Sinus and Nasal Cancer: Types, Causes, Symptoms, Diagnosis, Treatment and Prevention

Sinus and Nasal Cancer

~Introduction

Sinus and nasal cancer, also known as paranasal sinus and nasal cavity cancer, represents a rare but serious group of malignancies that originate in the air-filled spaces (sinuses) and passageways within the nose. Together, they account for less than 5% of all head and neck cancers, but their location near critical structures—such as the eyes, brain, and cranial nerves—makes early detection and treatment essential.

Because symptoms often resemble common sinus infections or allergies, these cancers are frequently diagnosed at later stages, increasing the risk of complications and reducing treatment options. Understanding their types, presentation, causes, diagnosis, and management is crucial for improving outcomes.

~Anatomy Overview

The nasal cavity and paranasal sinuses include:

• Nasal cavity: The hollow space behind the nose that warms, filters, and moistens air.

• Paranasal sinuses: Air-filled chambers around the nose, including:

  • Maxillary sinuses (cheeks)

  • Ethmoid sinuses (between the eyes)

  • Frontal sinuses (forehead)

  • Sphenoid sinuses (deep behind the nose)

These spaces are lined with mucous membranes, glandular cells, nerve endings, and supporting bone structures—any of which may give rise to cancer.

~Types of Sinus and Nasal Cancer

Several types of malignancies can occur in this region:

1. Squamous Cell Carcinoma (Most Common)

Arises from the lining of the nasal cavity or sinuses, accounting for 50–60% of cases.

2. Adenocarcinoma

Originates from glandular cells; commonly associated with wood dust exposure.

3. Esthesioneuroblastoma (Olfactory Neuroblastoma)

Arises from the olfactory nerve cells responsible for smell.

4. Sarcomas

Including osteosarcoma, chondrosarcoma, and rhabdomyosarcoma, originating from bone or soft tissues.

5. Melanoma

Occurs in pigment-producing cells of the nasal cavity.

6. Lymphoma

Non-Hodgkin lymphoma can occur in nasal or sinus tissues.

7. Sinonasal Undifferentiated Carcinoma (SNUC)

A highly aggressive cancer with rapid spread.

Each type behaves differently, influencing prognosis and treatment strategies.

~Causes and Risk Factors

The precise cause is not always known, but several risk factors significantly increase the likelihood of these cancers:

1. Occupational Exposures

One of the strongest associations. Risk is higher in people exposed to:

• Wood dust (furniture workers, carpenters)

• Leather dust (shoemakers)

• Formaldehyde

• Nickel or chromium dust

• Flour dust (bakers)

• Textile fibers

• Chemical fumes

These exposures can cause chronic irritation or mutation of the mucosal lining.

2. Tobacco Smoking

Increases the risk of squamous cell carcinoma and other sinus cancers.

3. Human Papillomavirus (HPV)

Some sinonasal tumors, particularly squamous cell carcinoma, are associated with HPV infection.

4. Chronic Sinus Inflammation

Long-term sinusitis and nasal polyps have been linked to a slightly increased risk.

5. Radiation Exposure

Previous radiation therapy to the head and neck region increases susceptibility decades later.

~Signs and Symptoms

Symptoms depend on the tumor’s location and stage. They often resemble common ENT conditions, causing delayed diagnosis.

Common Early Symptoms

• Persistent nasal congestion on one side

• Frequent sinus infections

• Nasal obstruction or difficulty breathing

• Bloody or persistent nasal discharge

Late or Advanced Symptoms

• Facial swelling or pain

• Headaches

• Double vision or vision loss

• Tearing or eye swelling

• Decreased sense of smell

• Loose teeth or numbness of the upper jaw

• A mass or lump inside the nose

• Facial deformity

• Ear pain or hearing loss (due to blockage)

• Neurological symptoms if the tumor invades the skull base

Any persistent unilateral nasal symptoms lasting more than a few weeks should be evaluated by an ENT specialist.

~Diagnostic Evaluation

Proper diagnosis requires careful imaging, examination, and tissue analysis.

1. Physical Examination

ENT specialists use nasal endoscopy, a thin scope inserted through the nose, to visualize abnormal growths.

