Paranasal Sinus and Nasal Cavity (Sinonasal) Tumors
Sinus cancers, nasal cancers and skull base cancers usually originate in the maxillary sinus, the nasal cavity, and the ethmoid sinus, in that order. Cancers that originate at the top of your maxillary sinus, located between the eyes and the upper jaw, can invade your eyes and affect your vision. Those that invade through the back wall can access the nerves and vessels at the base of your skull and move directly into your brain. Those tumors represent extremely advanced disease.
Tumors arising in the ethmoid sinus, between the eye sockets and the nose, and the nasal cavity can also spread to an eye or the optic nerve. They can also invade the thin bone at the base of your skull and spread within your brain.
Paranasal sinus tumors refer to either malignant (cancerous) or benign (non-cancerous) tumors that are found in this area. These tumors can be further classified into their exact location and the type of cell that comprises this tumor. Both location and cell type can influence the prognosis and type of treatment for the tumor.
Many different types of cancers can be found within the sinus cavities, nasal passageway and skull base. These cancers include:
- Squamous carcinoma, which is the most common type of malignant tumor in the paranasal sinuses.
- Salivary gland cancers, occurring in the sinonasal cavity. These cancers include adenocarcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.
- Ethesioneuroblastoma, a common cancer of the nasal cavity. This cancer arises from the olfactory nerves in the roof of the ethmoid sinuses and has an extremely good prognosis.
- Sarcomas, tumors arising from soft tissue, cartilage, and bone, which may occur in the nasal cavity and skull base. Their prognoses vary considerably. Low-grade tumors have an excellent prognosis while the outcome for high grade lesions is not as good.
- Melanoma, occurring in the nasal cavity mucosa, similar to the melanomas that occur on the skin. This is an aggressive tumor even in the face of treatment. Skin cancers, such as basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma, whether locally aggressive or recurrent, can invade the skull base.
- Lymphomas, which occur in the sinonasal cavity.
Diagnosis of Paranasal Sinus and Sinonasal Malignancy
Early diagnosis and multimodality therapy is the key to successful treatment of these tumors. However, because of the location of the tumor, they tend to present as symptoms that are shared with the common cold and other ENT complaints. These include nasal obstruction, ear fullness, nose bleeding, visual changes, headache or facial pain. The vast majority of patients with these symptoms have benign, easily treatable conditions such as chronic sinusitis; however, symptoms that persist need to be evaluated to rule out a more ominous cause such as a tumor.
The diagnosis requires a referral to an otolaryngologist (ENT) with the ability to visualize the tumor with special telescopes, which allow clinicians to see into the nose with high-definition cameras. Even with the use of these specialized telescopes, many of these tumors cannot be seen. Further investigation using high-resolution computed tomography (CT) or magnetic resonance imaging (MRI) can detect these tumors with a high degree of accuracy. Depending on the location of the tumor they may be biopsied during an in-office procedure under local anesthesia or in the operating room under general anesthesia.
Treatment of Paranasal Sinus and Sinonasal Malignancy
After proper diagnosis, each patient’s case is discussed during a multidisciplinary tumor board, composed of surgical oncologists, medical oncologists, radiation oncologists, radiologists and pathologists. Surgical treatment includes both open (external-skin incisions) and minimally invasive (without incisions) techniques, depending on the type and location of the tumor. At our Skull Base Surgery Center our surgeons are fellowship-trained in both open and endoscopic skull base surgery. Our recommended treatment is the approach that can provide patients both the highest chance for cure and their best quality of life.