Nasal Cavity and Paranasal Sinus Cancer

This is Cancer.Nets Guide to Nasal Cavity and Paranasal Sinus Cancer. Use the menu below
to choose the Overview section to get started. Or, you can choose another section to learn
more about a specific question you have. Each guide is reviewed by experts on the
Cancer.Net Editorial Board, which is composed of medical, surgical, radiation, gynecologic,
and pediatric oncologists, oncology nurses, physician assistants, social workers, and patient
advocates.
This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2014
ON THIS PAGE: You will find some basic information about these diseases and the parts of
the body they may affect. This is the first page of Cancer.Nets Guide to Nasal Cavity and
Paranasal Sinus Cancer. To see other pages, use the menu on the side of your screen. Think of
that menu as a roadmap to this full guide.
Cancer begins when normal cells in the body change and grow uncontrollably, forming a
mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant,
meaning it can spread to other parts of the body. A benign tumor means the tumor will not
spread and usually can be removed without growing back.
Nasal cavity and paranasal sinus cancer are malignant tumors that begin in the inside of the
nose or paranasal cavities around the nose. The nasal cavity is the space just behind the nose
where air passes on the way to the throat. The paranasal sinuses are air-filled areas that
surround the nasal cavity on the cheeks, the maxillary sinuses; above and between the eyes,
the ethmoid and frontal sinuses; and behind the ethmoids, the sphenoid sinuses. The
maxillary sinus is the most common location of paranasal sinus cancer.
Nasal cavity and paranasal sinus cancer are two of the major types of cancer in the head and
neck region and belong to a group of tumors known as head and neck cancer.
Types of nasal cavity and paranasal sinus cancer
The nasal cavity and paranasal sinuses contain several types of tissue, and each contains
several types of cells. Different cancers can develop from each kind of cell. The differences
are important because they determine how fast growing the cancer is and the type of
treatment needed.
The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue with
the following cell types: squamous epithelial cells, minor salivary gland cells, nerve cells,
infection- fighting cells, and blood vessel cells. Some tumor types found in these cells and
tissues include the following:
Squamous cell carcinoma. This is the most common type of nasal cavity and paranasal sinus
cancer. Squamous cells are flat cells that make up the thin surface layer of the structures of
the head and neck.

Adenocarcinoma. This is the second most common type of nasal cavity and paranasal sinus
cancer. It begins in the gland cells.
Malignant melanoma. This develops from cells called melanocytes that give the skin its
color. It is usually an invasive, fast growing cancer; however, it only accounts for about 1%
of tumors found in this area of the body. Learn more about melanoma.
Inverting papilloma. These are benign, wart-like growths that may develop into squamous
cell carcinoma. Approximately 10% to 15% of these can develop into cancer.
Esthesioneuroblastoma. This type of cancer is related to the nerves that control the sense of
smell. It occurs on the roof of the nasal cavity and involves a structure called the cribriform
plate, a bone located deep in the skull between the eyes and the sinuses. This type of cancer
looks similar to neuroendocrine cancer, so it is important to figure out which one it is.
Midline granuloma. This refers to a group of several unrelated conditions that cause the
breakdown of the healthy tissue of the nose, sinuses, and nearby tissues. Some cases are due
to immune system problems, and many others are actually a type of lymphoma, a cancer of
the lymphatic system. The lymphatic system carries lymph, a colorless fluid containing a type
of white blood cell, called lymphocytes. Lymphocytes are part of the immune system and
help fight germs in the body.
Lymphoma. This is a type of cancer that originates in the lymph tissue within the lining of
the nasal cavity and paranasal sinuses, called the mucosa.
Sarcoma. Sarcoma is a type of cancer that begins in muscle, connective tissue, or bone.
ON THIS PAGE: You will find out more about the factors that increase the chance of
developing these types of cancer and things you can do to help prevent them. To see other
pages, use the menu on the side of your screen.
A risk factor is anything that increases a persons chance of developing cancer. Although risk
factors often influence the development of cancer, most do not directly cause cancer. Some
people with several risk factors never develop cancer, while others with no known risk factors
do. However, knowing your risk factors and talking about them with your doctor may help
you make more informed lifestyle and health care choices.
Two risk factors greatly increase the risk of nasal cavity and paranasal sinus cancer:
Tobacco use. Use of tobacco is the single largest risk factor for head and neck cancer.
Tobacco products include cigarettes, cigars, pipes, chewing tobacco, and snuff. Eighty-five
percent (85%) of head and neck cancer is linked to tobacco use. Additionally, recent research
suggests that people who have used marijuana may be at higher risk for head and neck
cancer. Secondhand smoke may also increase a persons risk of head and neck cancer.
Alcohol. Frequent and heavy consumption of alcohol is a risk factor for head and neck
cancer. Using alcohol and tobacco together increases this risk even more.
Other factors can raise a persons risk of developing nasal cavity or paranasal sinus cancer:

