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Nasal Cancer

Deciding on a Treatment Plan

Your doctors will typically use National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology(NCCN Guidelines®) for Head and Neck Cancers, as well as their own professional experience, to decide on the appropriate treatment course.13Referenced 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. If these NCCN Guidelines® are not followed, they will discuss it with you and explain why your situation might be special. There are no separate NCCN Guidelines for nasal cavity tumors as of yet, so you should discuss with your doctors the best management for these types of tumors.

Before starting treatment, your doctor will make sure that the following steps are completed.

Pretreatment evaluation

  • A full history and physical examination, including a complete head and neck exam (mirror and fiberoptic exam if needed)
  • An evaluation by the members of a head and neck cancer team
  • A biopsy to confirm a diagnosis of cancer
  • Imaging of the lungs to check for spread, if needed
  • CT with contrast or MRI with contrast of the primary tumor, the neck, and the skull base
  • A dental evaluation, if needed
  • A PET-CT may be considered for advanced disease
  • Pretreatment medical clearance and optimization of medical conditions

For mucosal melanoma, the pretreatment evaluation includes the following:

  • A thorough history and physical examination, including a complete head and neck exam (mirror and fiberoptic exam if needed)
  • Verification of the pathology of the mucosal melanoma
  • CT with contrast or MRI with contrast to check how extensive the disease is, particularly for sinus cancers
  • Imaging of the lungs to check for spread, if needed
  • A PET-CT to look for distant, or metastatic, disease

Then, your doctor will recommend a course of treatment for you, depending on a number of factors. Like all cancers in the head and neck, there are three general therapeutic options to consider:

The NCCN Guidelines for Head and Neck Cancers include specific guidelines for maxillary sinus cancers, ethmoid sinus cancers, and mucosal melanoma as well as other guidelines.13Referenced 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. You should discuss with your doctors the best management for these types of tumors. In general, surgical removal with or without radiation is the best method of treating most of these cancers.

The NCCN Guidelines for Mucosal Melanoma (most of which start in the sinonasal area) are as follows:13Referenced 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.

Mucosal melanoma (sinonasal) 

Stage III

You should undergo wide resection of the main tumor, with strong consideration of post-operative radiation to the primary site.
Mucosal melanoma (sinonasal) 

Stage IVA

T4a, N0

You should undergo wide resection of the main tumor, with post-operative radiation to the primary site.
Mucosal melanoma (sinonasal) 

Stage IVA

T3-4a, N1

You should undergo wide resection of the main tumor, with a neck dissection for cancerous lymph nodes in the neck, followed by post-operative radiation to the primary tumor site and the neck.
Mucosal melanoma (sinonasal) 

Stage IVb

The preferred method is to be enrolled in a clinical trial. Other options include radiation alone or some sort of systemic therapy.
Mucosal melanoma (sinonasal) 

Stage IVC

The preferred treatment method is a clinical trial, but best supportive care, radiation, or some sort of systemic therapy are possible options as well.
References

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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.

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