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Nasal Cavity and Paranasal Sinus Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find some basic information about these diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Nasal Cavity and Paranasal Sinus Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the nasal cavity and paranasal sinuses

The nasal cavity is the space just behind the nose where air passes on its way to the throat. The paranasal sinuses are air-filled areas that surround the nasal cavity. The paranasal sinuses include:

  • Maxillary sinuses, located in the cheeks

  • Ethmoid sinuses, located on the bridge of the nose between the eyes

  • Frontal sinuses, located above the eyes

  • Sphenoid sinuses, located behind the ethmoids

See this guide's Medical Illustrations section for a basic drawing of the location of the paranasal sinuses.

About nasal cavity and paranasal sinus cancer

Cancer begins when healthy cells in the body change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. A benign tumor usually can be removed without it growing back.

Nasal cavity and paranasal sinus cancer are malignant tumors. They are 2 of the major types of cancer that develop in the head and neck region. They belong to a group of tumors known as head and neck cancer. Although paranasal sinus cancer can develop in any of the sinuses, it usually begins in the maxillary sinus.

Types of nasal cavity and paranasal sinus cancers

The nasal cavity and paranasal sinuses contain several types of tissue, and each contains several types of cells. Different cancers can develop from each kind of cell. The differences are important because they determine how fast the cancer can grow and the type of treatment needed.

The nasal cavity and paranasal sinuses are lined by a layer of mucus-producing tissue that contains these types of cells:

  • Squamous epithelial cells

  • Minor salivary gland cells

  • Nerve cells

  • Infection-fighting cells called lymphocytes

  • Blood vessel cells

The types of cancer that may develop from these cells include:

  • Squamous cell carcinoma. This is the most common type of nasal cavity and paranasal sinus cancer. Squamous cells are flat cells that make up the thin surface layer of the structures of the head and neck.

  • Adenocarcinoma. This is the second most common type of nasal cavity and paranasal sinus cancer. It begins in gland cells.

  • Melanoma. Melanoma develops from cells called melanocytes that give the skin its color. It is usually an invasive, fast-growing cancer. It only accounts for about 1% of tumors found in this area of the body.

  • Inverted papilloma. These are benign, wart-like growths that may develop into squamous cell carcinoma. Around 10% to 15% of these will develop into cancer.

  • Esthesioneuroblastoma. This type of cancer is related to the nerves that control the sense of smell. It occurs on the roof of the nasal cavity and involves a structure called the cribriform plate. The cribriform plate is a bone located deep in the skull between the eyes and the sinuses. This type of cancer looks similar to neuroendocrine cancer, so it is important to distinguish between them.

  • Midline granuloma. This refers to a group of several unrelated conditions that cause the breakdown of the healthy tissue of the nose, sinuses, and nearby tissues. Some cases are due to immune system problems, and many others are actually a type of lymphoma (see below).

  • Lymphoma. Lymphoma is a cancer of the lymphatic system. The lymphatic system carries lymph, a colorless fluid containing lymphocytes. Lymphoma may develop in the lymph tissue found in the lining of the nasal cavity and paranasal sinuses, called the mucosa.

  • Sarcoma. Sarcoma is a type of cancer that begins in muscle, connective tissue, or bone.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to head and neck cancer. This free fact sheet is available as a PDF, so it is easy to print.

  • Cancer.Net Blog: Read an ASCO expert’s opinion about what newly diagnosed patients should know about head and neck cancer.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with nasal cavity or paranasal sinus cancer, with general survival rates. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 03/2023

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with nasal cavity and paranasal sinus cancer each year. You will also read general information on surviving these diseases. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original source for these statistics is provided at the bottom of this page.

How many people are diagnosed with nasal cavity and paranasal sinus cancer?

Both nasal cavity and paranasal sinus cancer are uncommon. They make up only 3% to 5% of head and neck cancers in the United States. People in certain other areas of the world, such as Denmark, are more likely to develop these diseases.

In the United States, cancer of the nasal cavity or paranasal sinus is more common as people grow older. Approximately 4 out of 5 people diagnosed with nasal cavity or paranasal sinus cancer are at least 55 years old. White people are diagnosed with nasal cavity or paranasal sinus cancer far more often than Black people.

