I. Overview The incidence of malignant tumors of nasal cavity and sinuses is not high, accounting for 2.05-3.66% of systemic malignant tumors. In China, the incidence rate in the north is higher than that in the south. The ratio of male to female incidence is about 1.5-3.0:1, and most of them occur between 40-60 years old. Among sinus malignancies, the incidence of maxillary sinus malignancy is the highest, reaching 80%. Malignant tumors originating in the nasal cavity are relatively rare and are mostly reported in combination with malignant tumors of the septal sinus or maxillary sinus. Moreover, the prognosis of nasal cavity tumors is slightly better than sinus tumors because they are easily detected and treated earlier. Sinuses are bony cavities around the nasal cavity that open into the nasal cavity and are paired left and right, four pairs in total. They are maxillary sinus, septal sinus, frontal sinus and pterygoid sinus respectively. Due to its hidden anatomical location, there is no obvious clinical manifestation in the early stage. When symptoms and signs appear, the tumor has already developed considerably or is at a more advanced stage. Therefore, early diagnosis is difficult and easily misdiagnosed, and the treatment effect is worse than that of nasal malignant tumors.
Early warning signs (1) Nasal congestion: It is the most common symptom, accounting for about 85%. Generally, it is unilateral nasal congestion first, but when the tumor compresses the nasal septum, it can cause secondary nasal congestion on the opposite side and even block the nasal and pharyngeal cavities and cause breathing difficulty. Nasal congestion is a very common symptom in our daily life, so we should not be overly nervous, after all, the incidence of nasal sinus cancer is not too high. Cold, allergy, chronic rhinitis, etc. may cause nasal congestion, but this kind of nasal congestion is usually bilateral or alternating, with fluctuating symptoms – heavier during the attack and relieved after the attack; most nasal congestion caused by tumor is unilateral, with overall progressive development and getting heavier. Of course, some patients with deviated septum also have unilateral nasal congestion, but most of the symptoms have appeared from a young age and do not develop over the years, of course, it is more reassuring to go to hospital for examination and clarification.
(2) Snotty blood: Nasal sinus tumor can be accompanied by bloody or purulent discharge. Early symptoms of nasal cancer can be manifested as unexplained unilateral recurrent bleeding nasal discharge, this symptom of sinus cancer appears later, and the blood in the discharge is more stale, darker in color, showing dark red or brown. Tumor tissue necrosis occasionally has more bleeding. Therefore, for unilateral progressive nasal congestion or pus-blooded mucus, patients should go to hospital for examination in time. Of course, blood in the snot or nasal bleeding is a very common symptom that most people have experienced before, most of them are not caused by tumor, the low temperature and dry air in winter stimulates and damages the nasal mucosa, the bad habit of digging the nose, acute inflammation causes nasal congestion, trauma or forceful nasal blowing may appear blood in the snot. Identification.
(3) Pain and sensory abnormalities: The main symptoms are pain in the nasal cavity, unilateral cheek pain or migraine, and the patient may also have numbness in the cheek or ant-like sensation in the cheek, which is mainly due to the lesion affecting the sensory nerve. However, this symptom is usually not obvious at the beginning. These patients often start to mistake it for a cold or other minor physical discomfort, and delay the disease, losing the time to detect the disease early and treat it early.
(4) Dental lesions: In patients with sinus malignancy, especially maxillary sinus carcinoma, the tumor may invade the upper alveolar bone downward and a series of symptoms appear. The main symptoms are pain or loosening of unilateral upper molar teeth, or the wound of upper molar teeth after extraction does not heal. Especially for the patients who have a wound that does not heal after upper molar extraction, after a period of symptomatic treatment has no effect, you can think differently, not just looking for the cause in the dentist, but looking for an ENT doctor to check whether there are lesions in the tissues and organs around the teeth.
(5) Nasal odor, olfactory disorder or abnormality: If the tumor grows rapidly, ischemic necrosis may occur and produce nasal malodor or odor under the action of nasal bacteria. As the tumor blocks the nasal cavity or invades the olfactory area, it causes olfactory disorder. When patients find that their sense of smell becomes poor on one hand, and on the other hand, they often smell bad odor or other strange odor in their nasal cavity, they should be highly alert and seek medical attention in time for early detection of malignant tumor in nasal cavity or sinus.