2. Imaging Studies

CT Scan

Evaluates bone erosion and sinus involvement.

MRI

Provides detailed images of soft tissues, brain, and orbit.

PET-CT

Helps identify metastases and assess overall tumor burden.

3. Biopsy

A definitive diagnosis requires tissue sampling, often taken during endoscopy. Pathologists identify the tumor type and grade.

4. Laboratory Tests

Blood work supports staging but is not diagnostic.

5. Staging

Staging (from I to IV) depends on:

• Tumor size

• Local invasion into bone, orbit, skin, or brain

• Lymph node involvement

• Distant metastasis (lungs, liver)

~Treatment Options

Management requires a multidisciplinary team, often including ENT surgeons, oncologists, radiation specialists, and radiologists. Treatment depends on tumor type, stage, location, and patient health.

1. Surgery (Primary Treatment for Many Types)

Surgery aims to completely remove the tumor with clear margins. Techniques include:

Endoscopic Sinus Surgery (Minimally Invasive)

Used for smaller or localized tumors.

Open Surgery

Required for larger or aggressive tumors, involving:

• Maxillectomy (removal of upper jaw bone)

• Craniofacial resection

• Orbital exenteration (if eye is involved)

• Removal of nasal cavity structures

Advances in endoscopic skull base surgery have reduced the need for open procedures in select cases.

2. Radiation Therapy

Radiation is often used:

• After surgery (to kill remaining cancer cells)

• With chemotherapy for advanced disease

• As primary therapy when surgery is not possible

Techniques include:

• IMRT (Intensity-Modulated Radiotherapy)

• Proton therapy, beneficial for skull base involvement

3. Chemotherapy

Often combined with radiation (chemoradiation) in advanced stages.
Common drugs include:

• Cisplatin

• Carboplatin

• 5-fluorouracil (5-FU)

• Taxanes (paclitaxel, docetaxel)

Used in:

• Locally advanced disease

• Recurrent tumors

• Palliative settings

4. Targeted Therapy & Immunotherapy

Targeted Therapy

• EGFR inhibitors (e.g., cetuximab) show benefit in some squamous cell carcinomas.

• BRAF/MEK inhibitors for tumors with BRAF mutations.

Immunotherapy

Checkpoint inhibitors such as nivolumab and pembrolizumab:

• Effective in recurrent or metastatic disease

• Help activate the immune system against cancer cells

5. Reconstruction and Rehabilitation

Cancers of the nose and sinuses often require reconstructive procedures using:

• Flaps

• Prosthetics

• Skull base reconstruction techniques

Rehabilitation may include:

• Speech therapy

• Dental reconstruction

• Ophthalmologic support

• Psychological counselling

~Prognosis

Prognosis depends on:

• Tumor stage at diagnosis

• Histological type

• Completeness of surgical removal

• Involvement of orbital or cranial structures

• Lymph node or distant metastasis

General Prognosis

• Early-stage survival: 60–80%

• Advanced-stage survival: <30%

• Sinonasal undifferentiated carcinoma and sarcomas have poorer outcomes

• Adenocarcinoma often has better prognosis than other types

Early detection dramatically improves outcomes.

~Prevention and Awareness

Key Prevention Strategies

• Avoid or reduce exposure to occupational dusts (wood, leather, chemicals)

• Maintain proper workplace ventilation

• Use protective masks in high-risk industries

• Avoid smoking and secondhand smoke

• Manage chronic sinus infections with medical support

• Vaccination and safe practices to reduce HPV risk

Early Warning Signs

Seek medical evaluation if you experience:

• Persistent one-sided nasal blockage

• Unexplained nosebleeds

• Facial pain or pressure not responding to treatment

• A lump in the nose or face

~Conclusion

Sinus and nasal cancers, though rare, pose significant challenges due to their subtle early symptoms and proximity to vital structures like the brain and eyes. Awareness, timely diagnosis, and appropriate treatment greatly influence outcomes. Advances in imaging, minimally invasive surgery, targeted therapies, and immunotherapy have improved survival rates and quality of life for many patients.

Understanding risk factors and recognizing early warning signs are essential steps in reducing disease burden. With ongoing research and improved clinical techniques, the outlook for patients with sinus and nasal cancer continues to evolve positively.