General Medical Information

Paranasal Sinus and Nasal Cavity Cancer

The majority of tumors of the paranasal sinuses present with advanced disease, and cure rates are generally poor (50% or less). Nodal involvement is infrequent. Metastases from both nasal cavity and paranasal sinus may occur, but most patients die of direct extension into vital areas of the skull or of rapidly recurring local disease. Squamous cell carcinoma is the most frequent type of malignant tumor in the nose and paranasal sinuses (70%-80%). Papillomas are distinct entities that may undergo malignant degeneration. The cancers grow within the bony confines of the sinuses and often are asymptomatic until they erode and invade adjacent structures.[1-3]

The importance of pretreatment evaluation and staging, as well as the need for multidisciplinary planning of treatment, must be stressed. Generally, the first opportunity to treat patients with head and neck cancers is the most effective, although occasionally salvage surgery or salvage radiation therapy, as appropriate, may be successful. Since most failures of treatment occur within 2 years, the follow-up of patients must be frequent and meticulous during this period. In addition, because nearly one third of these patients develop second primary cancers in the aerodigestive tract, a lifetime of follow-up is essential. Although distant metastases are found in 20% to 40% of patients who do not respond to treatment, loco-regional recurrence is the rule and accounts for the majority of cancer deaths.

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 major lymphatic drainage route of the maxillary antrum is through the lateral and inferior collecting trunks to the first station submandibular, parotid, and jugulodigastric nodes and through the superoposterior trunk to retropharyngeal and jugular nodes.

Some data indicate that various industrial exposures may be related to cancer of the paranasal sinus and nasal cavity. The risk of a second primary head and neck tumor is considerably increased.[4]

References

1. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, and oropharynx. In: DeVita VT, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 797-860.

2. Laramore GE , ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.

3. Thawley SE, Panje WR, Batsakis JG, et al.: Comprehensive Management of Head and Neck Tumors. New York: W.B. Saunders Company, 1986.

4. Johns ME, Kaplan MJ: Advances in the management of paranasal sinus tumors. In: Wolf GT, eds.: Head and Neck Oncology. Boston: Martinus Nijhoff Publishers, 1984, pp 27-52.