(6) Ocular lesions and visual disturbance: When the tumor invades the orbit, the eye can be displaced upward, outward or forward, and the movement of the eye can be restricted, leading to diplopia and conjunctival edema. However, by the time the patient develops this symptom, the tumor changes are no longer limited to the early stage.
(7) Neck mass: In patients with cervical lymph node metastasis, enlarged lymph nodes may be palpated in the upper neck or submandibular region. Self-examination of neck lumps can be found in the section on nasopharyngeal carcinoma.
III. Risk groups Smoking and chemical gas irritation are possible causative factors, and may also be associated with long-term exposure to wood dust. It is also thought to be associated with long-term work in an environment of nickel dust. Some benign lesions are more prone to malignancy than others, such as nasal cavity and sinus invagination papilloma, which also requires vigilance.
4. Diagnosis Malignant tumors of nasal cavity and sinus are clinically difficult to diagnose early because of the hidden growth site of the former in early stage, especially the latter is confined to the bony sinus cavity, and it is generally not difficult to diagnose when the disease develops to advanced stage. For those patients with unexplained unilateral progressive nasal congestion, bloody nose, nasal facial pain and abnormal sensation, unilateral upper row of molar pain or looseness, nasal malodor or odor, limited eye movement leading to diplopia, and neck mass, they should go to the hospital for examination by specialists in time.
Specialists usually start with an anterior rhinoscopy, which is almost painless and most patients can detect problems with this simple examination. For lesions in the posterior part of the nasal cavity, the doctor may also perform an indirect nasopharyngoscopy to view the posterior part of the nasal cavity from the back. Of course the anatomy of the nasal cavity is complex with many crevices and folds, and both of these examinations have some blind spots. If the lesion is indeed relatively early, small in scope and hidden, then nasal endoscopy can help solve the problem.
In the early stage, sinus cancer is hidden in the bone cavity, so it is usually impossible to see it directly, so the diagnosis mainly relies on imaging examinations, such as radiography or CT.
Overall, clinical diagnosis is often based on the patient’s medical history, the site and time of first symptoms, the site of the largest tumor volume, and the imaging results such as CT. The examination of pathology is the gold standard for confirming the diagnosis – the most definite and important diagnosis.
Early stage nasal cancer can be treated by radiation therapy alone, and better results can be achieved without surgery. For intermediate and advanced stage patients, comprehensive treatment of radiotherapy + chemotherapy is needed. For advanced nasal cavity cancer that has involved sinuses, preoperative radiotherapy + surgery is the main treatment and some of them need to be combined with chemotherapy. The prognosis of advanced nasal cavity cancer is poor, and the 5-year survival rate is only about 20%.
For early stage sinus malignancy, surgery is the preferred treatment. Radiation therapy is often used before or after surgery with better efficacy. Generally, 60 cobalt or linear gas pedal radiation therapy can be used. A combination of radiotherapy + surgery + chemotherapy can be used for patients with intermediate or advanced stages. For most of the malignant tumors of nose and sinuses, chemotherapy can be used for patients who are unwilling to receive or not suitable for radiation therapy and surgery or incomplete surgery. Chemotherapy can also be used as palliative treatment for patients who have relapsed after surgery and cannot be operated again. In addition, with the development of interventional radiology, anti-cancer drugs are injected into the nutrient vessels of cancer tumors through super-selective vascular interventions to achieve better therapeutic effects. Due to the difficulty of early diagnosis, the 5-year survival rate of malignant tumors of sinus only reaches 30%-40% even with comprehensive treatment. Therefore, early diagnosis is extremely important to improve the survival rate.
Prevention The etiological prevention of nasal cavity and sinus tumor is mainly to avoid bad stimulation of respiratory tract, to quit smoking, to strengthen labor protection, and to closely follow up the patients with nasal inversion papilloma. Secondary prevention is to pay attention to the above mentioned early warning signs, to seek medical consultation in time when abnormalities are detected, and to have regular health checkups without symptoms. Tertiary prevention is mainly rehabilitation, because the treatment of nasal sinus tumor may cause changes in facial appearance and function, and it is necessary to reduce the sequelae under the guidance of physicians, so that patients can return to society.