What is the survival rate for nasal cavity and paranasal sinus cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from nasal cavity or paranasal sinus cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with nasal cavity or paranasal sinus cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with nasal cavity and paranasal sinus cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for nasal cavity and paranasal sinus cancer in the United States is 59%.

The survival rates for nasal cavity and paranasal sinus cancer vary based on several factors. These include the stage and grade of cancer, a person’s age and general health, and how well the treatment plan works.

If the cancer is located only in the nasal cavity or paranasal sinus, the 5-year relative survival rate is 86%. If the cancer has spread to nearby tissues or organs and/or to regional lymph nodes, the 5-year relative survival rate is 52%. If there is distant spread to other parts of the body, the 5-year relative survival rate is 43%. Talk with your doctor about what you can expect with your specific diagnosis.

Experts measure relative survival rate statistics for nasal cavity and paranasal sinus cancer every 5 years. This means the estimate may not reflect the results of advancements in how nasal cavity and paranasal sinus cancer is diagnosed or treated from the last 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society website. (Source accessed January 2023.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by nasal cavity or paranasal sinus cancer. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find a drawing of the nasal cavity and paranasal sinuses. Use the menu to see other pages.

This illustration of the human face shows the location of the paranasal sinuses, which are air-filled areas that surround the nasal cavity. The frontal sinuses are located above the eyebrows. The ethmoid sinuses are small and located on the bridge of the nose, between the eyes. The maxillary sinuses are located in the cheeks on either side of the nose, just below the eyes. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and PreventionIt describes the factors that may increase the chance of developing nasal cavity or paranasal sinus cancer and what people can do to lower their risk. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find out more about the factors that increase the chance of developing nasal cavity or paranasal sinus cancer and what people can do to lower their risk. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

There are 2 risk factors that greatly increase the risk of nasal cavity and paranasal sinus cancers:

  • Tobacco use. Use of tobacco is the single largest risk factor for head and neck cancer. Tobacco products include cigarettes, cigars, pipes, chewing tobacco, and snuff. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Secondhand smoke may also increase a person’s risk of developing head and neck cancer.

  • Alcohol. Frequent and heavy consumption of alcohol is a risk factor for head and neck cancer. Using alcohol and tobacco together increases this risk even more.

Other factors can raise a person’s risk of developing nasal cavity or paranasal sinus cancer:

  • Gender. Nasal cavity and paranasal sinus cancer occurs twice as often in men as in women.

  • Age. Nasal cavity and paranasal sinus cancer are most commonly found in people between the ages of 45 and 85.

  • Human papillomavirus (HPV). Research shows that infection with this virus is a risk factor for nasal cavity and paranasal sinus cancer. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. HPV vaccines can prevent people from developing certain cancers. Learn more about HPV and cancer.

  • Specific inhalants.Breathing in certain substances may increase the risk of developing nasal cavity or paranasal sinus cancer. Many of these substances are commonly found in places where people work. These substances include:

    • Dust from the wood, textiles, or leather industries

    • Flour dust

    • Nickel dust

    • Chromium dust

    • Mustard gas

    • Fumes from rubbing alcohol, also called isopropyl alcohol

    • Radium fumes

    • Glue fumes

    • Formaldehyde fumes

    • Solvent fumes used in furniture and shoe production

  • Exposure to air pollution. Being exposed to air pollution may increase a person’s risk of developing nasal cavity and paranasal sinus cancer.

  • Marijuana use. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause nasal cavity and paranasal sinus cancer, including ways to prevent it. Although there is no proven way to completely prevent nasal cavity or paranasal sinus cancer, you may be able to lower your risk. Talk with your health care team for more information about your personal risk of cancer.

  • The most important thing a person can do is to stop the use of all tobacco products, even for people who have been using tobacco for many years. This is difficult to do but there are different ways to try with support to help.

  • Avoiding exposure to substances that have been known to increase the risk of cancer may help reduce this risk. Workers should wear a protective face mask to avoid breathing in potentially harmful substances. Workplace exposure and industrial-related hazards can also be reduced with appropriate air filtering. Workers in these areas need to be aware of their potential risk of exposure.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Screening

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find out more about screening for nasal cavity and paranasal sinus cancers, including risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for nasal cavity and paranasal sinus cancers

It is always important to receive regular health and dental screenings. This is particularly important for people who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past.