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk
factor for nasal cavity and paranasal sinus cancer. HPV is most commonly passed from
person to person during sexual activity. There are different types, or strains, of HPV, and
some strains are more strongly linked with certain types of cancers. HPV vaccines protect
against specific strains of the virus.
Specific inhalants. Breathing in certain substances, most commonly found in the work
environment, may increase the risk of developing nasal cavity or paranasal sinus cancer.
These substances include:

Dust from the wood, textiles, or leather industries

Flour dust

Nickel dust

Chromium dust

Mustard gas

Asbestos

Rubbing alcohol, also called isopropyl alcohol, fumes

Radium fumes

Glue fumes

Formaldehyde fumes

Solvent fumes used in furniture and shoe production

Exposure to air pollution. Being exposed to air pollution may increase a persons risk of
nasal cavity and paranasal sinus cancer.
Gender. Nasal cavity and paranasal sinus cancer occurs twice as often in men than women.
Age. This type of cancer is most commonly found in people between the ages of 45 and 85.
Prevention
Research continues to look into what factors cause this type of cancer and what people can do
to lower their personal risk. There is no proven way to completely prevent nasal cavity and
paranasal sinus cancer, but there may be steps you can take to lower your cancer risk. Talk
with your doctor if you have concerns about your personal risk of developing these types of
cancer.

Although some risk factors for nasal cavity and paranasal sinus cancer cannot be changed,
such as a persons age and gender, several can be avoided by making lifestyle changes.
Stopping the use of all tobacco products is the most important thing a person can do, even for
people who have been smoking for many years.
Also, avoiding exposure to substances that have been known to increase the risk of cancer
and wearing a protective facemask to reduce breathing in potentially harmful substances may
help reduce this risk. Workplace exposure and industrial-related hazards can be reduced by
appropriate air filtering, and workers in these areas need to be aware of their potential risk of
exposure.
ON THIS PAGE: You will learn about how doctors describe a cancers growth or spread, as
well as the way the tumor cells look when viewed under a microscope. This is called the
stage and grade. To see other pages, use the menu on the side of your screen.
Staging is a way of describing where the cancer is located, if or where it has spread, and
whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the
cancers stage, so staging may not be complete until all of the tests are finished. Knowing the
stage helps the doctor to decide what kind of treatment is best and can help predict a patients
prognosis, which is the chance of recovery. There are different stage descriptions for different
types of cancer.
One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation
for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine
the stage of cancer:

How large is the primary tumor and where is it located? (Tumor, T)

Has the tumor spread to the lymph nodes? (Node, N)

Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five
stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a
common way of describing the cancer, so doctors can work together to plan the best
treatments.
Here are more details on each part of the TNM system for nasal cavity and paranasal sinus
cancer:
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe
the size and location of the tumor. Some stages are also divided into smaller groups that help
describe the tumor in even more detail. Specific tumor stage information is listed below.
TX: The primary tumor cannot be evaluated.
T0: No evidence of a tumor is found.

