Sinonasal carcinomas are a rare group of malignancies that develop in the nasal cavity, nasopharynx (located at the uppermost portion of the throat, behind the nose and above the soft palate), or paranasal sinuses (air-filled spaces behind the forehead, nasal bones, cheeks and eyes).
Sinonasal carcinomacancer arising from tissues that line organs is more common in men, and is generally diagnosed between the ages of 45-85. However, anyone can develop this disease.
Types of Sinonasal Carcinoma
There are several different types of sinonasal carcinoma, which are categorised by the types of cellsthe basic structural and functional unit of all living things they develop from.
Sinonasal Squamous Cell Carcinoma
Sinonasal squamous cell carcinomas are the most common type of sinonasal carcinoma, and develops from the squamous cells that line the nasal cavity and paranasal sinuses. This type of tumoura tissue mass that forms from groups of unhealthy cells is often aggressive, can have a high recurrenceto occur or happen again rate, and may not have as good of a prognosisto predict how a disease/condition may progress and what the outcome might be as other types of sinonasal cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs.
Sinonasal Adenocarcinomas
Sinonasal adenocarcinomas are the second most common type of sinonasal carcinoma, and develops from the mucus-producing cells in the nasal cavity and paranasal sinuses. They can be further categorised into:
- Salivary type (develop from seromucinous glands and surface epithelium and are similar to those found in salivary gland cancers).
- Non-salivary type (develop from surface epithelium alone), which is further subdivided into:
- Intestinal type (cancer cells resemble carcinomas or adenomas of the intestinesportion of the digestive system that digests food (small intestine) and absorbs salts and water (large intestine), also called bowel).
- Non-intestinal type (cancer cells don’t resemble salivary type adenocarcinomas or intestinal type adenocarcinomas).
This type of cancer is often aggressive and can have a high recurrence rate, however they can have an improved prognosis when caught early.
Rare Types of Sinonasal Carcinomas
Rare types of sinonasal carcinomas include:
- Sinonasal adenoid cystic carcinoma.
- Sinonasal undifferentiated carcinoma.
- NUT carcinoma / NUT midline carcinoma of sinonasal cavity.
- SWI/SNF complex deficient sinonasal carcinoma.
- Teratocarcinosarcoma.
- HPV related multiphenotypic sinonasal carcinoma.
- Sinonasal lymphoepithelial carcinoma.
- Sinonasal neuroendocrine carcinoma.
Treatment
If a sinonasal carcinoma is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for sinonasal carcinoma may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence to remove as much of the tumour as possible.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of sinonasal carcinoma remains unknown, the following factors may increase the likelihood of developing the disease:
- Being exposed to certain workplace substances and chemicals, potentially including:
- Leather dust.
- Glues.
- Formaldehyde.
- Chrome.
- Nickel.
- Flour.
- Textiles.
- Organic solvents.
- Having a history of smoking.
- Being infected with the human papillomavirus (HPV).
- Having nasal polyposis.
- Having an inverted sinonasal papilloma.
- Having chronica long-lasting disease that changes slowly over time sinusitis.
- Having previous radiation therapy for the treatment of retinoblastoma.
Not everyone with these riskthe possibility that something bad will happen factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Symptoms of sinonasal carcinomas may include:
- Persistent blocked sinuses.
- Sinus pressure.
- Headaches.
- Pain in the sinus area.
- Runny nose.
- Nosebleeds.
- A lump or sore inside of the nose that does not heal.
- A lump on the face or roof of the mouth.
- Numbness and/or tingling in the face.
- Swelling or difficulties with the eyes, potentially including:
- Diplopiaseeing two images of a single object, also known as double vision.
- Blurriness.
- Eyes pointing in different directions.
- Pain in the upper teeth and/or loose teeth.
- Pain and/or pressure in the ear.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Some of the information regarding symptoms was obtained from the Paranasal Sinus and Nasal Cavity Cancer Treatment (Adult) (PDQ) page published by the National Cancer Insitute.
Diagnosis
If your doctor suspects you have a sinonasal carcinoma, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body of the head and neck.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Nasoendoscopyexamination of the lining of the nasal passages and the nasopharynx with a small, flexible instrument known as a nasoendoscope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
