What is Nasal Cancer?
Nasal cancer or more specifically, paranasal sinus and nasal cavity cancer is best described as a group of cancers that can affect the tissues of the nose, palate, and the sinuses near the nose. Cancer of the nose is relatively rare. It can be difficult to notice in its early stages because symptoms are hardly noticeable and sometimes get mistaken for infections.
Common symptoms of paranasal sinus and nasal cavity cancer include blocked nose, voice changes, cheek swelling, headaches and painful or numb cheek. Nasal cancers can spread to the lymph nodes in the neck. The lymph nodes are small, bean-shaped structures in the lymphatic system. It is part of the body’s immune system. Cancer that has spread and grown in the lymph nodes shows up as a painless lump in the neck.
Nasal Cancer Survival Rate
The five-year survival rate refers to the percentage of patients with a disease alive five years after the disease is diagnosed. The five-year survival rate for paranasal sinus and nasal cavity cancer is 58 per cent. However, the survival rates are based on several factors, including the stage and grade of the cancer. If the cancer is located only in the nasal cavity or paranasal sinus, the five-year survival rate is 84 per cent. If it has spread to nearby tissues or organs and/or regional lymph nodes, the five-year survival rate drops to 51 per cent. If there is further spread to other parts of the body, the five-year survival rate is even lower which is 42 per cent.
It is best to talk with your doctor about what you can expect with your specific diagnosis and remember that statistics on the survival rates for people with paranasal sinus and nasal cavity cancer are just an estimate. This estimate comes from annual data based on the number of people with these types of cancer specifically in the United States. On top of that, experts measure the survival statistics every five years. As such, the estimate may not show the results of better diagnosis or treatment available for less than five years. Refer to the experts to get clearer explanations and clarifications on all of the statistics and data.
Nasal Cancer Staging
One step in effective diagnosis of nasal and sinus cancer is identifying the cancer’s stage or the size of the cancer and whether it has spread. The stage helps doctors choose the best treatment option for the patients.
The specific staging is complex. It also depends on where in the nasal cavity or paranasal sinuses the tumour is located. In general, however, doctors classify nasal cancer in these stages:
- Stage 0: Physicians identify cancer that has not yet spread. This is also called carcinoma in situ (CIS).
- Stage I: Cancer has formed in one area and may have spread into the nearby bone.
- Stage II: The tumour is in two areas and may have spread into the nearby bone.
- Stage III: A stage III tumour has spread, either into nearby bone or other organs or to one or more lymph nodes on the same side of the neck.
- Stage IV: Cancer has spread to more lymph nodes and to other parts of the head or elsewhere in the body. Doctors classify Stage IV tumours as IVA, IVB or IVC, depending on the size and where cancer cells are located.
Symptoms of Nasal Cancer
The first symptoms of paranasal sinus and nasal cavity cancer might feel like a cold or sinus infection, such as nasal congestion or sinus pain. Symptoms may include:
- Nasal congestion and obstruction or discharge
- Difficulty breathing
- Recurring sinus infections
- A feeling of pressure in the middle of the face
- A lump or sore that does not heal inside the nose
- A lump on the face or the roof of the mouth
- Pain in the sinus region or upper teeth
- Swelling or other trouble with the eyes
- Dentures fitting poorly, or upper teeth feeling loose or numb
If any of these symptoms do not go away, it is important to schedule an appointment with a head and neck cancer expert for an accurate nasal cancer diagnosis.
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Risk Factors of Nasal Cancer
Researchers have found a few risk factors that make a person more likely to develop nasal cancer. Most of these are exposures to inhaled substances in the workplace while other risk factors are similar to those for other cancers in the head and neck area, such as smoking.
People who work in certain jobs are more likely to develop nasal cancers. The increased risk seems to be related to breathing in certain substances while at work such as:
- Wood dust from carpentry (such as furniture and cabinet builders), sawmills, and other wood-related industries
- Dust from textiles (textile plants)
- Leather dust (shoemaking)
- Flour (baking and flour milling)
- Nickel and chromium dust
- Mustard gas (a poison used in chemical warfare)
- Radium (a radioactive element rarely used today)
These workplace exposures have less clear links to nasal and paranasal sinus cancer:
- Organic solvents
- Smoking increases the risk of nasal cavity cancer, specifically the squamous cell type.
Human papillomavirus (HPV) infection
The human papillomavirus (HPV) is a group of over 200 related viruses. They are called papillomaviruses because some of them cause a type of benign (not cancer) growth called a papilloma, more commonly known as a wart.
Cancers of the nasal cavity and paranasal sinuses are about two times more common in men than women.
About 80 per cent (eight out of 10 people) of people diagnosed with cancer of the nasal cavity or paranasal sinus are older than 55 years of age.
Cancers of the nasal cavity and paranasal sinuses are much more common among White people than Black people.
Hereditary retinoblastoma treatment
People with the hereditary form of retinoblastoma, a type of eye cancer that typically develops in children, have an increased risk of nasal cavity cancer if the retinoblastoma was treated with radiation.
