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 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.
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.
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:
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 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.
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.
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.
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.
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.
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.
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.