Nasal and paranasal sinus cancer
What is it?
This is a tumor that can develop in the nasal cavity and paranasal sinuses, such as the ethmoid (located between the eye and nose), sphenoid (located behind the eyes), frontal (located in the forehead), or maxillary (located in the jaw). The maxillary sinus is most commonly affected, followed by the nasal cavity and ethmoidal sinus, and less commonly the frontal and sphenoid sinuses. The risk factors are mainly occupational: chromium, nickel and isopropyl acid treatment are scientifically correlated with the occurrence of carcinomas of the nose and paranasal sinuses, but especially with ethmoid adenocarcinoma (ITAC), which is almost entirely associated with wood and skin treatment. It occurs mostly between the ages of 55 and 65, twice as often in men as in women. The predominant types in descending order of frequency are: squamous cell carcinoma, adenocarcinoma (ITAC and non-ITAC), salivary carcinoma, especially adenoid cystic carcinoma, lymphoepithelial carcinoma, undifferentiated carcinoma (SNUC), mucoepidermoid carcinoma and neuroendocrine carcinomas (SNEC) such as extesioneuroblastoma.
Which are the symptoms?
With tumors of the paranasal sinuses (nasal cavity, maxillary sinus, ethmoid), a feeling of progressive nasal obstruction, especially unilateral, frequent dripping of blood or epistaxis prevails. Sometimes the disease manifests with pain, changes in facial skin sensitivity, irregular facial swelling, double vision, unexplained tooth mobility.
- frequent dripping of blood
- epistaxis
- nasal obstruction
- irregular facial swelling
- double vision
- unexplained tooth mobility
- decreased or absent sense of smell
- feeling of compression in the ears
- othalgia
- purulent nasal discharge
- headache
- enlarged lymph nodes in the neck
How is it diagnosed?
The ENT specialist performs a thorough examination and takes tissue samples from suspicious areas under general anesthesia (biopsy).
In addition, a CT (computerized axial tomography) scan of the neck or MRI (magnetic resonance imaging) with contrast agent is recommended to better examine the tumor size and possible involvement of adjacent structures and glands in the neck (lymph nodes), and in more aggressive cases, a PET (positron emission tomography) or CT (computerized axial tomography) scan of the chest and abdomen with contrast agent can be performed to evaluate distant organs.
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How is it treated?
If the tumor is still small and localized, it is removed surgically, which can often be performed radically (removal of the entire tumor), even by less invasive methods, i.e., endoscopic access, with possible subsequent radiotherapy depending on the risk factors inherent to this type of disease.
On the other hand, if the tumor is at an advanced stage, healing is still possible, but the main therapeutic approach is a more invasive destructive surgery, craniofacial resection, followed by radiotherapy, sometimes, in selected cases, chemotherapy, depending on disease characteristics, risk of tumor return, patient age and other conditions.
If surgery is not possible because of the extent of the disease or because of other conditions the patient suffers from and which are contraindicated for surgery, radiotherapy may still be a treatment option, perhaps simultaneously with chemotherapy or sequentially with induction chemotherapy (chemotherapy given before radiotherapy to reduce disease volume, followed by concomitant radiotherapy or chemo-radiotherapy).
In the case of progressive disease involving other organs (metastatic), the goal may no longer be cure, but the chronic course of the disease with chemotherapy, while radiotherapy will be given to treat symptomatic areas or areas at risk of bleeding/fracture.
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Where do we treat it?
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