Nasal Cancer Causes
It is hard to pinpoint what causes each case of paranasal sinus and nasal cavity cancer. We only know some of the risk factors for these cancers and how some of them cause normal cells to become cancer. For example, some risk factors, such as workplace exposure to certain chemicals, may cause these cancers by damaging the DNA of cells that line the inside of the nose and sinuses.
Genes and cancer
The development of normal human cells mostly depends on the information contained in the cells’ DNA. DNA is the chemical in our cells that makes up our genes – the instructions for how our cells function. We usually look like our parents because they are the source of our DNA but it affects more than how we look.
Some genes have instructions for controlling when cells grow, divide, and die:
- Genes that help cells grow, divide, and stay alive are called proto-oncogenes.
- Genes that help keep cell growth under control or make cells die at the right time are called tumour suppressor genes.
Cancers can be caused by DNA changes that turn on proto-oncogenes or turn off tumour suppressor genes. This leads to cells growing out of control. Changes in many different genes are usually needed to cause nasal cavity or paranasal sinus cancer.
Diagnosing Nasal Cancer
A medical history and a physical examination of the head and neck is the first step in diagnosing suspected paranasal sinus and nasal cavity cancer. A small fibre-optic scope may be used to see into the nasal cavity and sinuses. If cancer is suspected, an MRI, CT or PET scan may be used to diagnose the condition. An endoscope can be used to biopsy the suspected mass, either using local or general anaesthesia. The removed sample is analysed by a pathologist to determine whether it is cancerous
Nasal Cancer Treatment
There are different types of treatment for patients with paranasal sinus and nasal cavity cancer. Different types of treatment are available for patients with paranasal sinus and nasal cavity cancer. Some treatments are standard and currently being used, while some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Patients with paranasal sinus and nasal cavity cancer should have their treatment planned by a team of doctors with expertise in treating head and neck cancer.
Treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. The medical oncologist works with other doctors who are experts in treating patients with head and neck cancer and who specialize in certain areas of medicine and rehabilitation. Patients who have paranasal sinus and nasal cavity cancer may need special help adjusting to breathing problems or other side effects of cancer and its treatment. If a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out, plastic surgery may be done to repair or rebuild the area. The treatment team may include the following specialists:
- Radiation oncologist.
- Oral surgeon or head and neck surgeon.
- Plastic surgeon.
- Speech and language pathologist.
- Rehabilitation specialist.
Three types of standard treatment are used:
- Surgery (removing the cancer in an operation) is a common treatment for all stages of paranasal sinus and nasal cavity cancer. A doctor may remove the cancer and some of the healthy tissue and bone around the cancer. If the cancer has spread, the doctor may remove lymph nodes and other tissues in the neck.
- After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer. The total dose of radiation therapy is sometimes divided into several smaller, equal doses delivered over a period of several days. This is called fractionation.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
- The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy is used to treat paranasal sinus and nasal cavity cancer.
- External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid hormone levels in the blood may be tested before and after treatment.
- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
- The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Nasal Cancer Prevention
Most people with cancer of the nasal cavity (nose) and paranasal sinuses have no known risk factors, so there is currently no way to prevent most of these cancers. Luckily, there are some things people can do to lower their risk.
Avoid workplace chemicals and dust
Although not all nasal cavity and paranasal sinus cancers can be prevented, the risk of developing these cancers can be greatly reduced by avoiding exposures to certain substances in the workplace. Fortunately, awareness of the possible danger from these exposures has increased, and workplace safety measures to help protect people have improved. Still, if you are working with any of the high-risk substances, it is important for you to find out if you are being protected from harmful exposure.
Smoking is another risk factor for cancers of the nasal cavity and sinuses that people can avoid to help prevent the disease.
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Nasal Cavity and Paranasal Sinus Cancer Guide. Cancer.Net website. Available at: https://www.cancer.net/cancer-types/nasal-cavity-and-paranasal-sinus-cancer/statistics. Updated Jan, 2021. Accessed Aug 5, 2021.
Nasal Cancer. Henry Ford Health System website. Available at: https://www.henryford.com/services/head-neck-cancers/types/nasal-cancer. Accessed Aug 5, 2021.
Risk Factors for Nasal Cavity and Paranasal Sinus Cancers. American Cancer Society website. Available at: https://www.cancer.org/cancer/nasal-cavity-and-paranasal-sinus-cancer/causes-risks-prevention/risk-factors.html. Accessed Aug 5, 2021.
Nasal and Sinus Tumors. Cedars Sinai website. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/n/nasal-and-sinus-tumors.html. Accessed Aug 5, 2021.
Paranasal Sinus and Nasal Cavity Cancer Treatment. National Cancer Institute website. Available at: https://www.cancer.gov/types/head-and-neck/patient/adult/paranasal-sinus-treatment-pdq. Updated: Nov 6, 2019. Accessed Aug 5, 2021.