People who use alcohol and tobacco should receive a general physical examination at least once a year, even if they do not have any symptoms. This is a simple, quick office visit in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using 1 or more of the diagnostic procedures described in Diagnosis.

The next section in this guide is Symptoms and Signs. It explains what changes or medical problems nasal cavity and paranasal sinus cancers can cause. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find out more about changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with nasal cavity or paranasal sinus cancer may experience the following symptoms or signs. Symptoms are changes that you can feel in your body. Signs are changes in something measured, like by taking your blood pressure or doing a lab test. Together, symptoms and signs can help describe a medical problem. Sometimes, people with nasal cavity or paranasal sinus cancer do not have any of the symptoms and signs described below. Or, the cause of a symptom or sign may be a medical condition that is not cancer.

  • Nasal obstruction or persistent nasal congestion and stuffiness, which is often called sinus congestion

  • Chronic sinus infections that do not go away with antibiotic treatment

  • Frequent headaches or pain in the sinus region

  • Pain or swelling in the face, eyes, or ears

  • Persistent tearing of the eyes

  • Bulging of 1 of the eyes or loss of vision

  • Decreased sense of smell

  • Pain or numbness in the teeth

  • Loosening of teeth

  • A lump on the face, nose, or inside the mouth

  • Frequent runny nose

  • Frequent nosebleeds

  • Difficulty opening the mouth

  • A lump or sore inside the nose that does not heal

  • Fatigue

  • Unexplained weight loss

  • A lump in the neck

These types of cancer are usually diagnosed in their later stages because early-stage cancer typically does not cause any symptoms. Nasal cavity or paranasal sinus cancer is often discovered when a person is being treated for seemingly benign, inflammatory disease of the sinuses, such as sinusitis.

A person who notices any of these changes should talk with a doctor and/or dentist right away. Ask for a detailed physical examination, particularly if the symptoms continue for several weeks. Nasal cavity and paranasal sinus cancers have a much better chance of being treated successfully when they are found early.

Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. Managing symptoms may also be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How nasal cavity and paranasal sinus cancers are diagnosed

This section describes options for diagnosing nasal cavity or paranasal sinus cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

Physical examination

To make the diagnosis, a complete medical history and physical examination are necessary. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and/or mirror for a clearer view.

Signs of nasal cavity or paranasal sinus cancer are often very similar to symptoms of chronic or allergic sinusitis. The physical examination is important, and doctors may perform 1 or more of the tests listed below to reach a diagnosis. There are no specific blood or urine tests that can be performed to help make an early diagnosis of nasal cavity or paranasal sinus cancer.

Other diagnostic tests

In addition to a physical examination, the following tests may be used to diagnose nasal cavity or paranasal sinus cancer:

  • 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. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Endoscopy. An endoscopy 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. Sedation is the use of medication to help a person become more relaxed, calm, or sleepy. This examination has different names depending on the area of the body that is examined, such as laryngoscopy, which examines the larynx; pharyngoscopy, which examines the pharynx; or nasopharyngoscopy, which examines the nasal cavity and nasopharynx.

    In some cases, a diagnosis of paranasal sinus cancer will be made during endoscopic surgery for what is believed to be benign chronic sinusitis. Before completing the surgery, the surgeon should take a sample of healthy-looking tissue for a biopsy to test for benign chronic sinusitis. This procedure is called a frozen section examination. For more information about surgery, see the Types of Treatment section.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. An x-ray can show if the sinuses are filled with something other than air. If they are, the issue is usually not cancer but, instead, an infection that is treatable. If that treatment doesn’t work to clear the sinuses, then other 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 scan, also called a CT scan (see below).

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. CT scans are very useful in identifying cancer of the nasal cavity or 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 part of the brain near the sinuses. MRI can be used to measure a tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Bone scan. A bone scan may be done to see if cancer has spread to the bones. 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 lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Stages and Grades

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as what the cancer cells look like under a microscope. This is called the stage and grade. Use the menu to see other pages.

What is cancer staging?

