Paranasal sinus cancer
Paranasal sinus cancer is a rare type of head and neck cancer. You may find it helpful to read it alongside our general information about head and neck cancers.
The spaces within the bones behind the nose and cheeks are called the paranasal sinuses. Each space, or sinus, is lined with cells that produce mucus, moisten the air that we breathe and prevent the lining of the nose from drying out. When a person talks, the voice echoes through the sinuses, giving it an individual tone.
Paranasal sinus cancer
Back to top
Cancer of the paranasal sinuses is rare in the West, but more common in countries such as Japan or South Africa. About 400 new cases of paranasal sinus cancer are diagnosed in the UK each year.
This type of cancer can occur at any age, but it's very rare in people under 40. It's more common in men than women.
Causes and risk factors of paranasal sinus cancer
Back to top
Like many other types of cancer, the exact causes of paranasal sinus cancer are unknown.
People who use snuff for many years, or those who work in the wood or furniture industry and are exposed to wood dust, are more likely to develop paranasal sinus cancer. Smoking and air pollution are also risk factors.
Paranasal sinus cancer is not infectious and can't be passed on to other people. It's not caused by an inherited faulty gene, so the relatives of someone with paranasal sinus cancer aren't more likely to develop it.
Signs and symptoms of paranasal sinus cancer
Back to top
The symptoms can vary depending on which sinuses are affected. The most common symptoms include:
blocked sinuses that do not clear
pain behind the nose or in the upper teeth
swelling around the eyes.
Other symptoms may include:
numbness of the cheek, upper lip, upper teeth or side of the nose
These symptoms may occur due to conditions other than cancer, and most people with these symptoms won't have paranasal sinus cancer. However, like most cancers, paranasal sinus cancer is best treated when diagnosed at an early stage. Therefore, any of the symptoms above should be reported to your GP if they don't improve over a few days.
How paranasal sinus cancer is diagnosed
Back to top
Your GP will examine you and arrange for any further tests that may be necessary. You will need to be referred to a hospital specialist for these tests, and for expert advice and treatment.
The doctor at the hospital will take your full medical history, carry out a physical examination and take blood samples to check your general health. The following tests are commonly used to make a firm diagnosis:
These may be taken to show the size and position of the cancer, and to check the bones of the face.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have the scan.
Before having the scan, you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
During this procedure a fine tube with a light at the end (nasendoscope) is guided through the nose into the sinus area. If an abnormal area is seen, a small piece of tissue will be taken to be examined under a microscope for cancer cells (biopsy). This may be carried out under a local or general anaesthetic. This test can be uncomfortable and you may be given an anaesthetic spray beforehand to numb your nose and throat.
You will then be asked not to eat or drink anything for about an hour afterwards, until your throat has lost the numb feeling.
Staging of paranasal sinus cancer
Back to top
The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type and stage of the cancer helps the doctors decide on the most appropriate treatment for you.
The most commonly used staging system is called the TNM system:
T refers to the size or position of the primary tumour (where the cancer first starts in the body).
N refers to which lymph nodes are affected, if any.
M refers to metastatic disease (when the cancer has spread to other parts of the body).
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.
The exact details of the T, N and M will depend on the type of cancer.
In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.
Stage 1 describes a cancer at an early stage when it is usually small in size and hasn’t spread. Stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in between these stages.
The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.
Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer might differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes
‘Local recurrence’ means the cancer has come back in the same area after treatment
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
Your doctors can give you more information about the stage of your particular cancer.
Grading of paranasal sinus cancer
Back to top
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.
Low-grade means that the cancer cells look very like normal cells. They are usually slow-growing and less likely to spread. In high-grade tumours, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
Treatment for paranasal sinus cancer
Back to top
Paranasal sinus cancers can start in different types of cells within the sinuses. The type of treatment given will depend on a number of things, including the position and stage of the cancer, the type of cancer, the grade and your general health. The following treatments may be used alone or in combination with one another. Your doctor will discuss with you the most appropriate treatment for your situation.
Surgery may be used, depending on the position of the cancer and whether or not it has spread into the surrounding area of lymph nodes. Surgery can sometimes be quite extensive, and in some cases skin grafts or flaps are needed.
If necessary, modern prostheses (false facial parts) can be used to give a good appearance to your face after the surgery. It can be difficult to prepare for and cope with this kind of surgery. However, help is available from the support organisations listed below.
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal tissue. Radiotherapy is given from a radiotherapy machine, much like an x-ray machine. It does not make you radioactive.
Sometimes radiotherapy may be given on its own to treat a paranasal sinus cancer (radical radiotherapy).
More commonly it’s given after surgery to reduce the chance of the cancer coming back (adjuvant therapy).
Depending on the type of radiotherapy treatment you receive, you may have some side effects. These may include feeling sick (nausea) and being sick (vomiting), eye irritations (conjunctivitis), dry eyes and headaches.
If side effects occur, it’s important to tell your doctor so they can prescribe appropriate medicines. The side effects generally start to reduce a couple of weeks after the treatment has finished.
Hair loss only occurs where the treatment beam enters and leaves the body. Sometimes hair loss in these areas may be permanent. In many cases, however, the hair will start to grow back a few weeks after the treatment finishes.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Paranasal sinus cancers are occasionally treated with chemotherapy, either before other treatments or at the same time as radiotherapy treatment (chemoradiation).
Cancer research trials (clinical trials)
Back to top
You may be asked to take part in a cancer research trial. For example, you may be offered chemotherapy treatment as part of a trial. Before any trial is allowed to take place it must have been approved by an ethics committee, which checks that the trial is in the interest of patients.
Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.
Follow-up for paranasal sinus cancer
Back to top
After your treatment is completed you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems or notice any new symptoms between these times, let your doctor know as soon as possible.
You are likely to experience a number of different emotions, from shock and disbelief to fear and anger. These feelings may be overwhelming and difficult to control, particularly if you have experienced changes in your appearance and feel self-conscious. These feelings are natural, and it's important for you to be able to express them.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. You may wish to contact our cancer support specialists for information about counselling in your area.
Changing Faces provides free help, support and information for people with a facial disfigurement. Produces a variety of written information.
Let's Face It
Let's Face It provides support, information, social activities and advice on camouflage make-up for people with facial disfigurement.
This information has been compiled using information from a number of reliable sources, including:
DeVita, et al. Cancer: Principles and Practice of Oncology. 7th edition. 2005. Lippincott Williams and Wilkins.
Improving Outcomes in Head and Neck Cancers. November 2004. National Institute for Health and Clinical Excellence (NICE).
J Tobias and D Hochauser. Cancer and its management. 6th edition. 2010. Wiley Blackwell.
Raghavan, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
UpToDate. Paranasal sinus cancer. (accessed October 2012).
With thanks to: Dr Amen Sibtain, Consultant Clinical Oncologist; and the people affected by cancer who reviewed this edition.
Reviewing is just one of the ways you could help when you join our Cancer Voices