Updated: May 2003
Cancers of the maxillary sinus are the most common of the paranasal sinus cancers. Tumors of the ethmoid sinuses, nasal vestibule, and nasal cavity are less common, and tumors of the sphenoid and frontal sinuses are rare. The majority of tumors of the paranasal sinuses present with advanced disease. The cancers grow within the bony confines of the sinuses and often are asymptomatic until they erode and invade adjacent structures. Nodal involvement is infrequent. Metastases from both nasal cavity and paranasal sinus may occur, but most deaths are due to direct extension into vital areas of the skull or loco-regional recurrences.
Squamous cell carcinoma is the most frequent type of malignant tumor in the nose and paranasal sinuses (70%-80%). Inverted papillomas are distinct entities that may undergo malignant degeneration.
The importance of adequate pretreatment evaluation and staging, as well as the need for multidisciplinary pretreatment assessment must be stressed.
1. Patient Assessment
The assessment of the tumor is based on inspection, palpation, and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathological data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation.
Many of these tumours obstruct the drainage of the superior sinuses, MRI is usually able to distinguish between tumour and retained secretions and is the scan of choice in the evaluation of these patients. CT is less effective in making this distinction and is often misleading. If a patient relapses, complete restaging must be done in order to select the appropriate additional therapy.
Staging of nasal cavity and paranasal sinus carcinomas is not as well established as for other head and neck tumors. Only the maxillary sinus and ethmoid sinus have a staging system (TNM) agreed on by the International Union Against Cancer (UICC).American Joint Committee on Cancer (AJCC).
2. Treatment Principles
Treatment of tumors of the paranasal sinuses and of the nasal cavity should be planned on an individual basis because of the complexity involved.
Except for T1 mucosal or early carcinomas of the maxillary infrastructure, the accepted method of treatment is a combination of radiation therapy and surgery. Routine radical neck dissection or elective neck irradiation is recommended only for patients presenting with positive nodes.
Radical craniofacial surgical resection may be possible in selected advanced clinical situations if there is the potential for cure. This radical surgical procedure requires, however, the involvement of individuals with specialized expertise and should be performed in hospitals which have adequate support facilities.
3. Recurrent Paranasal Sinus and Nasal Cavity Cancer
Recurrent disease after surgery may be managed with radiation therapy or craniofacial resection with postoperative radiation therapy. Those recurring after radiation therapy may be considered for craniofacial or salvage resection, if indicated. Otherwise, chemotherapy should be considered. Chemotherapy for recurrent squamous cell cancer of the head and neck has been shown to be efficacious as palliation and may improve quality of life and length of survival.