Our highly skilled surgeons, including Marc Cohen (right), are often able to remove nasal cavity and sinus tumors using minimally invasive approaches.
Nasal cavity and sinus cancers are diseases in which cells in and around the nose grow and multiply abnormally, forming a tumor. You may have symptoms such as nasal congestion or headaches. Your doctor may discover the tumor during treatment for a sinus infection.
Nasal cavity and sinus cancers are rare. They affect only about 2,000 people in the United States each year. Many nasal cavity or sinus tumors are not cancerous, but some are. That said, certain types of tumors that aren’t cancerous to start with can become cancerous if they go untreated.
Learning as much as you can about your diagnosis can help you feel better prepared to speak with your doctor about your possible treatment options and care. If you or a loved one have been told that you have nasal cavity or sinus cancer, here is some information to help get you started.
Anatomy of the Nasal Cavity and Paranasal Sinuses
The nasal cavity is a large, air-filled space above and behind your nose in the middle of your face. It has two openings called the nostrils, which warm and moisturize the air you breathe in. Your nose and sinuses are covered with a layer of cells that produce mucus and warm the air you breathe. They also affect how your voice sounds when you speak.
Inside the nasal cavity, you have four different types of paranasal sinuses. The paranasal sinuses are a group of hollow, air-filled spaces that surround your nasal cavity. These include:
- maxillary sinuses, which are located behind the cheeks
- ethmoid sinuses, which are located between the eyes
- sphenoid sinuses, which are located behind the ethmoid sinuses, deep in the nasal cavity
- front sinuses, which are located above the eyes
Tumors are more likely to begin in the nasal cavity than in the sinuses. When tumors do develop in the sinuses, they tend to form in the maxillary sinuses.
Symptoms of Nasal Cavity and Sinus Cancers
Nasal cavity and sinus tumors rarely cause symptoms at their earliest stages. Most people tend to notice symptoms when the tumor has grown large enough to block the nasal cavity or the affected sinus, or when it has spread to other nearby tissue.
Common signs of nasal cavity cancer and sinus cancer include:
- nasal congestion that doesn’t go away
- chronic sinus infections that don’t respond to antibiotics
- frequent headaches
- facial pain
- nosebleeds
- swelling around the eyes
- decreased sense of smell
More-advanced disease is associated with:
- loose teeth
- numbness around the cheek and upper lip
- double vision
- swelling in the mouth, jaw, or neck
Risk Factors for Nasal Cavity and Sinus Cancers
Tobacco use is a risk factor for nasal cavity and sinus cancers.
If you have a noncancerous tumor called an inverted papilloma in your nasal passages or sinuses, you are at a greater risk. Up to 10 percent of all inverted papillomas become cancerous if left untreated.
Nasal cavity and sinus cancers are also more common among people who have had significant exposure to:
- wood dust
- nickel
- chemicals used in leather processing
Types of Nasal Cavity and Sinus Cancers
The type of nasal cavity or sinus tumor you have is determined by how cells taken from the tumor look under a microscope. These cells are collected during a biopsy.
The most common type of nasal cavity or sinus cancer is squamous cell carcinoma. Squamous cells are the thin, flat cells that make up the lining of the nasal and sinus passages.
Other examples of cancerous tumor types include salivary gland cancer, sarcoma, esthesioneuroblastoma, lymphoma, sinonasal undifferentiated carcinoma, and melanoma.
Examples of noncancerous nasal cavity and sinus tumors include squamous papilloma, inverted papilloma, and adenoma.
Determining the type of nasal cavity or sinus cancer helps doctors predict how the disease will respond to specific treatments. This way we can personalize your treatment.
Diagnosis of Nasal Cavity and Sinus Cancers
A biopsy is the first step in the diagnosis of nasal cavity or sinus cancer. During a biopsy, a small amount of the tumor is removed. A pathologist then examines the sample to determine what type of tumor you have.
Special X-rays, such as CT scans, MRIs, or PET/CT scans, may provide more details about how deep the cancer is and if it has spread.
The information from your biopsy and imaging scans allows your doctor to tell you the stage of the cancer. The stage measures how widespread or advanced the cancer is. It guides the recommendations for your treatment.
Treatment of Nasal Cavity and Sinus Cancers
The goals for the treatment of nasal cavity or sinus cancer are to:
- cure the cancer
- preserve your appearance
- preserve normal function
The extent and depth of the cancer guides your plan of care. Surgery is the most common treatment for nasal cavity and sinus cancers. Often surgery is the only treatment needed for noncancerous tumors and early-stage cancers.
If the disease is more advanced, radiation, chemotherapy, or both may be used to shrink the tumor. This can be done before or after surgery to reduce the risk of the cancer coming back. A type of radiation treatment called proton therapy has been shown to be particularly effective for nasal cavity and sinus tumors. Memorial Sloan Kettering is one of only a limited number of cancer centers nationwide that offer proton therapy.
Like other types of radiation therapy, proton therapy kills cancer cells by damaging their DNA. However, proton therapy may cause fewer side effects than other types of radiation therapy. That’s because protons deliver the radiation directly to the tumor.
