Paranasal Sinus Cancer
Paranasal sinus (PNS) cancer is rare. It usually is squamous cell carcinoma but can also be adenocarcinoma, and it occurs most often in the maxillary and ethmoid sinuses. In most cases its cause is not known, symptoms develop late, and survival is generally poor.
Although rare in the US, PNS cancer is more common in Japan and among the Bantu people of South Africa. Men over 40 yr are affected most often.
The cause is uncertain, but chronic sinusitis is not believed to be a cause. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) may play a role in some cases. Risk factors include
Because the sinuses provide room for the cancer to grow, symptoms usually do not develop until the cancer is well advanced. Pain, nasal obstruction and discharge, epistaxis, diplopia, ear pain or fullness, facial paresthesias, and loose maxillary teeth below the affected sinus result from local pressure of the cancer on adjacent structures. Tumor is sometimes visible in the oral or nasal cavities.
Treatment for most early-stage cancers is complete surgical excision. Recent advances in surgical techniques, particularly endoscopic techniques, can sometimes achieve complete tumor excisions, spare surrounding tissues, and achieve reconstruction. If risk of recurrence is high, radiation therapy is given post operatively. If surgical excision is not realistic or would cause excessive morbidity, radiotherapy plus chemotherapy may be used.In some cases, chemotherapy is given to shrink the tumor; if the tumor responds well to the chemotherapy, it is resected surgically. If not, the tumor can be treated with radiation.