Paranasal Sinus and Nasal Cavity Cancer

Paranasal sinus and nasal cavity cancer is a type of malignancy that originates in the paranasal sinuses or the nasal cavity. This cancer is more prevalent in males and typically affects individuals between the ages of 50 and 70.

Early symptoms are often minimal, making early diagnosis challenging. The primary risk factors include exposure to certain environmental substances, tobacco use, and alcohol consumption. Diagnosis and treatment involve a combination of imaging techniques, physical examinations, and various therapeutic interventions.

Signs and Symptoms

In the early stages, paranasal sinus and nasal cavity cancer may not present significant symptoms, often being discovered incidentally during treatment for other sinus conditions like sinusitis. However, as the disease progresses, more apparent symptoms emerge due to the spread of malignant cells into adjacent structures.

Common signs include sinus pressure, pain, nasal obstruction, headaches, nosebleeds, and ear pain.

If the tumour invades the orbit, symptoms may include proptosis and diplopia. Invasion into the infratemporal fossa, pterygopalatine fossae, or masseteric space can cause trismus, facial swelling, toothache, and mid-face or jaw numbness. Cranial cavity invasion can lead to headaches, nerve damage, and cerebrospinal fluid leaks.

Risk Factors

Cigarettes and Tobacco Products

Smoking is a significant risk factor, with smokers having a 20% increased risk of developing nasal cancer. The risk escalates with the duration and quantity of smoking. Quitting smoking reduces this risk. Additionally, secondhand smoke exposure can also contribute to the risk of nasal cancer.

Environmental Factors

Exposure to wood dust, nickel dust, radium fumes, and formaldehyde fumes used in leather and textile production increases the risk of developing these cancers. Air pollution is also a contributing factor.

Other Factors

Alcohol consumption, although not linked to specific histological types, may increase the risk. Diets high in salted and smoked foods, human papillomavirus infection, and chronic nasal conditions also elevate the risk of developing paranasal sinus and nasal cavity cancer.

Diagnosis

Physical Examination

A physical examination can reveal signs like swollen lymph nodes or lumps. Although there are no specific blood or urine tests for this cancer, medical history can provide essential diagnostic clues.

Imaging Techniques

• X-rays, CT Scans, and MRI: X-rays help identify sinus abnormalities, while MRI is more effective for soft tissue and fluid tumour detection. CT scans are useful for detecting bone damage.
• Bone Scan: Used to check if cancer has spread to the bone.
• PET Scan: Helps detect cancer cells in the body.

Biopsy

A biopsy involves examining a tissue sample under a microscope to confirm the presence of cancerous cells. This is often the definitive diagnostic method.

Nasoscopy

A nasoscopy, an endoscopic procedure, involves inserting a nasoscope into the nose to identify abnormal areas. Tissue samples can be extracted for further examination.

Treatment

Treatment typically involves surgery, radiation therapy, and chemotherapy.

Surgery

Surgery aims to remove cancerous tissue and is often followed by chemotherapy and radiation therapy. The extent of surgery depends on the spread of cancer. In cases where cancer has spread significantly, extensive craniofacial surgery may be required, and prostheses or soft tissue may be used to fill the resulting gaps. Neck dissection might be performed if cancer has spread to the neck lymph nodes.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells and is often used post-surgery. VMAT is preferred over IMRT for its precision. Side effects may include tooth decay, which can be mitigated by dental treatment before radiation, and skin irritation.

Chemotherapy

Chemotherapy is used before or after surgery or radiation therapy to treat paranasal sinus and nasal cavity cancer. Common side effects include infections and hair loss.

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Self-assessment MCQs (single best answer)

Which demographic is most commonly affected by paranasal sinus and nasal cavity cancer?

Which of the following is NOT a common symptom of paranasal sinus and nasal cavity cancer?

Which imaging technique is particularly effective for detecting soft tissue and fluid tumours?

What is the primary purpose of a biopsy in diagnosing paranasal sinus and nasal cavity cancer?

Which of the following environmental factors does NOT increase the risk of paranasal sinus and nasal cavity cancer?

What is a potential side effect of radiation therapy for paranasal sinus and nasal cavity cancer?

Which treatment method involves using high-energy radiation to kill cancer cells?

What does a nasoscopy involve?

Which of the following is a risk factor specifically related to lifestyle?

What is the preferred radiation therapy technique for its precision in treating paranasal sinus and nasal cavity cancer?