Tis: This is a very early stage cancer when cancer cells are found only in one layer of tissue.
It is also called carcinoma (cancer) in situ.
Tumors of the paranasal sinuses are also evaluated by their exact location. See the Overview
section for descriptions.
Primary tumor (T) in the maxillary sinus
T1: The tumor is limited to the inside of the sinus and does not erode or invade bone.
T2: The tumor erodes or invades bone surrounding the sinuses.
T3: The tumor invades the surrounding bone, the skin of the cheek, or the other sinuses.
T4a: The tumor invades the bone surrounding the eye, the skin of the cheek, or the bones in
the back of the throat.
T4b: The tumor invades any of the following: the back of the eye, the brain area, or the bones
of the skull, other than those behind the nose and the back of the head.
Primary tumor (T) in the nasal cavity and ethmoid sinus
T1: The tumor is limited to the inside of the sinus with no involvement with the bone.
T2: The tumor extends into the nasal cavity.
T3: The tumor extends into the maxillary sinus or to the bone surrounding the eye.
T4a: The tumor has spread throughout the facial bones or into the base of the skull.
T4b: The tumor invades any of the following: the back of the eye, the brain area, or the back
of the head.
Node. The N in the TNM staging system stands for lymph nodes, the tiny, bean-shaped
organs that help fight infection. Lymph nodes near the head and neck are called regional
lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Since
there are many nodes in the head and neck area, the doctors careful evaluation of lymph
nodes is an important part of staging.
NX: The regional lymph nodes cannot be evaluated.
N0: There is no evidence of cancer in the regional lymph nodes.
N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and
the cancer found is 3 centimeters (cm) or smaller.
N2: This describes any of the following three conditions:
N2a: The cancer has spread to a single lymph node on the same side as the primary tumor,
and it is larger than 3 cm but not larger than 6 cm.

N2b: The cancer has spread to more than one lymph node on the same side as the primary
tumor, but none measure larger than 6 cm.
N2c: The cancer has spread to more than one lymph node on either side of the body, but none
measure larger than 6 cm.
N3: The cancer is found in at least one nearby lymph node and is larger than 6 cm.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to
other parts of the body.
MX: Distant metastasis cannot be evaluated.
M0: The cancer has not spread to other parts of the body.
M1: The cancer has spread to another part(s) of the body.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications (or T, N,
M and G, used to describe the tumor grade, which is explained below).
Stage 0: This is a very early cancer (Tis) with no spread to lymph nodes (N0) or distant
metastasis (M0).

Larger image
Stage I: This is a noninvasive cancer (T1) with no spread to lymph nodes (N0) and no distant
metastasis (M0).

Larger image
Stage II: This is an invasive cancer (T2) that has not spread to lymph nodes (N0) or to distant
parts of the body (M0).

Larger image
Stage III: This includes invasive cancer (T3) with no spread to regional lymph nodes (N0)
and no metastasis (M0), as well as invasive cancer (T1, T2, T3) that has spread to regional
lymph nodes (N1) but shows no sign of metastasis (M0).

Larger image
Stage IVA: This is an invasive cancer (T4a) that either has no lymph node involvement (N0)
or has spread to only one same-sided lymph node (N1) but with no metastasis (M0). It is also
used for any cancer (any T) with more significant nodal involvement (N2) but with no
metastasis (M0).

Larger image
Stage IVB: This is an invasive cancer (any T) that has spread to lymph nodes (any N) but has
no metastasis (M0). It is also used for any cancer (any T) that is found in lymph nodes and is
larger than 6 cm (N3) but has no metastasis (M0).

Larger image
Stage IVC: This refers to any tumor (any T, any N) when there is evidence of distant spread
(M1).

Larger image
Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a
recurrence, the cancer may need to be staged again (called re-staging) using the system
above.

Grade
Doctors also describe this type of cancer by its grade (G), which describes how much cancer
cells look like healthy cells when viewed under a microscope. The doctor compares the
cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of
cells grouped together. If the cancer looks similar to healthy tissue and contains different cell
groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very
different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The
cancers grade can help the doctor predict how quickly the cancer will spread. In general, the
lower the tumors grade, the better the prognosis.
GX: The grade cannot be evaluated.
G1: The cells look more like healthy tissue and is well differentiated.
G2: The cells are only moderately differentiated.
G3: The cells dont resemble healthy tissue and is poorly differentiated.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois.
The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition
(2010) published by Springer-Verlag New York, www.cancerstaging.net.
ON THIS PAGE: You will find out more about body changes and other things that can signal
a problem that may need medical care. To see other pages, use the menu on the side of your
screen.