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor recommend the best kind of treatment, and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

This page provides detailed information about the system used to find the stage of nasal cavity and paranasal sinus cancer and the stage groups for these cancers, such as stage II or stage IV.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages for nasal cavity or paranasal sinus cancer: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for nasal cavity and paranasal sinus cancers.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor.

Stages may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

Tumors of the paranasal sinuses are evaluated by their exact location. See the Introduction for descriptions.

Primary tumor (T) in the maxillary sinus

TX: The primary tumor cannot be evaluated.

Tis: This is a very early stage cancer in which cancer cells are found only in 1 layer of tissue. It is also called carcinoma (cancer) in situ.

T1: The tumor is limited to the inside of the sinus and does not erode or invade bone.

T2: The tumor erodes or invades the bone surrounding the sinuses.

T3: The tumor invades the surrounding bone, the skin of the cheek, or the other sinuses.

T4a: The tumor invades the bone surrounding the eye, the skin of the cheek, or the bones in the back of the throat.

T4b: The tumor invades any of the following: the back of the eye, the brain area, or the bones of the skull, other than those behind the nose and the back of the head.

Primary tumor (T) in the nasal cavity and ethmoid sinus

TX: The primary tumor cannot be evaluated.

Tis: This is a very early stage cancer in which cancer cells are found only in 1 layer of tissue. It is also called carcinoma (cancer) in situ.

T1: The tumor is limited to the inside of the sinus.

T2: The tumor extends into the nasal cavity.

T3: The tumor extends into the maxillary sinus or to the bone surrounding the eye.

T4a: The tumor has spread throughout the facial bones or into the base of the skull.

T4b: The tumor invades any of the following: the back of the eye, the brain area, or the back of the head.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Since there are many nodes in the head and neck area, the doctor’s careful evaluation of lymph nodes is an important part of staging.

Evaluation of the lymph nodes can be done in 2 ways. If the evaluation is done by an oncologist in the clinic, it is called a clinical definition. If the evaluation is done on a tissue sample by a pathologist in a lab, it is called a pathological definition.

Clinical definition

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to 1 lymph node on the same side as the primary tumor. The cancer found is 3 centimeters (cm) or smaller. It does not extend into the tissue beyond the involved lymph node, called extranodal extension (ENE).

N2a: The cancer has spread to 1 lymph node on the same side as the primary tumor. It is between 3 cm and 6 cm in size. There is no ENE.

N2b: The cancer has spread to more than 1 lymph node on the same side as the primary tumor, and all are smaller than 6 cm. There is no ENE.

N2c: The cancer has spread to more than 1 lymph node on either side of the body, and all are smaller than 6 cm. There is no ENE.

N3a: The cancer is found in at least 1 nearby lymph node and is larger than 6 cm. There is no ENE.

N3b: The cancer has spread to any node, and it has spread to the tissue surrounding the lymph node (ENE).

Pathological definition

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to 1 lymph node on the same side as the primary tumor. The cancer found is 3 cm or smaller. It does not extend into the tissue beyond the involved lymph node, called extranodal extension (ENE).

N2a: The cancer has spread to 1 lymph node on either side of the primary tumor. It is smaller than 3 cm, and ENE is present. Or, it has spread to 1 lymph node on the same side of the primary tumor, it is between 3 cm and 6 cm in size, and there is no ENE.

N2b: The cancer has spread to more than 1 lymph node on the same side as the primary tumor, and all are smaller than 6 cm. There is no ENE.

N2c: The cancer has spread to more than 1 lymph node on either side of the body, and all are smaller than 6 cm. There is no ENE.

N3a: The cancer is found in at least 1 nearby lymph node and is larger than 6 cm. There is no ENE.

N3b: The cancer is found in 1 lymph node on the same side as the primary tumor, it is larger than 3 cm, and there is ENE. Or, the cancer has spread to many nodes on either side of the body, and there is ENE.

Metastasis (M)

The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part(s) of the body.

Grade (G)

Doctors also describe nasal cavity and paranasal sinus cancer by its grade (G). The grade describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The grade cannot be evaluated.

G1: The cells look more like healthy tissue and are well differentiated.

G2: The cells are only moderately differentiated.

