Nasal Cancer and Paranasal Sinus Cancers: Stages, Causes, Symptoms, Treatment, Survival Rate, Diagnosis

Paranasal means close to the nose and paranasal sinus is the hollow spaces in the bones filled up with air around the nose.^[1] The sinuses are surrounded with cells that develop mucus which prevents the nose from drying out.^[2] Nasal cancer or paranasal cancer occurs in the nasal cavity and paranasal sinus. Squamous cell carcinoma is the most popular form of nasal and paranasal sinus cancer that develops in the squamous cells inside the nasal cavity and paranasal sinus.^[3] There are more types that include.

• Sarcoma that grows in the connective tissues and muscle
• Midline granulomas develops in the middle part of the face
• Melanoma grows in melanocytes, the cell responsible for bestowing the natural color of the skin
• Inverting Papilloma is a benign tumor that grows inside the nose. It turns into malignant rarely.^[4]

Nasal cancer and paranasal sinus cancer may be caused due to the following reasons.

• When exposed to certain chemicals while at work like.
• Sawmill
• Bakery mill
• Furniture chemicals
• Metal-plating
• Shoe chemicals
• Smoking
• Human Papillomavirus.

The above mentioned chemicals cause damage to the DNA of the cells of the nasal cavity and the paranasal sinuses. Researches have showed specific changes in genes to be the reason behind nasal and paranasal sinus cancer.^[5]

Diagnoses of nasal and paranasal sinus cancer occurs accidentally. There are quite a few signs and symptoms of nasal and paranasal sinus cancer that show up. They are.

• Bleeding from the nose
• Post nasal drip flowing backward into the nose or throat
• Repeated pain below the eye area
• Nose blocked at one side
• Congestion of nose which does not improve rather the condition gets worse
• Draining of pus from the nose
• Losing the capacity of the sense of smell
• Teeth getting lose or numb
• The growth of facial mass or mass in the nose are or in the top of the mouth
• One eye bulging out
• Constant watering from the eyes
• Losing hearing sensitivity
• Poor or losing out on vision
• Painful ear or feeling a pressure
• A persistent headache
• Problem in opening the mouth
• Feeling of lumps in the neck areas which is the growing size of lymph nodes.

Experiencing these symptoms clearly does not mean the patient is suffering from nasal and paranasal sinus cancer. Rather majority of these symptoms are also signs of other problems too. Therefore, it is important to get oneself checked and get it diagnosed very carefully.^[6]

After examining the condition and the symptoms of the patient, the doctor might ask the patient to undergo several tests to confirm and determine the diseases and its stages. Imaging tests are being performed to find the suspected tumor, to check the size, to understand the spread of the cancer cells. The doctor might also suggest a surgery if it is possible to remove the cancerous tumor.

• Physical Examination and History. The history relating to family and the health habits, previous illness are significantly noted.
• X-rays to Diagnose Nasal Cancer and Paranasal Sinus Cancer. Pictures of the sinuses are taken to check if there is fluid accumulation in the sinus. If a nasal or paranasal sinus cancer is diagnosed then along with sinus x-ray, a chest x-ray is also being done to check if cancer has spread to the lungs which are most likely to happen.
• CT Scan. This is also done by performing an x-ray, but these are more detailed pictures passing through the soft tissues from different angles. This also gives 3D cross sections of the affected area. CT scan helps to determine if the tumor has affected and damaged the bones. CT (computerized tomography) scan is more useful in taking detailed images of the areas which have more bones and cartilages.
• MRI Scan. The magnetic resonance imaging makes use of strong radio waves and magnetic waves instead of x-rays. MRI is extremely useful as it helps the doctor to judge if the abnormality is in the fluid or tumor or if the tumor is malignant. This can also help in finding out if cancer has spread to the nearby tissues such as eyes, brain or into the blood vessels.
• PET Scan. It is known as the positron emission tomography scan. In this procedure, a radioactive sugar is injected into the blood cells. A cancer cell will absorb more sugar hence the picture of those affected areas can be taken to determine the stage and the spread of cancer.
• Biopsy. It is performed where a small part of the tissue of the affected part is taken out to get it checked under the microscope in the lab.
• Nasoscopy. This procedure is recommended to probe deep into the unusual areas inside the nose. The nanoscope is a thin tube with a lens. It is inserted inside the nose to view closely and to take out tissue sample for further examination.^{[7] [8]}

After nasal and paranasal sinus cancer is diagnosed, the next step is to stage the cancer. Depending on the stage of nasal and paranasal sinus cancer, the doctor would plan the treatment.

