Treatment

The treatment of nasal cavity and paranasal sinus cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. A neurosurgeon (a doctor who specializes in surgery on the brain and spinal cord) should be a part of this team when a tumor in the skull and facial areas needs to be removed.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Nasal cavity and paranasal sinus cancer 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, and breathes.

Head and neck cancer specialists often form a multidisciplinary team to care for each person, and an evaluation should be done before any treatment begins. The team may include medical and radiation oncologists (doctors who specialize in cancer); surgeons; otolaryngologists (ear, nose, and throat doctors); dentists; maxillofacial prosthodontists (specialists who perform restorative surgery in the head and neck areas); physical therapists; speech pathologists; psychiatrists; nurses; dietitians; and social workers.

Descriptions of the most common treatment options for nasal cavity and paranasal sinus cancer are listed below. There are three main treatment options are: surgery, radiation therapy, and chemotherapy. One of these treatments, or a combination of them, may be used.

Surgery

During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove all of the tumor and leave negative margins (no trace of cancer in the healthy tissue). Surgery is frequently used to remove cancer of the paranasal sinus and nasal cavity. However, it’s not possible to completely remove the entire cancer; additional treatments may be necessary.

Depending on the location, stage, and the type of the cancer, a person may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected. Surgery often has some risks because of the proximity of the eyes, mouth, brain, and important nerves and blood vessels in the area. A craniofacial resection or skull base surgery is often necessary in paranasal sinus cancer and demands the close cooperation between a neurosurgeon (a specialist who operates on the brain and spine)and a head and neck surgeon to completely remove the tumor. Maxillectomies (different types of tumor resection that remove part or all of the bony roof of the mouth) are sometimes recommended to treat paranasal sinus cancer, and occasionally it is possible to save the eye on the side of the cancer.

A relatively new approach called endoscopic sinus surgery is less destructive to normal tissue than conventional operations and can occasionally be used for nasal cavity and paranasal sinus tumors, especially if they are benign. The surgeon, using a thin, telescope-like tube inserted into the nasal cavity or sinus, makes a small incision to remove the tumor. As mentioned in the Diagnosis section, endoscopic sinus surgery is often used for chronic sinusitis, and during such surgery it may be that cancer is discovered.

Surgery often causes swelling of the face, mouth, and throat, making it difficult to breathe, and sometimes a tracheostomy (hole in the windpipe) to make breathing easier may be necessary for some period of time after surgery.

Reconstructive (plastic) surgery may be used after removal of the sinuses. If the eye is removed, a specialist called a prosthodontist can provide a prosthesis (an artificial replacement). More often, when the maxilla (upper jaw) is removed, a prosthodontist may play a large role in the rehabilitation process.

If the doctor suspects that the cancer has spread, a neck dissection (the lymph nodes in the neck are removed) may also be performed. 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.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. 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 cancer site. The implant is left in place for several days while the person stays in the hospital.

Specific types of external radiation therapy, include intensity modulated radiation therapy (IMRT), which allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells and causing fewer side effects. Proton therapy (also called proton beam therapy) is another type of external-beam 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 and paranasal sinus cancer when the tumor is located close to the eye or central nervous system (brain and spinal cord). Learn more about proton therapy.

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

Before beginning radiation therapy for any head and neck cancer, people should receive a thorough examination from an oncologic dentist (a dentist experienced in treating people with head and neck cancer). Since 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 treatment.

Radiation therapy to the head and neck may cause the following side effects:

• Redness or skin irritation to the treated area
  
  
• Dry mouth or thickened saliva, from damage to salivary glands
  
  
• Bone pain
  
  
• Nausea
  
  
• Fatigue
  
  
• Mouth sores and/or sore throat
  
  
• Dental problems (usually preventable)
  
  
• Painful or difficulty swallowing
  
  
• Loss of appetite, due to a change in sense of taste
  
  
• Hearing loss, due to a buildup of fluid in the middle ear
  
  
• Buildup of earwax, which dries out because of the radiation therapy’s effect on the ear canal

Radiation therapy may also cause a condition called hypothyroidism, in which the thyroid gland (located in the neck) slows down and causes the person to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have his or her thyroid checked regularly.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

For nasal cavity and paranasal sinus cavity cancer, chemotherapy is most often used to treat advanced cancer or to treat symptoms. Some chemotherapy is available in clinical trials (research studies) that may treat cancer at an earlier stage. And, many combined treatments (such as chemotherapy and radiation therapy) are performed as part of a clinical trial.

The use of chemotherapy before or after surgery and/or radiation therapy, or in combination with radiation therapy (called concurrent chemoradiotherapy), is frequently recommended for this type of cancer. This treatment is still in an investigative phase and should be done as part of a clinical trial.

Learn more about chemotherapy and preparing for treatment. The medications 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. Learn more about your prescriptions by using searchable drug databases.

Find out more about common terms used during cancer treatment.