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Nose and Sinus Cancers

Determining the Type of Sinonasal Cancer

Only after a pathologist analyzes some cells or actual pieces of tissue from the lesion will your doctor be able to tell you if you have cancer. Remember that not all lumps and bumps inside the nose and sinuses are cancer. Some growths are benign (non-cancerous), and there are some tumors that are on the borderline between benign and malignant (cancerous). You should speak to your doctor about the best treatment for these in your specific case. In many cases, borderline growths should be removed with surgery. Examples of these types of tumors are:

  • Schneiderian papillomas: These might be related to HPV infections, and they can be found on the front part of the nasal septum (fungiform-type) or on the lateral nasal wall (inverted and cylindrical types). There is a chance of squamous cell carcinoma within some of these papillomas; therefore, they should be surgically removed.

Other borderline tumors include:

  • Angiofibroma
  • Ameloblastoma
  • Fibrous dysplasia
  • Ossifying fibroma
  • Giant cell tumor

Some lesions in the nasal and sinus cavities are in fact cancer. The best way to divide these types of tumors is based on the cell type from which the cancer started.1, Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer. 2001 Dec 15;92(12):3012-29.6 Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002 Sep;24(9):821-9.

Epithelial-based cancers include:

  • Squamous cell carcinoma: These are cancers that arise from the lining of the nasal cavity and sinuses. There are a few different subtypes of squamous cell carcinomas, some more aggressive than others. Examples of these include verrucous squamous cell carcinomas (which have less tendency to invade deeply), basloid squamous cell carcinoma and well-to-poorly differentiated squamous cell carcinomas.7 Wieneke JA, Thompson LD, Wenig BM. Basaloid squamous cell carcinoma of the sinonasal tract. Cancer. 1999 Feb 15;85(4):841-54.
  • Adenocarcinoma: This type of cancer arises from gland-like elements in this region that are in the lining of the sinonasal tract or to salivary glands in the area. Adenocarcinoma is the second most common type of sinonasal cancer.
  • Minor salivary gland cancers: There are minor salivary glands in this region of the head and neck as well. Therefore, cancer types can include:
    • Adenocarcinoma
    • Adenoid cystic carcinoma
    • Mucoepidermoid carcinoma
  • Melanoma: These cancers come from skin cells that give skin its color. In rare cases, melanoma can be found in the lining of the mouth, nose and/or throat; this is called mucosal melanoma.8 Marcus DM, Marcus RP, Prabhu RS, Owonikoko TK, Lawson DH, Switchenko J, Beitler JJ. Rising incidence of mucosal melanoma of the head and neck in the United States. J Skin Cancer. 2012;2012:231693. doi: 10.1155/2012/231693. Epub 2012 Dec 2. Actually, approximately two-thirds of all mucosal melanomas start out in the nasal cavity and paranasal sinuses (another one-third arise in the oral cavity, and the rest are in various other mucosal sites of the head and neck, such as the throat).9 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 9: Mucosal Melanoma of the Head and Neck. These are aggressive cancers, even when small.
  • Olfactory neuroblastoma (esthesioneuroblastoma): This is an extremely rare cancer that is thought to begin from the tissue lining in the roof of the nose that is responsible for smell.
  • Sinonasal undifferentiated carcinoma (SNUC): This is a rare but very aggressive cancer. It is unclear what the cell of origin is. It often involves multiple different sites.10 Ejaz A, Wenig BM. Sinonasal undifferentiated carcinoma: clinical and pathologic features and a discussion on classification, cellular differentiation, and differential diagnosis. Adv Anat Pathol. 2005 May;12(3):134-43.
  • Neuroendocrine carcinoma11 Perez-Ordonez B, Caruana SM, Huvos AG, Shah JP. Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses. Hum Pathol. 1998 Aug;29(8):826-32.

Non-epithelial based sinonasal cancers include12 Spiro JD, Soo KC, Spiro RH. Nonsquamous cell malignant neoplasms of the nasal cavities and paranasal sinuses. Head Neck. 1995;17:114-118.:

  • Sarcoma: These are soft tissue tumors that arise from different types of tissues, including fibrous tissue, cartilage, bone, muscles and blood vessels, to name a few. Some examples of sarcomas that have been found in the sinonasal area include:
    • Fibrosarcoma
    • Hemangiopericytoma
    • Angiosarcoma
    • Kaposi’s sarcoma
    • Rhabdomyosarcoma
    • Malignant fibrous histiocytoma
    • Chrondrosarcoma
    • Osteogenic sarcoma
  • Lymphoma: Lymphoid tissue is located all over the body; this is why lymphoma might appear as a lump in the sinonasal area.
  • Chordoma: This is a rare bone tumor that occurs along the spine.

Even more rarely, spread of cancers from other sites could show up in this area as a metastasis. This includes spread of lung, kidney, breast or ovarian cancer.

References

1 Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer. 2001 Dec 15;92(12):3012-29.

2 Leclerc A, Martinez Cortes M, Gérin M, Luce D, Brugère J. Sinonasal cancer and wood dust exposure: results from a case-control study. Am J Epidemiol. 1994 Aug 15;140(4):340-9.

3 Brinton LA, Blot WJ, Becker JA, Winn DM, Browder JP, Farmer Jr JC, Fraumeni Jr JF. A case-control study of cancers of the nasal cavity and paranasal sinuses. Am J Epidemiol. 1984 Jun;119(6):896-906.

4 Battista G, Comba P, Orsi D, Norpoth K, Maier A . Nasal cancer in leather workers: an occupational disease. J Cancer Res Clin Oncol. 1995;121(1):1-6.

5 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

6 Katz TS, Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Villaret DB. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002 Sep;24(9):821-9.

7 Wieneke JA, Thompson LD, Wenig BM. Basaloid squamous cell carcinoma of the sinonasal tract. Cancer. 1999 Feb 15;85(4):841-54.

8 Marcus DM, Marcus RP, Prabhu RS, Owonikoko TK, Lawson DH, Switchenko J, Beitler JJ. Rising incidence of mucosal melanoma of the head and neck in the United States. J Skin Cancer. 2012;2012:231693. doi: 10.1155/2012/231693. Epub 2012 Dec 2.

9 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 9: Mucosal Melanoma of the Head and Neck.

10 Ejaz A, Wenig BM. Sinonasal undifferentiated carcinoma: clinical and pathologic features and a discussion on classification, cellular differentiation, and differential diagnosis. Adv Anat Pathol. 2005 May;12(3):134-43.

11 Perez-Ordonez B, Caruana SM, Huvos AG, Shah JP. Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses. Hum Pathol. 1998 Aug;29(8):826-32.

12 Spiro JD, Soo KC, Spiro RH. Nonsquamous cell malignant neoplasms of the nasal cavities and paranasal sinuses. Head Neck. 1995;17:114-118.

13 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 6, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.