People with nasal cavity or paranasal sinus cancer may experience the following symptoms
or signs. Sometimes, people with nasal cavity or paranasal sinus cancer do not show any of
these symptoms. In fact, these types of cancer are usually diagnosed in their later stages
because early stage cancer typically does not cause any symptoms. Nasal cavity or paranasal
sinus cancer is often discovered when a person is being treated for seemingly benign,
inflammatory disease of the sinuses, such as sinusitis. However, these symptoms may be
caused by a medical condition that is not cancer.

Nasal obstruction or persistent nasal congestion and stuffiness, which is often called
sinus congestion

Chronic sinus infections that do not respond to antibiotic treatment

Frequent headaches or pain in the sinus region

Pain or swelling in the face, eyes, or ears

Persistent tearing of the eyes

Bulging of one of the eyes or vision loss

Decreased sense of smell

Pain or numbness in the teeth

Loosening of teeth

A lump on the face, nose, or inside the mouth

Frequent runny nose

Frequent nosebleeds

Difficulty opening the mouth

A lump or sore inside the nose that does not heal

Fatigue

Unexplained weight loss

A lump in the neck

A person who notices any of these warning signs should talk with a doctor and/or dentist right
away and ask for a detailed physical examination, particularly if the symptoms continue for
several weeks. Nasal cavity and paranasal sinus cancer has a much better chance of being
treated successfully when they are found early.

Your doctor will ask how long and how often youve been experiencing the symptom(s), in
addition to other questions. This is to help find out the cause of the problem, called a
diagnosis.
Because many of these symptoms can be caused by other, noncancerous health conditions, it
is always important to receive regular health and dental screenings; this is particularly
important for people who routinely drink alcohol or who currently use tobacco products or
have used them in the past. In fact, people who use alcohol and tobacco should receive a
general physical examination at least once a year even if they do not have any symptoms.
This is a simple, quick office visit in which the doctor looks in the nose, mouth, and throat for
abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will
recommend a more extensive examination using one or more of the diagnostic procedures
mentioned in the Diagnosis section.
If cancer is diagnosed, relieving symptoms remains an important part of cancer care and
treatment. This may also be called symptom management, palliative care, or supportive care.
Be sure to talk with your health care team about symptoms you experience, including any
new symptoms or a change in symptoms.
ON THIS PAGE: You will learn about the different ways doctors use to treat people with
these types of cancer. To see other pages, use the menu on the side of your screen.
This section outlines treatments that are the standard of care, the best proven treatments
available, for these specific types of cancer. When making treatment plan decisions, patients
are also encouraged to consider clinical trials as an option. A clinical trial is a research study
to test a new approach to treatment to evaluate whether it is safe, effective, and possibly
better than the standard treatment. Clinical trials may test such approaches as a new drug, a
new combination of standard treatments, or new doses of current therapies. Your doctor can
help you review all treatment options. For more information, see the Clinical Trials and
Latest Research sections.
Treatment overview
In cancer care, different types of doctors often work together to create a patients overall
treatment plan that combines different types of treatments. This is called a multidisciplinary
team. For nasal cavity or paranasal sinus cancer, the team may include medical and radiation
oncologists (doctors who specialize in treating people with cancer), surgeons,
otolaryngologists (ear, nose, and throat doctors), dentists, maxillofacial prosthodontists
(specialists who perform restorative surgery in the head and neck areas), physical therapists,
speech pathologists, psychiatrists, nurses, dietitians, and social workers. A neurosurgeon (a
doctor who specializes in surgery on the brain and spinal cord) should also be part of this
team when a tumor in the skull or facial area needs to be removed.
Nasal cavity and paranasal sinus cancer can often be cured, especially if found early.
Although curing the cancer is the primary goal of treatment, preserving the function of the
nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they
consider how treatment might affect a persons quality of life, such as how the person feels,
looks, talks, eats, and breathes.

