Definition

Malignant (cancerous) tumors of the nose and sinuses are relatively rare and include many different types of cancers. Some of the more common diseases are:

  • Basal cell and squamous cell carcinoma
  • Adenocarcinoma
  • Adenoid cystic carcinoma
  • Sinonasal undifferentiated carcinoma (SNUC)
  • Esthesioneuroblastoma
  • Sarcomas (arising from soft tissue, cartilage, and bone)
  • Melanoma
  • Lymphoma

Causes

No direct cause of sinonasal tumors has been determined except for an association between squamous cell carcinoma and cigarette smoking.

Risk Factors

Risk factors associated with an increased chance of developing this condition.

  • Age (these tumors usually appear in middle age)
  • Male gender
  • History of exposure to wood dust
  • Occupational exposure to cadmium, nickel and other minerals
  • Exposure to leather tanning, industrial fumes

Symptoms

Symptoms vary depending on where the tumor is growing. The most common symptoms are nasal congestion and discharge. Because these are also symptoms of other, benign processes such as sinusitis and allergies, this can often delay the diagnosis of a malignancy. Nasal tumors are usually diagnosed earlier than sinus tumors, because of the earlier onset of symptoms. Patients may also present with:

  • Difficulty breathing through one side of the nose
  • Nasal bleeding
  • Nasal obstruction (usually on one side only)
  • Loss of sense of smell
  • Facial pressure, swelling or pain
  • Bulging eye
  • Double vision
  • Tearing
  • Visual loss
  • Loosening or numbness of the upper teeth

Patients with very advanced lesions may experience:

  • Difficulty opening the mouth
  • Hearing loss and/or ear pain
  • Headaches
  • Mental status changes

Diagnosis

  • Endoscopic examination by an experienced otolaryngologist (ENT doctor)
  • MRI
  • CT
  • Tissue biopsy is essential for an accurate diagnosis
  • Chest X-ray, CT of the chest, abdomen and pelvis, or PET scan to rule out metastatic disease

Treatment

An accurate diagnosis from the tissue biopsy is essential to guiding treatment. Treatment is planned for each individual case and depends on the type, size, and location of the tumor. It may include one or all of the following:

  • Surgery often involving both a neurosurgeon and ENT surgeon.  Minimally invasive surgery may be appropriate in selected cases.
  • Radiation
  • Chemotherapy
  • Long-term follow up and imaging

Prevention

There is no known way to prevent malignant sinonasal tumors, although not smoking may decrease the risk of squamous cell carcinoma. Early, accurate diagnosis may lessen the morbidity of undetected advanced disease.

Case Study

A 61 year old woman had a long history of nasal congestion which finally led to a biopsy. The pathology came back as an esthesioneuroblastoma, a cancer of the olfactory nerve. After having a craniofacial resection recommended by her local doctor the patient did her own internet research and contacted Dr. Eric Genden because she did not want open surgery if there was another option. He got Dr. Joshua Bederson involved and together, using the BRAINLAB frameless guidance system, they performed a transnasal, transethmoidal, transfrontal microscopic resection and microscopic/endoscopic repair. She did well and was discharged on the third day after surgery.

Aside from a brief visit to the emergency room for a minor post-operative complication, she returned to her out of state home and running her own business. She underwent radiation therapy locally and has continued to do well, while being followed closely by her local and MSMC physicians.


Disclaimer

Content generated and provided by Joshua B. Bederson, MD, Professor and Chairman of the Department of Neurosurgery at The Mount Sinai Health System.  Some of the information contained in this article was adapted from the National Institutes of Health, http://health.nih.gov/.  Last reviewed June 2011 by the Department of Neurosurgery at The Mount Sinai Health System

If you want to learn more about treating malignant sinonasal tumors, call the Mount Sinai Department of Neurosurgery at 212-241-2377.