Nasal paranasal sinus cancer is one of the most common malignant tumors of the head and neck. Since the nasal cavity is adjacent to and connected with the paranasal sinuses, tumors of the septal sinus and maxillary sinus can easily invade the nasal cavity and form nasal masses. Nasal tumors can also invade into the paranasal sinuses. It is often difficult to distinguish whether the primary site is in the nasal cavity or in the paranasal sinuses. Among them, cancer of septal sinus and maxillary sinus of nasal cavity are more common, while cancer of butterfly sinus and frontal sinus are less common.
Abnormal manifestations 1. Nasal congestion and thick mucousy snot. There is fishy smell in the snot, and blood in the snot or nasal bleeding is common.
2. Swelling of the nose and/or facial cheek area, often caused by the tumor destroying the bone wall and spreading to the facial soft tissue.
3.Limited toothache and loose teeth. Unexplained pain in the upper dentition, especially pain in the molar region. When the alveolar bone at the bottom wall of maxillary bone is destroyed by tumor erosion, loosening of teeth in the upper teeth can occur. Sometimes there is a bulging swelling in the maxillary gum or hard palate, which is a common symptom of maxillary sinus.
4. Abnormal facial sensation and difficulty in opening mouth. This symptom appears when the tumor invades the maxillary sinus and destroys the bone of the posterior wall of maxillary sinus, invades the pterygopalatine fossa and mouth opening muscle.
5.Ocular symptoms: When the tumor invades the orbit through the maxillary sinus or septal sinus, lacrimation, bulbar conjunctiva congestion and edema, eye displacement, diplopia, or even complete fixation of the eye and blindness may occur.
6.Ear symptoms: When the tumor involves the nasopharyngeal cavity, tinnitus or hearing loss may occur.
7.Headache: When tumor blocks nasal cavity, poor drainage of secretions and secondary paranasal sinusitis may lead to headache. Headache is also the first symptom of pterygoid sinus cancer and frontal sinus cancer.
8. Enlarged lymph nodes in front of the ear, cheek, submandibular or neck can be detected, which may be caused by infectious enlargement or cancer metastasis.
Treatment of sinus cancer 1. Undifferentiated cancer or low differentiated cancer without distant organ metastasis of nasal sieve sinus cancer, radiotherapy should be considered first. Highly differentiated squamous carcinoma, adenocarcinoma and cystic adenoid carcinoma mostly adopt comprehensive treatment, i.e. surgery plus radiotherapy. For squamous carcinoma, preoperative radiotherapy is mostly adopted; for adenocarcinoma, postoperative radiotherapy is mostly adopted; for malignant melanoma, radiotherapy is first, then surgery, and finally chemotherapy. Those with distant metastasis should generally prefer chemotherapy or symptomatic treatment.
2.Early stage of nasal paranasal sinus cancer can be cured by radiotherapy alone; middle and late stage of cancer can be treated by preoperative and/or postoperative radiotherapy in a planned way to improve the control rate and reduce the recurrence rate. Controlling infection and improving drainage during radiotherapy (e.g. window drainage before radiotherapy for maxillary sinus cancer) can improve the environment around the tumor bed and enhance the radiotherapy effect.
3.Surgical treatment, radiotherapy and chemotherapy for maxillary sinus cancer, each treatment method alone is not ideal. Surgical treatment is slightly better, but large surgical resection is disfiguring, which is not easy for patients to accept and prone to local recurrence after surgery. Although radiotherapy alone can cure and preserve the face, it is mainly suitable for early stage cases or those with poorly differentiated tumor cells and sensitive to radiotherapy treatment. Radiotherapy alone is inferior to surgery, and chemotherapy alone is less effective. However, the combination of radiotherapy and surgery, and the planned implementation of preoperative and/or postoperative radiotherapy can improve the survival rate. Comprehensive treatment is advocated for both intermediate and advanced cases.
4.Simple frontal sinus cancer is rare and can be treated with integrated radiotherapy and surgery. Due to its anatomical characteristics, pterygoid sinus cancer is located at the base of skull, so it is difficult to be removed radically by surgery, and radiotherapy is the main treatment.