Descriptions of the most common treatment options for nasal cavity and paranasal sinus
cancer are listed below. The three main treatment options are surgery, radiation therapy, and
chemotherapy. One of these treatments, or a combination of them, may be used. Your care
plan may also include treatment for symptoms and side effects, an important part of cancer
care. Treatment options and recommendations depend on several factors, including the type
and stage of cancer, possible side effects, and the patients preferences and overall health.
Take time to learn about all of your treatment options and be sure to ask questions about
things that are unclear. Also, talk about the goals of each treatment with your doctor and what
you can expect while receiving the treatment. Learn more about making treatment decisions.
Surgery
Surgery is frequently used to remove cancer of the paranasal sinus or nasal cavity. A surgical
oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is
to remove all of the tumor and leave no trace of cancer in the healthy tissue, also called
negative margins. However, usually its not possible to completely remove the cancer with an
operation, so additional treatments may be necessary. This may include more than one
operation to remove the cancer and to help restore the appearance and function of the tissues
affected.
Common types of surgery for nasal cavity and paranasal sinus cancer include:
Excision. During an excision, the doctor performs an operation to remove the cancerous
tumor and some of the healthy tissue around it, called a margin.
Maxillectomy. This is a surgery that removes part or all of the hard palate, which is the bony
roof of the mouth. Artificial devices called prostheses or, more recently, flaps of soft tissue
with and without bone can be placed to fill gaps from this operation. A maxillectomy is
sometimes recommended to treat paranasal sinus cancer. Occasionally, it is possible to save
the eye on the side of the cancer.
Craniofacial resection/skull base surgery. This is an extensive surgery often recommended
for paranasal sinus cancer that removes more tissue than a maxillectomy. It requires the close
cooperation of the health care team, particularly cooperation between a neurosurgeon and a
head and neck surgeon.
Endoscopic sinus surgery. This relatively new approach is less destructive to healthy tissue
than traditional operations. Occasionally, it can be used for nasal cavity and paranasal sinus
tumors, especially if they are benign. The surgeon makes a small incision to remove the
tumor using a thin, telescope-like tube inserted into the nasal cavity or sinus. As mentioned in
the Diagnosis section, endoscopic sinus surgery is often used for chronic sinusitis, and cancer
may be discovered during such surgery.
Neck dissection. This is the surgical removal of lymph nodes in the neck area. If the doctor
suspects the cancer has spread, a neck dissection may be performed, often at the same time as
another surgery. A neck dissection may cause numbness of the ear, weakness when raising the
arm above the head, and weakness of the lower lip. The side effects are caused by injury to

nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and
arm may go away in a few months. Weakness will be permanent if a nerve is removed as part
of a dissection.
Reconstructive (plastic) surgery. If surgery requires removing large or specific areas of
tissue, reconstructive surgery may be recommended. If the eye is removed, a specialist called
a prosthodontist can provide an artificial replacement, called a prosthesis. More often, when
the upper jaw, called the maxilla, is removed, a prosthodontist may play a large role in the
rehabilitation process.
In general, surgery often includes risks because the eyes, mouth, brain, and important nerves
and blood vessels are nearby. Surgery often causes swelling of the face, mouth, and throat,
making it difficult to breathe; sometimes a hole in the windpipe, called a tracheostomy, may
be necessary to make breathing easier for some period of time after surgery. It is important to
talk with your surgeon(s) about which side effects to expect before having the surgery and
your plan for recovery. Learn more about cancer surgery.
Radiation therapy
Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. A
doctor who specializes in giving radiation therapy to treat cancer is called a radiation
oncologist.
For this type of cancer, radiation therapy is most often used in combination with surgery,
given either before or after the operation. It may also be given along with chemotherapy (see
below). For some types of tumors in the nasal cavity or paranasal sinus, radiation therapy
may be the main treatment. It can also be an option if a person cannot have surgery or decides
not to have surgery.
The most common type of radiation treatment is called external-beam radiation therapy,
which is radiation given from a machine outside the body. Specific types of external radiation
therapy include intensity-modulated radiation therapy (IMRT) and proton therapy. IMRT
allows more effective doses of radiation therapy to be delivered while reducing the damage to
healthy cells and causing fewer side effects. Proton therapy uses protons, rather than x-rays.
At high energy, protons can destroy cancer cells. Proton therapy may be used in nasal cavity
or paranasal sinus cancer when the tumor is located close to the eye or central nervous
system, which includes the brain and spinal cord. An external-beam radiation therapy
regimen (schedule) usually consists of a specific number of treatments given over a set period
of time.
When radiation treatment is given using implants, it is called internal radiation therapy or
brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive
materials that are surgically implanted in or near the tumor site. The implant is left in place
for several days while the person stays in the hospital.
Before beginning any type of radiation therapy for these types of cancer, people should
receive a thorough examination from a dentist experienced in treating people with head and