G3: The cells don’t resemble healthy tissue and are poorly differentiated.

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Stage groups for nasal cavity and paranasal sinus cancer

Doctors combine the T, N, and M information (see above) to say what stage the cancer is.

Stage 0: This is a very early cancer (Tis) with no spread to lymph nodes (N0) or distant metastasis (M0).

Stage I: This is a noninvasive cancer (T1) with no spread to lymph nodes (N0) and no distant metastasis (M0).

Stage II: This is an invasive cancer (T2) that has not spread to lymph nodes (N0) or to distant parts of the body (M0).

Stage III: This includes invasive cancer (T3) with no spread to regional lymph nodes (N0) and no metastasis (M0), as well as invasive cancer (T1, T2, T3) that has spread to regional lymph nodes (N1) but shows no sign of metastasis (M0).

Stage IVA: This is an invasive cancer (T4a) that either has no lymph node involvement (N0) or has spread to only 1 same-sided lymph node (N1) but with no metastasis (M0). It is also used for any cancer that is not considered very advanced (T1, T2, T3, T4a) with more significant nodal involvement (N2) but with no metastasis (M0).

Stage IVB: This is an invasive cancer (any T) that has spread to lymph nodes (N3) but has no metastasis (M0). It is also used for very advanced cancer (T4b) that has not metastasized (any N, M0).

Stage IVC: This refers to any tumor (any T, any N) when there is evidence of distant spread (M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

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Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with nasal cavity or paranasal sinus cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for nasal cavity and paranasal sinus cancers. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How nasal cavity and paranasal sinus cancers are treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

For nasal cavity or paranasal sinus cancer, the team may include:

  • Medical oncologist: A doctor who treats cancer using chemotherapy, immunotherapy or other medications, such as targeted therapy.

  • Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.

  • Surgical oncologist: A doctor who treats cancer using surgery.

  • Neurosurgeon: A doctor who specializes in surgery on the brain and spinal cord. If a tumor in the skull or facial area needs to be removed, a neurosurgeon should also be part of this team.

  • Otolaryngologist: A doctor who treats ear, nose, and throat problems.

  • Dentist: A doctor who specializes in preventing and treating conditions and diseases in the mouth and oral cavity.

  • Maxillofacial prosthodontist: A specialist who performs restorative surgery in the head and neck areas.

  • Physical therapist: A health care professional who helps patients improve their physical strength and ability to move.

  • Speech-language pathologist (SLP): This professional, also called a speech therapist, specializes in communication and swallowing disorders. An SLP helps patients regain speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

  • Psychologist/psychiatrist: These mental health professionals address the emotional, psychological, and behavioral needs of the person with cancer and those of their family.

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Nasal cavity and paranasal sinus cancers can often be cured, especially if found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, eats, sees, and breathes.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for nasal cavity and paranasal sinus cancers because there are different treatment options. Learn more about making treatment decisions.

The common types of treatments used for nasal cavity or paranasal sinus cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. The 4 main treatment options are surgery, radiation therapy, chemotherapy, and immunotherapy. Your treatment plan may include 1 of these treatments or a combination of them.

Surgery

Surgery is frequently used to remove a tumor in the paranasal sinus or nasal cavity. During the operation, a surgical oncologist will remove the tumor and some surrounding healthy tissue, called a margin.

The goal of surgery is to remove all of the tumor and leave no trace of cancer in the healthy tissue, also called a negative margin. However, it is usually not possible to completely remove the cancer during an operation, so additional treatments may be necessary. This may include more than 1 operation to remove the cancer and to help restore the appearance and function of the affected tissues.

Common types of surgery for nasal cavity or paranasal sinus cancer include:

  • Excision. During a surgical excision, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it, called a margin.

  • Maxillectomy. This is a surgery that removes part or all of the hard palate, which is the bony roof of the mouth. Artificial devices called prostheses or, more recently, flaps of soft tissue with and without bone can be placed to fill gaps from this operation. A maxillectomy is sometimes recommended to treat paranasal sinus cancer. Occasionally, it is possible to save the eye on the side of the cancer.

