Nasal Cavity/Paranasal Sinuses

Head and Neck Cancer Introduction Page
oral cavity
oropharynx
(soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal wall, post-cricoid region)
nasal cavity/paranasal sinuses
nasopharynx
salivary glands
paragangliomas (glomus tumors)
thyroid


Nasal Cavity/Paranasal Sinuses

Background
Signs and Symptoms
Clinical Evaluation
Treatment
Follow-Up

Background


Illustration courtesy of Lippincott Williams & Wilkins © 2004

The nasal cavity and adjacent sinuses are located above the roof of the mouth (hard palate) and border the eyes and the brain at the level of the skull base.

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Signs and Symptoms

Tumors affecting the nasal cavity and sinuses may show up as symptoms normally related to adjacent structures. These symptoms include progressive nasal obstruction, nasal bleeding, and nasal discharge. Also, symptoms are sometimes similar to those of sinus infections, including headaches, upper dental pain and discomfort behind the cheeks, or above the eyes. Facial swelling may be present.

Other symptoms include double vision, increased prominence of one eye or increased tearing, numbness of the palate, and difficulty or pain with opening the mouth.

People with a history of chronic sinus infections (especially with nasal polyps) and wood dust exposure seem to be at a higher risk of developing these tumors.

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Clinical Evaluation

A thorough history and physical examination will be performed, including an endoscopy. An endoscopy, often done in the doctor’s office, involves placing a small instrument through the nose in order to see all the structures of the head and neck. These small endoscopes can easily evaluate the recesses of the nasal cavity. The procedure is painless.

If tumor is within the nasal cavity, a biopsy may be performed with local anesthesia. CT scan (which uses X-rays to create a two-dimensional image of the area), and MRI scans (which uses a magnetic field and pulses of radio wave energy to visualize the detailed anatomy) will evaluate the extent of the tumor. These tools may also help define any involvement of the eye, brain, surrounding soft tissue, or possible spread of tumor to the lymph nodes of the neck. Advanced tumors may require a PET scan, which creates computerized images of the metabolic changes that occur in tissue, to define possible tumor spread to other areas of the body.

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Treatment

Early-stage, smaller tumors are best treated by surgery, and postoperative radiation may also be suggested. There are a variety of surgical approaches to these tumors.

More advanced tumors require more extensive surgery. If the palate is involved, it may have to be removed. If this is necessary, a dental prosthodontist will create a dental mold to be inserted for rehabilitation. If tumor extends towards the skull base and brain, a surgical procedure combining the expertise of a head and neck oncologic surgeon and a neurosurgeon is necessary for proper tumor resection and reconstruction. Postoperative radiation will also be necessary.

Occasionally, more advanced tumors may also have extension into the soft tissues of the eye. In the proper circumstances, in order to avoid sacrificing the eye, preoperative radiation and/or chemotherapy will be recommended. With good tumor response, the tumor may regress enough to allow for surgery with sparing of the eye.

If there is evidence of tumor in the neck lymph nodes, these lymph nodes will also be surgically removed.

Click Here for more information about radiation oncology treatments for head and neck cancer.

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Follow-Up

After treatment is completed, the patient enters the follow-up phase. Usually, all of the treating physicians are involved in follow-up evaluations. For the first year, patients are usually seen every one to two months. During the second year, they are often seen every two to three months. After the second year, patients are usually seen every three to six months. Of course, the follow-up schedule is individualized for each patient.
Imaging procedures like CT scans, PET scans, or fused PET/CT scans, are done according to a routine that is individualized for each patient. Not all patients require these studies. A chest X-ray is usually done on an annual basis. Regular dental evaluation is done, because good dental care is essential to the head and neck health.

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