neck cancer. Because radiation therapy can cause tooth decay, damaged teeth may need to be
removed. Often, tooth decay can be prevented with proper treatment from a dentist before
beginning cancer treatment. After radiation therapy for nasal cavity or paranasal sinus cancer,
dental care should continue to help prevent further dental problems. People may receive
fluoride treatment to prevent cavities, also called dental caries. Read more about dental and
oral health during cancer treatment.
In addition, radiation therapy to the head and neck may cause redness or skin irritation in the
treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain,
nausea, fatigue, mouth sores, and/or sore throat. Other side effects may include pain or
difficulty swallowing; loss of appetite, due to a change in sense of taste; hearing loss, due to
buildup of fluid in the middle ear; and buildup of earwax that dries out because of the
radiation therapys effect on the ear canal. Radiation therapy may also cause a condition
called hypothyroidism in which the thyroid gland, located in the neck, slows down, causing
people to feel tired and sluggish. Every patient who receives radiation therapy to the neck
area should have his or her thyroid checked regularly. Researchers are conducting numerous
studies to find ways to reduce or better relieve the side effects of radiation therapy.
Learn more about radiation therapy.
Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer
cells ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor
who specializes in treating cancer with medication. A chemotherapy regimen (schedule)
usually consists of a specific number of cycles given over a set period of time. A patient may
receive one drug at a time or combinations of different drugs at the same time.
Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout
the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a
vein using a needle or in a pill or capsule that is swallowed (orally).
The use of chemotherapy before or after surgery and/or radiation therapy or in combination
with radiation therapy, called concurrent chemoradiotherapy, is frequently recommended for
these types of cancer. However, chemoradiotherapy is still being investigated and should be
done as part of a clinical trial.
For nasal cavity or paranasal sinus cavity cancer, chemotherapy may also be used to treat
advanced cancer (see below) or to treat symptoms. Some chemotherapy is available in
clinical trials that may treat cancer at an earlier stage.
The side effects of chemotherapy depend on the individual and the dose used, but they can
include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and
diarrhea. These side effects usually go away once treatment is finished.
Learn more about chemotherapy and preparing for treatment. The medications used to treat
cancer are continually being evaluated. Talking with your doctor is often the best way to learn