  • Craniofacial resection/skull base surgery. This is an extensive surgery often recommended for paranasal sinus cancer. During this operation, the surgeon removes more tissue than a maxillectomy. It requires the close cooperation of the health care team, particularly cooperation between a neurosurgeon and a head and neck surgeon.

  • Endoscopic sinus surgery. This relatively new approach is less destructive to healthy tissue than traditional operations. Occasionally, it can be used for a nasal cavity or paranasal sinus tumor, especially if it is benign. The surgeon makes a small incision to remove the tumor using a thin, telescope-like tube inserted into the nasal cavity or sinus. As mentioned in Diagnosis, endoscopic sinus surgery is often used to treat chronic sinusitis, and cancer may be discovered during such surgery.

  • Neck dissection. This is the surgical removal of lymph nodes in the neck area. If the doctor suspects the cancer has spread, a neck dissection may be performed, often at the same time as another surgery. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. The side effects are caused by injury to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away in a few months. Weakness will be permanent if a nerve is removed as part of a dissection.

  • Reconstructive (plastic) surgery. If surgery requires removing large or specific areas of tissue, reconstructive surgery may be recommended. If an eye is removed, a specialist called a prosthodontist can provide an artificial replacement, called a prosthesis. When the upper jaw, called the maxilla, is removed, a prosthodontist may play a large role in the rehabilitation process.

Surgery for nasal cavity or paranasal sinus cancer has risks because the eyes, mouth, brain, and important nerves and blood vessels are usually located near the tumor. Surgery often causes swelling of the face, mouth, and throat, making it difficult to breathe. Sometimes a hole in the windpipe, called a tracheostomy, may be necessary to make breathing easier after surgery. If lymph nodes were removed, a type of swelling called lymphedema may occur due to lymph fluid build-up. It is important to talk with your surgeon(s) about which side effects to expect before having surgery, as well as your plan for recovery. This discussion should include both physical and emotional side effects. Learn more about the basics of cancer surgery.

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.

For nasal cavity and paranasal sinus cancers, radiation therapy is most often used in combination with surgery. It is given either before or after the operation. Radiation therapy may also be given along with chemotherapy (see below). For some types of tumors in the nasal cavity or paranasal sinus, radiation therapy may be the main treatment. It can also be an option if a person cannot have surgery or decides not to have surgery.

External-beam radiation therapy

The most common type of radiation treatment is called external-beam radiation therapy. External-beam radiation therapy is radiation given from a machine outside the body. An external-beam radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Specific types of external radiation therapy include:

  • Intensity-modulated radiation therapy (IMRT). IMRT allows effective doses of radiation therapy to be delivered while reducing the damage to healthy cells.

  • Proton therapy. Proton therapy is a type of radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used in nasal cavity or paranasal sinus cancer when the tumor is located close to the eye or central nervous system, which includes the brain and spinal cord.

Internal radiation therapy

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor. The implant is left in place for several days while the person stays in the hospital.

Side effects of radiation therapy

Before beginning any type of radiation therapy, people should receive a thorough examination from a dentist experienced in treating people with head and neck cancer. Because radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning cancer treatment. After radiation therapy for nasal cavity or paranasal sinus cancer, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent cavities, also called dental caries. Read more about dental and oral health.

Radiation therapy to the head and neck may also cause redness or skin irritation in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and sore throat. Other side effects may include pain or difficulty swallowing, loss of appetite due to a change in sense of taste, hearing loss due to buildup of fluid in the middle ear, and earwax buildup.

In addition, radiation therapy may cause a condition called hypothyroidism in which the thyroid gland, located in the neck, slows down. This causes people to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have their thyroid checked regularly.

Researchers are conducting many studies to find ways to reduce or better relieve the side effects of radiation therapy. Learn more about the basics of radiation therapy.

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team how to safely store and handle them.

The types of medications used for nasal cavity or paranasal sinus cancer include:

  • Chemotherapy

  • Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medication used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A person may receive 1 drug at a time or a combination of different drugs given at the same time.

