The nasal cavity is just behind the nose. Air passes through it on its way to the throat during breathing. Located behind and sides of the nose are 4 groups of air-filled spaces starting with maxillary, ethmoid, frontal and sphenoid sinuses. They have several functions, one is to keeping the nose from drying out by humidifying and heating inhaled air. They function as echo chambers that allow the voice to resonate when a person is talking or singing. In addition, they protect vital structures including the brain during a trauma to the face by acting as a crumpling zone.
These air-filled spaces (paranasal sinuses) around the nose rarely develop tumors or cancers. In general, these tumors are rare, making up only about three percent of tumors in the upper respiratory tract. Some of them are slow growing tumors that stay close to where they started (inverted papilloma) and others are aggressive cancer (SNUC: sinonasal undifferentiated carcinoma) that grows rapidly and has a tendency to spread into other tissues nearby and to more distant parts of the body (metastasis).
Many different types of tumors can develop in the nose or sinuses. Some of these are listed below:
Inverted papillomas are benign tumors by definition, but can cause problems when they expand and apply pressure on nearby bone and cause changes. Five to twenty percent of these benign tumors may also transform to a malignant type if not treated. In general, squamous cell carcinomas are the most common malignant type of tumor, followed by adenoid cystic carcinoma and adenocarcinoma. Most of the tumors originate from the maxillary sinuses. Less commonly, it stems from the nasal cavity, ethmoid sinuses or even more rarely, from the frontal or sphenoid sinuses.
Otolaryngology surgeons at Brigham and Women’s Hospital (BWH) specialize in surgical techniques for head and neck cancer including sinonasal cancer. We offer the most current diagnostic methods and proven treatments, including minimally invasive surgical approaches aided by endoscopic technology. We are part of the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.
There are several identified causes for sinonasal malignancies. Exposure to industrial environmental fumes from nickel refining process, chromium compounds, wood dust, leather tanning can cause certain types of sinonasal cancers. Tobacco smoke also can cause nasal cancers. Certain Human Papilloma Viruses (HPV) are associated with various types of benign and malignant tumors of the sinonasal cavity. Prior irradiation for other cancers has also been associated with the development of a sinonasal cancer.
Sinonasal cancer often presents with symptoms similar to other inflammatory or infectious diseases of the sinus cavity:
Some patients (~12%) do not have any symptoms at all.
Sinonasal tumors are rare, making up only about three percent of tumors in the upper respiratory tract. They are more common in whites and twice more common in males than in females. Exposure to industrial fumes, tobacco, and radiation exposure can all increase ones risk of getting sinonasal cancers.
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity—such as smoking or diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.
A complete medical history, physical examination including an office endoscopy can help a clinician narrow the diagnosis. In addition one or more of the following procedures or imaging can help with obtaining a definite diagnosis.
Because sinonasal cancer can be hard to diagnose, patients should ask to have the tissue samples checked by a pathologist who has experience in diagnosing sinonasal cancer. Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.
Patients with sinonasal cancer should have their treatment planned by a team of experts in treating head and neck cancer including Brigham and Women’s Hospital (BWH) head and neck surgeons and radiation oncologists and Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) medical oncologists.
Treatment may include:
A Brigham and Women’s Hospital otolaryngologist will begin with a complete evaluation and assessment of your specific condition. As part of the assessment, we will establish which treatment is indicated. A customized treatment plan will be established and you will work with the appropriate BWH services.
Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.
If surgery is needed, you will be taken care of in the operating room by an experienced otolaryngology surgeon. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.
Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.
When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our otolaryngologists are faculty members at Harvard Medical School and active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the ear, nose and throat.
Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.
Learn about the Weiner Center for Preoperative Evaluation.
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