Malignant tumors of nasal cavity and sinuses are relatively rare, accounting for 1% of systemic malignant tumors and about 10% of head and neck tumors. Due to the close anatomical relationship between nasal cavity and sinuses, the tumors occurring in the nasal cavity and sinuses invade each other and often cannot distinguish the specific origin and are collectively called nasal cavity and sinus tumors. Nasal cavity tumors are most common, followed by maxillary sinus and septal sinus, while frontal sinus and pterygoid sinus tumors are rare. The high incidence age is 50-60 years old, and the incidence rate of men is significantly higher than that of women.
Performance: The early symptoms of nasal sinus cancer are not obvious and easily confused with chronic rhinitis, nasal polyps and other benign lesions or overlapping symptoms. The symptoms and signs are mainly squeezing and blockage symptoms caused by tumor occupancy and the corresponding neurological symptoms. There are different clinical manifestations depending on the site of onset and the scope of invasion.
1.Tumor of nasal cavity and septal sinus may manifest as blood snot, nasal blockage, tearing, eye displacement, ectropion, etc. Symptoms and signs of nerve compression or paralysis may appear when the nerve is involved.
2, maxillary sinus tumor: maxillary sinus is an irregular cavity with 5 or 6 sides. In case of invasion of other bony walls, symptoms such as toothache, loose teeth, facial swelling, pain, eye swelling, upward displacement, protrusion, diplopia and vision loss (II, III and IV pairs of cranial nerve palsy) may appear. In severe cases, temporal pain, difficulty in opening the mouth, tinnitus, hearing loss, headache and cranial nerve injury may occur.
3.Lymph node metastasis and distant metastasis of nasal sinus malignant tumor, the probability of lymph node metastasis in early stage is not high. The metastasis rate is very low and usually occurs simultaneously with the recurrence of the primary site or lymph node metastasis, and the main metastatic sites are lung, bone, liver, etc. in order.
Diagnosis: The diagnosis of nasal sinus cancer is based on the above symptoms and signs, as well as the necessary I-enhanced CT and MR imaging and histopathological biopsy to determine the diagnosis. Squamous cell carcinoma is the most common, accounting for about 50% of nasal sinus tumors. This is followed by adenocarcinoma, sarcoma, and involute papillary malignancy. It is important to note that a definitive pathologic diagnosis must be obtained prior to the development of a treatment plan and initiation of therapy. Avoid overly stimulating endoscopic debulking approaches that result in “diagnostic treatment”. For malignant melanoma, early biopsy is generally not recommended, but should wait until the examination is complete and treatment is about to begin, and the pathology report should be issued quickly.
Treatment: The principle of treatment for malignant tumor of nasal cavity and sinus, the current curative policy that can be affirmed is comprehensive treatment. The treatment is mainly based on pathological type, tumor site range, stage and individual situation to plan the treatment plan, using a combination of radiation and surgery as the main treatment, and adjuvant chemotherapy and biological therapy and other methods of comprehensive treatment. It is important to emphasize that the treatment must be planned first, and then given, rather than a “mixed treatment” with a disorderly accumulation of various means “as appropriate” after the treatment starts. From the perspective of treatment, accurate diagnosis, appropriate and reasonable comprehensive plan, precise and thorough surgical resection of nasal cavity and sinus malignant tumor are the keys to reduce the recurrence rate and improve the survival rate.
1. Radiotherapy is an important link in the comprehensive treatment of nasal cavity and sinus malignant tumors. According to the sequential arrangement, it is divided into preoperative radiotherapy and postoperative radiotherapy. Pre-operative radiotherapy is used, and 3D conformal intensity modulated radiotherapy technique is recommended. The dose is different from that of oral cavity, oropharynx, hypopharynx and larynx: the former also affects the radiobiological effect of tumor due to bony structure, so the preoperative radiotherapy should be 60-70Gy or even above, except for some special reasons, there is no need to worry too much about reducing the radiation dose or course of treatment to affect the surgery, while the preoperative radiotherapy dose of the latter is uniformly 50Gy. 2.Surgical treatment of nasal sinus Tumors occur in the facial area, so surgical treatment will inevitably bring about cosmetic and functional damage to patients. It is necessary for the patient to fully communicate with the doctor before treatment to understand the treatment plan and its purpose, as well as the possible complications of the treatment, and a good psychological condition to understand and accept the treatment plan is the basic premise to actively cooperate with the doctor. Surgery will decide whether to partially excise or to excise the whole nasal cavity or maxilla according to the type, location and extent of tumor invasion.
The concept of “whole” is relative and includes two aspects, i.e. removal of the entire anatomical structure and complete removal of the tumor tissue. Inadequate removal of the structure may result in residual tumor, which is an important cause of recurrence soon after surgery. The application of nasal endoscopic surgery for nasal maxillary sinus malignant tumor nasal resection is more promoted in some hospitals, emphasizing its advantage of improving the quality of life, and may weaken the concern of recurrence rate and survival rate as the main goal, but there is no rigorous scientific basis to prove its superiority over traditional open surgery, so it is not recommended as an effective “advanced technology”. Therefore, it is not recommended as an effective “advanced technique”. At present, it is only suitable for small, clear-bordered tumors of low malignancy, and is performed by surgeons who are skilled in lumpectomy and have rich experience in tumor treatment. At present, the operation and procedure of many nasal endoscopic “resection” of nasal cavity and sinus malignant tumors are mostly contrary to the principles of surgical oncology, and the clinical results are not ideal.
Prognosis: The overall 5-year survival rate of nasal cavity and sinus cancer is 35% to 60%. The main reason for treatment failure is local recurrence, followed by lymph node metastasis and distant metastasis. Factors affecting prognosis include clinical stage, tumor site and pathological type.