The Farber Center: For Radiation Oncology

Cancer that originates from the mucosal tissue lining the sinus cavities or rarely from the bone itself.

• Air-filled areas that surround the nasal cavity
• Near the cheeks: maxillary sinuses
• Above and between the eyes: ethmoid and frontal sinuses
• Behind the ethmoids: sphenoid sinuses
• Sinuses are made up of different types of cells. If these cells grow out of control, they can form a cancer. Depending on the cell type, different cancers can arise:
• Squamous cell carcinoma
• Adenocarcinoma
• Lymphoma
• Sarcoma
• The type of cell/cancer determines the treatment.
• These tumors are rare.
• More common in men
• Most common between ages of 45-85.

• Blocked sinuses that do not clear, or sinus pressure.
• Headaches or pain in the sinus areas.
• A runny nose.
• Nosebleeds.
• A lump or sore inside the nose that does not heal.
• A lump on the face or roof of the mouth.
• Numbness or tingling in the face.
• Problems with the eyes such as:
• Swelling
• Double vision
• Eyes pointing in different directions.
• Pain in the upper teeth, loose teeth, or dentures that no longer fit well.
• Pain or pressure in the ear.

Risk Factors

Certain jobs are more likely to develop nasal cavity and paranasal sinus cancer. The increased risk seems to be related to breathing in certain substances while at work, such as:

• Furniture-making.
• Sawmill work.
• Woodworking (carpentry).
• Shoemaking.
• Metal-plating.
• Flour mill or bakery work.

Family history: Most people with nasal cavity and paranasal sinus cancer do not have any relatives with this disease. Family history does not seem to be a risk factor for these cancers.
Smoking: Smoking increases the risk of nasal cavity cancer.
Retinoblastoma: People with the inherited form of a certain type of eye cancer, retinoblastoma, have an increased risk of nasal cavity cancer. The increase in nasal cavity cancer was only seen in those who had their retinoblastoma treated with radiation.

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 from the biopsy is analyzed by a pathologist (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. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasal cavity, nasopharynx).

In some cases, the 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 obtain a biopsy sample of normal-looking tissues and confirm the diagnosis in a procedure called a frozen section examination before completing the endoscopic surgery for benign chronic sinusitis.

X-ray: An x-ray is a picture of the inside of the body. 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 doesn’t 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 (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. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. CT scans are very useful in identifying cancer of the nasal cavity and 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 brain adjacent to the sinuses. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Bone scan: A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s 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. This test may be done to see if cancer has spread to the bones.

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 substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.

T categories for maxillary sinus cancer

Tis: Cancer cells are limited to the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.

T1: Tumor is only in the tissue lining the sinus (the mucosa) and does not invade bone

T2: Tumor begins to grow into some of the bones of the sinus. (Note: If the cancer grows into the bone of the back part of the sinus, it is classified as T3).

T3: Tumor begins to grow into the bone at the back of the sinus (called the posterior wall) or the tumor has grown into the ethmoid sinus, the tissues under the skin, or the eye socket.

T4a: Tumor grows into other structures such as the skin of the cheek, the front part of the eye socket, the bone at the top of the nose (cribiform plate), the sphenoid sinus, the frontal sinus, or certain parts of the face (the pterygoid plates and the infratemporal fossa). This is also known as moderately advanced local disease.

T4b: Tumor has grown into the area between the nasal cavity and the throat (called the nasopharynx), the back of the eye socket, the brain, the tissue covering the brain (the dura), some parts of the skull (middle cranial fossa, the clivus), or certain nerves. This is also known as very advanced local disease.

T categories for nasal cavity and ethmoid sinus cancer

TX: Primary tumor cannot be assessed

T0: No evidence of primary tumor

Tis: Cancer cells are only in the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.

T1: Tumor is only in the nasal cavity or one of the ethmoid sinuses, although it may have grown into the bones of the sinus.

T2: Tumor has grown into other nasal or paranasal cavities

T3: Tumor has grown into bone of the eye socket, the roof of the mouth (palate), the cribiform plate (the bone that separates the nose from the brain), and/or the maxillary sinus

T4a: Tumor has grown into other structures such as the front part of the eye socket, the skin of the nose or cheek, the sphenoid sinus, the frontal sinus, or certain bones in the face (pterygoid plates). This is also known as moderately advanced local disease. Cancers that areT4a are resectable (meaning they can be removed with surgery)

T4b: Tumor is growing into the back of the eye socket, the brain, the dura (the tissue covering the brain), some parts of the skull (the clivus, the middle cranial fossa), certain nerves, or the nasopharynx (the area between the nasal cavity and the throat). This is also known as very advanced local disease. Tumors are called T4b when they are not resectable (they cannot be removed with surgery)

N stands for spread to nearby lymph nodes in the neck

N0: There is no evidence of cancer in the regional nodes.

N1: Cancer has spread to a single node on the same side as the primary tumor and the cancer found in the node is 3 cm or smaller.

N2: Describes any of the following conditions:

• N2a: Cancer has spread to a single lymph node on the same side as the primary tumor, and is larger than 3 cm, but not larger than 6 cm.
• N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.
• N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in the lymph nodes is larger than 6 cm.

M is for metastasis (spread to distant organs).

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage Grouping

Stage 0
Tis, N0, M0

Stage I
T1, N0, M0

Stage II
T2, N0, M0

Stage III
T3, N0, M0, OR T1 to T3, N1, M0

Stage IVA
T4a, N0 or N1, M0, OR T1 to T4a, N2, M0

Stage IVB
T4b, Any N, M0, OR Any T, N3, M0

Stage IVC
Any T, Any N, M1

Depends on the stage and the pathology – or what is found at the time of biopsy/surgery Options will include:

• Surgery
• Radiation
• Chemotherapy

It may be that only one, two, or all three are necessary.

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.