prevent nasal and sinus cancer. There are some ways one can follow to lower the risks of nasal and sinus cancer.

• Maintain good hygiene.

• Try to avoid using all types of tobacco products.

• Avoid exposure to substances that are known to increase the risk of nasal and sinus cancer.

Conclusion:

Every cancer treatment has its own side effects or brings changes to the body. But there are people who have received the same treatment but have not faced any side effects. Hence, one needs to cope with the treatment physically and mentally. Do not worry about the side effects and risks. Talking with the loved ones and taking their support will be of great help. Try to manage the fear and anxiety along with the cancer treatment.