about the medications prescribed for you, their purpose, and their potential side effects or
interactions with other medications. Learn more about your prescriptions by using searchable
drug databases.
Getting care for symptoms and side effects
Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or
eliminate the cancer, an important part of cancer care is relieving a persons symptoms and
side effects. This approach is called palliative or supportive care, and it includes supporting
the patient with his or her physical, emotional, and social needs.
Palliative care can help a person at any stage of illness. People often receive treatment for the
cancer and treatment to ease side effects at the same time. In fact, patients who receive both
often have less severe symptoms, better quality of life, and report they are more satisfied with
treatment.
Palliative treatments vary widely and often include medication, nutritional changes,
relaxation techniques, and other therapies. You may also receive palliative treatments similar
to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy.
Talk with your doctor about the goals of each treatment in the treatment plan.
Before treatment begins, talk with your health care team about the possible side effects of
your specific treatment plan and supportive care options. And during and after treatment, be
sure to tell your doctor or another health care team member if you are experiencing a problem
so it is addressed as quickly as possible. Learn more about palliative care.
Metastatic nasal cavity and paranasal sinus cancer
If cancer has spread to another location in the body, it is called metastatic cancer. Patients
with this diagnosis are encouraged to talk with doctors who are experienced in treating this
stage of cancer, because there can be different opinions about the best treatment plan. Learn
more about seeking a second opinion before starting treatment, so you are comfortable with
the treatment plan chosen. This discussion may include clinical trials.
Your health care team may recommend a treatment plan that consists of chemotherapy or a
combination of surgery, radiation therapy, and chemotherapy. Supportive care will also be
important to help relieve symptoms and side effects.
For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to
bear. Patients and their families are encouraged to talk about the way they are feeling with
doctors, nurses, social workers, or other members of the health care team. It may also be
helpful to talk with other patients, including through a support group.
Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This
may also be called no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling
worried or anxious that the cancer will come back. While many remissions are permanent, its
important to talk with your doctor about the possibility of the cancer returning.
Understanding the risk of recurrence and the treatment options may help you feel more
prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer does return after the original treatment, it is called recurrent cancer. It may come
back in the same place (called a local recurrence), nearby (regional recurrence), or in another
place (distant recurrence).
When this occurs, a cycle of testing will begin again to learn as much as possible about the
recurrence, including whether the cancers stage has changed. After testing is done, you and
your doctor will talk about your treatment options. Often the treatment plan will include the
therapies described above, such as surgery, chemotherapy, and radiation therapy, but they
may be used in a different combination or given at a different pace. Your doctor may also
suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
People with recurrent cancer often experience emotions such as disbelief or fear. Patients are
encouraged to talk with their health care team about these feelings and ask about support
services to help them cope. Learn more about dealing with cancer recurrence.
If treatment fails
Recovery from cancer is not always possible. If treatment is not successful, the disease may
be called advanced or terminal cancer.
This diagnosis is stressful, and this is difficult to discuss for many people. However, it is
important to have open and honest conversations with your doctor and health care team to
express your feelings, preferences, and concerns. The health care team is there to help, and
many team members have special skills, experience, and knowledge to support patients and
their families. Making sure a person is physically comfortable and free from pain is
extremely important.
Patients who have advanced cancer and who are expected to live less than six months may
want to consider a type of palliative care called hospice care. Hospice care is designed to
provide the best possible quality of life for people who are near the end of life. You and your
family are encouraged to think about where you would be most comfortable: at home, in the
hospital, or in a hospice environment. Nursing care and special equipment can make staying
at home a workable alternative for many families. Learn more about advanced cancer care
planning.
ON THIS PAGE: You will read about your medical care after cancer treatment is finished
and why this follow-up care is important. To see other pages, use the menu on the side of
your screen.

After treatment for nasal cavity or paranasal sinus cancer ends, talk with your doctor about
developing a follow-up care plan. This plan may include regular physical examinations
and/or medical tests to monitor your recovery for the coming months and years.
ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you
received and develop a survivorship care plan once treatment is completed.
If the cancer recurs, it most commonly happens within the first two or three years after
diagnosis, so follow-up visits will be more frequent during the first two or three years.
Diagnostic examinations, such as CT scans, may be needed to watch for any signs of
recurrences or to monitor how well the current treatment is working.
Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People
may receive physical therapy and speech therapy to regain skills, such as talking and
swallowing. Supportive care to manage symptoms and maintain nutrition during and after
treatment may be recommended. Some people may need to learn new ways to eat or adjust to
eating foods that have been prepared differently. After surgery, a prosthodontist can help in
the restoration and rehabilitation of any oral cavity structures that were removed during
surgery.
Rehabilitation of physical changes resulting from a maxillectomy often requires a prosthesis.
Prevention of dental decay by fluoride application is very important to avoid loss of existing
teeth. Special eye care may also be necessary. Many times when a maxillectomy is done,
fluid will accumulate in the middle ear on the side of surgery. Surgery to the eardrum, called
a myringotomy, to drain this fluid may be required. Very frequently, especially after
craniofacial resection, people will lose their sense of smell, called anosmia. It is important for
these people to receive special coping strategies, especially around the house and work area,
in case of chemical spills, smoke from a fire, and other potentially harmful situations. People
who have received radiation therapy should avoid exposing the skin that received treatment
to the sun. If radiation therapy included the neck, the thyroid gland should be checked
regularly through blood tests.
People who have received treatment for nasal cavity or paranasal sinus cancer may look
different, feel tired, and be unable to talk or eat the way they did before treatment. Many
people experience depression. The health care team can help people cope with these physical
and emotional changes and connect them with support services. Support groups may help
people cope with changes following treatment.
People recovering from nasal cavity or paranasal sinus cancer are encouraged to follow
established guidelines for good health, such as maintaining a healthy weight, not smoking,
limiting alcohol consumption, eating a balanced diet, and having recommended cancer
screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate
physical activity can help rebuild your strength and energy level. Your doctor can help you
create an appropriate exercise plan based upon your needs, physical abilities, and fitness
level. Learn more about the next steps to take in survivorship, including making positive
lifestyle changes.

