Sinonasal (Nose and Paranasal Sinus) Malignancy
Tumors of the nose and paranasal sinuses occur much less frequently than inflammatory disease or polyps. Since the initial symptoms for both are similar, tumors are often overlooked at first. Cancerous tumors of the nose and sinuses account for less than 1% of all malignant lesions in the body and only 3% of all head and neck cancers. Therefore, a high index of suspicion is required to identify these tumors at an early stage. Risk Factors and Causes
In most instances no particular cause for a sinonasal tumor is found. However, exposure to hardwood dust, products of nickel processing, and radiation have been implicated as causative agents.
Symptoms As mentioned, sinonasal tumors may behave much like nasal congestion due to a septal deviation, allergies, chronic infection, or polyps. If nasal obstruction is persistent, particularly if it is one sided, a cause should be sought. Other symptoms such as recurrent nose bleeds , non healing nasal sores, localized facial pain or numbness , facial swelling , visual changes, or a persistently blocked tear duct also warrant evaluation.
Tumor Types Squamous cell carcinoma is the most common cancerous tumor of the nose and paranasal sinuses. It arises from the lining of the nose and sinuses. Other malignancies such as adenoid cystic carcinoma (from salivary glands), adenocarcinoma (from saliva or mucous glands) esthesioneuroblastoma (from thecells of the smell organ), melanoma , and lymphoma may also occur.
Evaluation The otolaryngolgist/head and neck surgeon will evaluate the patient through physical examination and radiographic testing. A nasal endoscope may be used in the office for a detailed view of the nasal cavity, and occasionally, to perform a biopsy. Imaging studies including CT (computed tomography) and MRI (magnetic resonance imaging) scans are also helpful.
Treatment
Several recent advances have improved the cure rates as well as the functional and cosmetic outcome for sinonasal tumors. Collaborative efforts amongst otolaryngologist/head and neck surgeons , neurosurgeons , and plastics and reconstructive surgeons has allowed for more extensive, complete tumor removal with improved reconstruction. In addition, rapidly evolving endoscopic techniques has provided less invasive methods for accessing and removing selected tumors . Image guided surgery has improved surgical accuracy. New radiation therapy techniques such as IMRT (intensity modulated radiation therapy) has provided high dose, targeted treatment for maximal benefit with diminished side effects. The VCU Head and Neck Cancer Center offers these advances in the comprehensive evaluation and treatment of nasal and sinus cancers.
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