Close

Nose and Sinus Cancers

Deciding on a Treatment Plan

 

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 and/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:

Treatment guidelines are slightly different for maxillary versus ethmoid sinus tumors. They are also different for mucosal melanoma, so you should discuss with your doctors the best management for these types of tumors.

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 Al-Mamgani A, van Rooij P, Mehilal R, Tans L, Levendag PC. Combined-modality treatment improved outcome in sinonasal undifferentiated carcinoma: single-institutional experience of 21 patients and review of the literature. Eur Arch Otorhinolaryngol. 2013;270(1):293-299. doi:10.1007/s00405-012-2008-5

14 Amin M, Edge S, Greene F, et al. (2017). AJCC Cancer Staging Manual, 8th ed. New York: Springer.

15 Chen AM, Daly ME, Bucci MK, et al. Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: are we making improvement? Int J Radiat Oncol Biol Phys. 2007;69(1):141-147. doi:10.1016/j.ijrobp.2007.02.031

16 Dirix P, Nuyts S, Geussens Y, et al. Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2007;69(4):1042-1050. doi:10.1016/j.ijrobp.2007.04.044

17 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;92(12):3012-3029. http://www.ncbi.nlm.nih.gov/pubmed/11753979.

18 McLean JN, Nunley SR, Klass C, Moore C, Müller S, Johnstone PAS. Combined modality therapy of esthesioneuroblastoma. Otolaryngol Head Neck Surg. 2007;136(6):998-1002. doi:10.1016/j.otohns.2006.11.051

19 Mourad WF, Hauerstock D, Shourbaji RA, et al. Trimodality management of sinonasal undifferentiated carcinoma and review of the literature. Am J Clin Oncol. 2013;36(6):584-588. doi:10.1097/COC.0b013e31825eb3a5

20 Ock C-Y, Keam B, Kim TM, et al. Induction chemotherapy in head and neck squamous cell carcinoma of the paranasal sinus and nasal cavity: a role in organ preservation. Korean J Intern Med. 2016;31(3):570-578. doi:10.3904/kjim.2015.020

21 Porceddu S, Martin J, Shanker G, et al. Paranasal sinus tumors: Peter MacCallum Cancer Institute experience. Head Neck. 2004;26(4):322-330. doi:10.1002/hed.10388

22 Cohen, E. E., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N. , Hutcheson, K. A., Stubblefield, M. D., Abbott, D. M., Fisher, P. S., Stein, K. D., Lyman, G. H. and Pratt‐Chapman, M. L. (2016), American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA: A Cancer Journal for Clinicians, 66: 203-239. doi:10.3322/caac.21343

23 Homer, J., F.R.C.S., Jones, N., F.R.C.S., & Bradley, P., F.R.C.S. (1997). The role of endoscopy in the management of nasal neoplasia. American Journal of Rhinology & Allergy, 11(1), 41-48. doi:10.2500/105065897781446757