Doctors frequently recommend chemotherapy before or after surgery for nasal cavity or paranasal sinus cancer. Chemotherapy may also be used in combination with radiation therapy. This is called concurrent chemoradiotherapy. Chemoradiotherapy is still being researched and should be done as part of a clinical trial. Chemotherapy may also be used to treat advanced cancer or to relieve certain symptoms. Some chemotherapy is available in clinical trials that may treat cancer at an earlier stage.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of people with recurrent or metastatic head and neck squamous cell carcinoma. Pembrolizumab can be used by itself if the tumor expresses a certain amount of the PD-L1 protein. Or it can be used in combination with chemotherapy regardless of the level of PD-L1 expressed by the tumor. Nivolumab can be used if the cancer continued to grow or spread during treatment with platinum-based chemotherapy.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Some patients can have very serious side effects from immunotherapy including lung, colon, or liver damage. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as immunotherapy, chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic nasal cavity or paranasal sinus cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include immunotherapy, chemotherapy, or a combination of surgery, radiation, and these medications. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, immunotherapy, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent nasal cavity and paranasal sinus cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are studied to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with nasal cavity or paranasal sinus cancer. To make scientific advances, doctors create research studies involving people, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Clinical trials are used for all types and stages of nasal cavity and paranasal sinus cancers. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Others volunteer for clinical trials because they know that these studies are a way to contribute to the progress in treating nasal cavity and paranasal sinus cancers. Even if they do not benefit directly from the clinical trial, their participation may benefit future people with these types of cancer.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, placebos are usually combined with standard treatment in most cancer clinical trials. Study participants will always be told when a placebo is used in a study. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

  • Describe the purposes of the clinical trial and what researchers are trying to learn.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together. You will need to meet all of the eligibility criteria in order to participate in a clinical trial. Learn more about eligibility criteria in clinical trials.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for nasal cavity and paranasal sinus cancer, learn more in the Latest Research section.

Cancer.Net offers more information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for nasal cavity or paranasal sinus cancer. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will read about the scientific research being done to learn more about these head and neck cancers and how to treat them. Use the menu to see other pages.

Doctors are working to learn more about nasal cavity and paranasal sinus cancers, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Combined therapies. Most research for head and neck cancer focuses on combining different types of treatments to improve treatment effectiveness and the patient’s quality of life.

  • Chemotherapy. As mentioned in the Types of Treatment section, clinical trials are testing new and current drugs in chemotherapy to treat different stages of nasal cavity and paranasal sinus cancers.

  • Immunotherapy. As outlined in the Types of Treatment section, immunotherapy is another type of therapy using medication. Immunotherapy is being studied in the treatment of head and neck cancers in general, so talk with your doctor to see if there are clinical trials that include nasal cavity or paranasal sinus cancer.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current nasal cavity and paranasal sinus cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in nasal cavity and paranasal sinus cancer, explore these related items that will take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. This part of cancer treatment is called palliative care or supportive care. It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for nasal cavity and paranasal sinus cancer are described in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to talk about any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, side effects can last after treatment ends. Doctors call these long-term side effects. Side effects that occur months or years after treatment are called late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects after a cancer diagnosis. This may include dealing with a variety of emotions, such as sadness, anxiety, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with the costs of cancer care

Cancer treatment can be expensive. It may be a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Coping with barriers to care

Some groups of people experience different rates of new cancer cases and experience different outcomes from their cancer. These differences are called “cancer disparities.” Disparities are caused in part by real-world barriers to quality medical care and social determinants of health, such as where a person lives and whether they have access to food and health care. Cancer disparities more often negatively affect racial and ethnic minoritiespeople with fewer financial resourcessexual and gender minorities (LGBTQ+)adolescent and young adult populationsolder adults, and people who live in rural areas or other underserved communities

If you are having difficulty getting the care you need, talk with a member of your health care team or explore other resources that help support medically underserved people

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

  • When and who should we call about side effects?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with nasal cavity or paranasal sinus cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.

Learn more about caregiving or read the ASCO Answers Guide to Caring for a Loved One with Cancer in English or Spanish.

Looking for More on How to Track Side Effects?

Cancer.Net Mobile app symptom tracker

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 32-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression, constipation, diarrhea, and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. You may use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with head and neck cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Cancer rehabilitation may be recommended (see "Rehabilitation," below), and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. If it occurs, cancer recurrence most commonly happens within the first 2 or 3 years after diagnosis, so follow-up visits will be more frequent during the first 2 to 3 years.

Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given. Diagnostic examinations, such as CT scans, may be needed to watch for any signs of recurrence or to monitor how well the current treatment is working.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects, called late effects, may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Rehabilitation

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy and speech therapy to regain skills, such as talking and swallowing. Some people may need to learn new ways to eat or adjust to eating foods that have been prepared differently. Palliative care to manage symptoms and maintain nutrition during and after treatment may be recommended. Listen to a podcast about managing eating challenges after treatment.

After surgery, a prosthodontist can help with the restoration and rehabilitation of any oral cavity structures that were removed during surgery. Rehabilitation of physical changes resulting from a maxillectomy often requires a prosthesis. Many times when a maxillectomy is done, fluid will accumulate in the middle ear on the side of surgery. Surgery to the eardrum, called a myringotomy, to drain this fluid may be required.

Frequently, especially after craniofacial surgical resection, people will lose their sense of smell, called anosmia. It is important for these people to receive special coping strategies to adapt to this change, especially around the house and work area, in case of chemical spills, smoke from a fire, and other potentially harmful situations.

Prevention of tooth decay with fluoride treatments is very important to avoid losing existing teeth. Special eye care may also be necessary. If an eye was removed, rehabilitative services can help you cope with vision loss.

People who have received radiation therapy should protect the skin that received treatment from the sun. If radiation therapy included the neck, the thyroid gland should be regularly checked with blood tests.

People who have received treatment for nasal cavity or paranasal sinus cancer may look different, feel tired, and be unable to talk or eat the way they did before treatment. Many people experience depression. The health care team can help people cope with these physical and emotional changes and connect them with support services. Support groups may help people cope with changes following treatment.

Learn more about cancer rehabilitation.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” is complicated because it means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and continues during treatment and through the rest of a person’s life.

For some, even the term “survivorship” does not feel right, and they prefer to use different language to describe and define their experience. Sometimes extended treatment will be used for months or years to manage or control cancer. Living with cancer indefinitely is not easy, and the health care team can help you manage the challenges that come with it. Everyone has to find their own path to name and navigate the changes and challenges that are the results of their cancer diagnosis and treatment.

Survivors may experience a mixture of feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life. Feelings of fear and anxiety will still occur as time passes, but these emotions should not be a constant part of your daily life. If they persist, be sure to talk with a member of your health care team.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from nasal cavity or paranasal sinus cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, exercising regularly, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Guide to Cancer Survivorship: Get this 48-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print.

  • Survivorship Resources: Cancer.Net offers information and resources to help survivors cope, including specific sections for childrenteens and young adults, and people over age 65. There is also a main section on survivorship for people of all ages.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Cancer.Net Mobile app question tracker

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of nasal cavity cancer or paranasal sinus cancer do I have?

  • Where exactly is the tumor located?

  • What stage and grade is the tumor? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Can you recommend an oncologic dentist before treatment begins?

  • Should I see a speech-language pathologist before treatment?

  • Should I see other specialists before treatment?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery do you recommend? Why?

  • Who will perform my surgery? How much experience does the doctor or team have with this type of surgery?

  • Will my surgery include a neck dissection? If so, what does this mean?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • Will it be necessary to remove part of my teeth or part of the palate (roof of my mouth)? If so, is rehabilitation with a prosthesis available?

  • Will it be necessary to have reconstruction done to replace lost tissue in the lower jawbone (mandible)?

  • Will I lose my eye or my eyesight?

  • Will anything happen to my sense of smell?

  • What other types of side effects can I expect? What will be done to prevent or manage them?

  • Who should I contact about any side effects I experience? And how soon?

  • Will other types of treatment, including additional surgery, be necessary?

Questions to ask about having radiation therapy, chemotherapy, or immunotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will I need to have this treatment?

  • Will I receive this treatment at a hospital or clinic? Or will I take it at home?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term or late effects of having this treatment?

  • What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will those tests be needed?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Nasal Cavity and Paranasal Sinus Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 11/2022

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Nasal Cavity and Paranasal Sinus Cancer. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Nasal Cavity and Paranasal Sinus Cancer. Use the menu to choose a different section to read in this guide.