The stages of nasal cancer or paranasal sinus cancer are determined based on certain information. They are.

• The size of the tumor
• If the nasal and paranasal sinus cancer has spread to the nearby lymph nodes
• If the tumor has spread to other organs or body parts.

The stages of determining nasal cancer or paranasal sinus cancer is little different from other types. Staging is important to decide on the treatment and the prognosis of nasal and paranasal sinus cancer. The stages are as follows.

Cancer cells that begin its growth in the nasal cavity or ethmoid sinus.

Cancer cells that start its growth in the maxillary sinus.

The nasal and paranasal sinus cancer stages are.

• Stage 0. The stage 0 is abnormal, wherein cells are traced in the outer layer of the tissue and is non-invasive.
• Stage I. The tumor is still residing in the area of its origination. It may have or may not have spread out in the bones and other tissues nearby.
• Stage II of Nasal And Paranasal Sinus Cancer. The malignant cells are expected to have invaded to some areas in the nasal cavity and the sinus but might not have reached the bone.
• Stage III of Nasal And Paranasal Sinus Cancer. The cancer affected area might have become 3 cm in diameter and have spread in the cribiform plate, or the maxillary sinus or lymph of the same side. There are possibilities of cancer reaching the top portion of the mouth or even till the bone that separates the nose and the brain.
• Stage IVA. This is a moderately advanced local disease wherein the tumor may reach the nearby areas like cheek, skull base, the frontal sinus etc. or to certain parts of the facial bones. It might have reached the nearby lymph nodes around the neck area but not the distant areas.
• Stage IVB. The stage is also known as very advanced local disease. At this stage, the cancer has started growing in the eye, cranial nerves, brain, eye and nasopharynx and to a lymph node as well.
• Stage IVC. At this stage the cancer has invaded distant parts of the body.^[9]

Nasal cancer or paranasal sinus cancer can be treated in several ways. Cancer can be completely omitted or cured if it is in an early stage. The entire process of treating cancer itself is a complex procedure. This is because it is unknown to the doctors how the patient’s body will react to the treatment. It primarily depends on the patient’s body immunity and other health condition or any past health issues that could be a matter of concern.

When it comes to the treatment of nasal cancer and paranasal sinus cancer treatment, treatments are as follows.

Radiation therapy is used as palliative treatment to eliminate cancer cells by diminishing the size of the tumor. Radiation is given before or after the surgery so as to restrict further growth and its reoccurrence. However, before taking radiation, the nasal cancer or paranasal sinus cancer patients must see oncologic dentist because radiation cause decay in tooth.^[10]

Chemotherapy is the process of using drugs to destroy the cancer cells. Intravenous drugs are injected or pills are recommended. Chemotherapy restricts its growth to other parts. Then again, it really depends on the stage and condition of the patient as to how effective the chemotherapy could be. It is combined with radiation in most cases.^[11]

Surgery is an elementary treatment recommended by the surgeons to eliminate the tumor completely and leave no trace of any cancer cells in the tissues. Sometimes surgeons are able to remove some tumors through endoscopy, while other tumors might not be removed and might require extensive surgery. Few types of surgeries are.

• Excision. The doctor eliminates the tumor and some healthy tissues around the tumor area.
• Maxillectomy. The hard palate above the mouth is eliminated. Artificial tissues are being placed to fill up the gaps.
• Craniofacial Skull Base Surgery. Soft tissues are removed.
• Neck Dissection. The lymph nodes from the neck region are removed if the doctor suspects that cancer has spread.^[12]

It is an advanced radiation therapy where protons are used to give radiations. It helps in the deposition of more radiation in the tumor directly without damaging the healthy tissues.^[13]

According to the 5-year survival rate, the nasal cancer and paranasal sinus cancer survival depends on grades and stages. In the stage I and II the survival rate is more than 60%; in the stage III, it is 50%; while only 35% survive when at stage IV.

Fighting cancer is not easy. Even with the best of treatment, a patient might not be able to respond well, while the other patient might. Hence, no concrete conclusion can be reached based on these statistics.^[14]

References:

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