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SINUS TUMORS |
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Nasal cavity tumorsoccur in the internal nasal structures, which include the nostrils, the passageway just behind the nostrils, septum (dividing wall), and the paranasal sinuses.
The paranasal sinuses have a complex anatomy and include multiple compartments including, the maxillary sinuses found beneath the cheeks and on the sides of thenose, the frontal sinuses in the forehead area, the ethmoid sinuses found at the roof of the nasal cavity between the eyes, and the sphenoid sinuses found deep behind the nose between the roots of the eyes. Most masses in the nasal cavity and the sinuses are benign and not cancerous. Due to the open exposure of these structures to the outside environment infection and inflammation is a common finding in these cavities leading to development of lesions that can appear very similar to a tumor. Evaluation by a specialist is of utmost importance to distinguish between a benign lesion and a more aggressive one, and to begin appropriate treatment. |
| Tobacco use increases the risk of squamous cell cancer in all areas of the head and neck. Prolonged exposure to wood dust has a correlation with development of adenocarcinoma. 10% of patients who have the benign tumor inverting papilloma go on to develop squamous cell carcinoma. Inverting papilloma, although benign, is a very destructive tumor and needs to be dealt with expediently and appropriately, because both the rate of recurrence and cancer transformation is high. |
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Pathology |
Benign |
polyps
Pyogenic
Granuloma |
Benign Tumors |
Septal Papilloma
Inverting pilloma |
Malignant Tumors |
Squamous Cell Carcinoma
Adenocarcinoma
Esthesioneuro-blastoma
Sarcoma (Variable Types)
Lymphoma
Melanoma |
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| The symptoms of nasal cavity and sinus cancer can be quite similar to those of other common diseases like allergies and sinusitis. These symptoms often include one sided runny nose, nosebleed, headache, sinus pressure, and/or blurred vision, but in a great proportion of patients there are no symptoms at all. When these cancers are detected and treated early, survival rates are greatly improved, so it’s important not to disregard seemingly minor ailments that linger. Unfortunately, due to the commonality of the symptoms most patients present later with larger tumors requiring aggressive treatment. Patients generally undergo diagnostic imaging, usually a CAT scan of the sinuses, to identify the cause of the symptoms. If a mass is found, surgical biopsy is then required to identify whether the mass is cancerous or not. MRI and PET Scanning may be needed and will be decided by your head and neck surgeon |
Inverting Papilloma – The standard treatment of inverting is surgical removal (medial maxillectomy). Traditionally, this was done through a facial incision on the lateral aspect of the nose termed lateral rhinotomy. In most cases now however the tumor is removed through the nostril (without any facial scars) by using the cutting edge techniques and technology: Endoscopic Medial Maxillectomy is performed with small endoscopes (thin scopes that show the images on the video screen) and image guidance systems |
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The image guidance equipment allows exact radiologic visualization of the tumor and the patient’s anatomy in the operating room (as if the surgeon is having access to live x-ray of the patient in the operating room); this guides the surgeon in deciding the extent and accuracy of the surgery.
This minimally invasive approach greatly minimizes the risk to the patient. |
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| Malignancies – The type and stage of the tumor shapes the treatment plan. Lymphomas are treated with non-surgical treatments. The other malignancies require surgical removal as the primary mode of therapy, the decision to use radiation and possibly chemotherapy is very much dependent the particular characteristics of the tumor. Small tumors can be excised with endoscopic approaches and image guidance. Larger tumors may require an open approach to allow complete removal. Squamous cell cancers, adenocarcinomas, melanomas, and sarcomas are very aggressive, and need to be removed completely with a margin of normal tissue around them to assure |
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| removal of small/microscopic pieces that may not be visible to the eye. The size of the tumor dictates the extent of surgery, and it can range from endoscopic excision to radical surgery (Craniofacial Resection, Maxillectomy, etc.) and reconstruction. If the tumor extends beyond the confines of the nasal cavity into the eye or the brain then the surgery will need to involve those areas as well; in such cases experts in those fields will be present to assure a thorough and successful surgery. |
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Esthesioneuroblastoma (or Olfactory Neuroblastoma) - can also be aggressive. This tumor arises from the nerve fibers in the roof of the nose in charge of our sense of smell. Due to the location of these tumors they often erode through the bone in the roof of the nose into the brain’s cavity and the brain itself.
As such most cases will need a cooperative surgical approach with both the head & neck surgeon and neurosurgeon present. A great majority of cases, despite extension into the brain, can be removed through the nose without the need to make a separate scalp (craniotomy)incision, and with the aid of image guidance systems, endoscopes, and micro-instruments. The decision for chemotherapy and radiation is again made based on the extent of the tumor. |
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Close follow up of patients on a regular basis is imperative for a variety of reasons: 1. The treatments are often rigorous and the effects are profound both physically and psychologically; a close relationship between the patient and the head & neck surgeon assures all the early and late side effects of therapy are dealt with appropriately, and some even avoided. 2. Close monitoring and appropriate surveillance allows early detection of a cancer if it recurs, thus allowing us to have an opportunity to successfully treat the tumor, and also detect it early enough so that the treatment may be minimal. |
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