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors
can use to find out whats wrong and identify the cause of the problem. To see other pages,
use the menu on the side of your screen.
Doctors use many tests to diagnose cancer and find out if it spread to another part of the
body, called metastasis. Some tests may also determine which treatments may be the most
effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis. If
a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.
Imaging tests may be used to find out whether the cancer has spread. This list describes
options for diagnosing these types of cancer, and not all tests listed will be used for every
person. Your doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of cancer suspected

Signs and symptoms

Previous test results

To make the diagnosis, a complete medical history and physical examination are necessary.
Signs of nasal cavity and paranasal sinus cancer are often very similar to symptoms of
chronic or allergic sinusitis. The physical examination is important, and doctors may perform
one or more of the tests listed below to reach a diagnosis. There are no specific blood or urine
tests that can be performed to help make an early diagnosis of either of these types of cancer
The following tests may be used to diagnose nasal cavity or paranasal sinus cancer:
Physical examination. The doctor feels for any lumps on the neck, lips, gums, and cheeks.
Also, the doctor will inspect the nose, mouth, throat, and tongue for abnormalities, often
using a light and/or mirror for a clearer view.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a
microscope. Other tests can suggest that cancer is present, but only a biopsy can make a
definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A
pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells,
tissues, and organs to diagnose disease.
Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible
tube called an endoscope. The person may be sedated as the tube is inserted through the
mouth or nose to examine the head and neck areas. Sedation is the use of medication to help a
person become more relaxed, calm, or sleepy. The examination has different names
depending on the area of the body that is examined, such as laryngoscopy, which examines
the larynx; pharyngoscopy, which examines the pharynx; or nasopharyngoscopy, which
examines the nasal cavity and nasopharynx.
In some cases, a diagnosis of paranasal sinus cancer will be made during an endoscopic
surgery for what is believed to be benign chronic sinusitis. During the endoscopic sinus
surgery, it is important for the surgeon to take a biopsy sample of normal-looking tissue and

confirm the diagnosis in a procedure called a frozen section examination before completing
the endoscopic surgery for benign chronic sinusitis. For more information about surgery, see
the Treatment Options section.
X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small
amount of radiation. An x-ray can show if the sinuses are filled with something other than air.
If so, it is usually not cancer but, instead, an infection that is treatable. If treatment doesnt
work to clear the sinuses, then other more specialized x-ray tests may be done to identify the
blockage. Signs of cancer on an x-ray may be followed up with a computed tomography scan,
also called a CT scan.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture
of the inside of the body with an x-ray machine. A computer then combines these images into
a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also
be used to measure the tumors size. Sometimes, a special dye called a contrast medium is
given before the scan to create a clearer picture. This dye can be injected into a patients vein
or given as a pill to swallow. CT scans are very useful in identifying cancer of the nasal
cavity or paranasal sinus.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce
detailed images of the body, especially images of soft tissue, such as the eye in its socket and
the part of the brain near the sinuses. MRI can also be used to measure the tumors size. A
contrast medium may be injected into a patients vein or given as a pill to swallow to create a
clearer picture.
Bone scan. This test may be done to see if cancer has spread to the bones. A bone scan uses a
radioactive tracer to look at the inside of the bones. The tracer is injected into a patients vein.
It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray
to the camera, and areas of injury, such as those caused by cancer, appear dark.
Positron emission tomography (PET) scan. A PET scan is a way to create pictures of
organs and tissues inside the body. A small amount of a radioactive sugar substance is
injected into the patients body. This sugar substance is taken up by cells that use the most
energy. Because cancer tends to use energy actively, it absorbs more of the radioactive
substance. A scanner then detects this substance to produce images of the inside of the body.
After diagnostic tests are done, your doctor will review all of the results with you. If the
diagnosis is cancer, these results also help the doctor describe the cancer; this is called
staging.