This is an important benefit because the optic nerves and brain stem are very near the nasal cavity and sinuses. Proton therapy is less likely to damage the surrounding healthy tissue of the eyes, the optic nerves, and the brain.
Surgery for Nasal Cavity and Sinus Cancers
For most people with nasal cavity or sinus tumors, surgery will be part of treatment. At Memorial Sloan Kettering, our surgeons often take a minimally invasive approach.
During minimally invasive surgery, an endoscope (a thin lighted tube with a camera at its tip) is inserted through the nasal passage for a magnified view of the tumor. Because the view is so clear, the surgeon is better able to remove all of the tumor while preserving healthy tissue. The risk of complications with this technique is very low. The surgery leaves no visible scar.
We may recommend a traditional open surgery instead. This type of operation requires one or more incisions. The precise location and size of the tumor help determine which of these surgeries is the right choice for you.
Learn more about other specific types of surgery that may be used to treat nasal cavity and sinus cancers.
Maxillectomy
Maxillectomy is a surgery to remove bones in the upper jaw. Our surgeons may recommend a maxillectomy if the tumor is located on the bones inside the walls of the nose or in the maxillary sinuses. For some people, it may be possible to have a minimally invasive medial maxillectomy. In this procedure, the surgeon removes the tumor and bone around the nose through the nostrils without an incision.
Endoscopic Skull-Base Surgery
In some cases, nasal cavity or sinus tumors may grow along the base of the skull. That’s because the bone that makes up the skull base also forms the top of the nasal cavity and some of the paranasal sinuses.
For these tumors, surgeons are sometimes able to perform endoscopic skull-base surgery. This approach involves inserting a small endoscope (a thin lighted tube with a camera at its tip) through the nasal passage for a magnified view of the skull base. This gives surgeons a high-definition view of the tumor.
Skull-base surgery is very complex. It requires a surgical team that includes a head and neck surgeon, a neurosurgeon, and sometimes a plastic surgeon.
At Memorial Sloan Kettering, we use MRIs during surgery to assist in the removal of sinonasal and skull-base tumors.
The pictures produced by an MRI show the difference between normal and diseased tissue. MRI scans do not involve the use of radiation.
Memorial Sloan Kettering is one of just a handful at hospitals around the country to use MRIs during surgery. This advanced technology allows our surgeons to confirm that a tumor has been entirely removed while patients are still under anesthesia.
This enhanced accuracy helps us preserve healthy tissue and prevent complications after surgery. It also reduces the likelihood that a second surgery will be needed.
Rhinectomy
Rhinectomy is a procedure in which the nose or part of the nose is removed. This approach is generally used only for people with extremely high-risk cancer.
MSK’s plastic and reconstructive surgeons have unparalleled expertise in helping people who require a rhinectomy. We help you understand your options and work with you so that you get back to looking and feeling your best.
Open Craniofacial Resection
Open craniofacial resection surgery involves removing the tumor through incisions in the face and skull. Surgeons operate on the tumor from both above and below. This gives a better chance of removing the entire tumor. It also decreases possible damage to the brain, the nerves, and other important areas.
This surgery is very complex. It requires experienced doctors. The surgical team consists of a head and neck surgeon, a plastic surgeon, and a neurosurgeon.
Lymph Node Removal
Nasal cavity and sinus cancers often spread to the lymph nodes in the neck first. Removing the lymph nodes in the neck (and other nearby tissue) may be done at the same time as the surgery to remove the nasal cavity or sinus cancer. The goal of this procedure is to remove lymph nodes that have been shown to contain, or that are likely to contain, cancer. This reduces the chance that the cancer may return in the future.
Why choose Memorial Sloan Kettering for your care?
At Memorial Sloan Kettering, we have particular expertise in caring for people with nasal cavity and paranasal sinus cancers. Our team consists of head and neck surgeons, neurosurgeons, plastic surgeons, radiation oncologists, medical oncologists, pathologists, radiologists, and speech and swallow therapists. We are committed to providing state-of-the-art care for people with these rare diseases.
MSK’s surgeons have access to the latest equipment. This includes high-definition endoscopes, image guidance, and intraoperative MRI. We have vast experience in techniques that minimize side effects.
Choose Memorial Sloan Kettering because:
- Our head and neck surgeons provide unparalleled skill and experience in treating nasal cavity and sinus cancers. We strive for both complete cancer removal as well as the preservation of your appearance and function.
- Our surgeons work closely with imaging experts who are focused solely on cancer that begins in the head and neck region. This collaboration allows us to create an exquisitely precise road map to remove the cancer.
- We are one of very few centers in the world that offer intraoperative MRI imaging for every skull-base tumor surgery. This technology enables our surgeons to view real-time images of a tumor during a procedure. It makes operations safer and more effective.
- We are one of a limited number of centers nationwide that offer proton therapy. It is a particularly safe and effective method for treating tumors of the nasal cavity and sinuses.
- MSK’s plastic and reconstructive surgeons have extensive experience in caring for people with nasal cavity and sinus cancers. Our goal is to preserve form and function by using the latest techniques available.
- We are dedicated to giving each patient the best quality of life possible. That’s why we take a holistic approach to care. Speech pathologists and a range of dental experts are key members of the surgery team.
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