Nasal cancers, also known as nasal cancer, are a group of tumors that affect the nose and sinuses. These cancers are rare, accounting for less than 3% of all malignant tumors in the head and neck area. Exposure to wood dust is the most common cause, followed by industrial fumes, nickel refining, leather tanning, chrome paints, and tobacco use. Despite their rarity, nasal cancer is a serious condition that affects the nasal cavity and surrounding areas. Therefore, understanding the growth rate, symptoms, and treatment options is crucial for early detection and effective management. This article in Dalili Medical provides a comprehensive overview of nasal cancer.

What is nasal cancer?

 

Nasal cancer is an abnormal growth of malignant cells in the nasal cavity or sinuses. Treatment options include surgery, radiation therapy, and chemotherapy. Nasal cancer refers to the development of cancerous cells in the nasal cavity or surrounding sinuses. The nasal cavity filters the air we breathe, while the sinuses help warm and humidify this air. Nasal cancer is relatively rare compared to other types of cancer, but it can be serious. Cancer cells can grow and invade surrounding tissue, causing a variety of symptoms, and can spread to other parts of the body (metastasis). The most common type of cancer in these areas is squamous cell carcinoma, but other types can occur, such as adenocarcinoma, adenoid cystic carcinoma, and melanoma.

**How ​​fast does nasal cancer grow?**

 

The speed at which nasal cancer grows varies depending on several factors, such as the type of cancer cells, the location of the tumour, and the person’s general health. In general, nasal cancer can be slow or fast growing, so it’s important to monitor any unusual symptoms and seek medical advice early.

**Is nasal cancer rare?**

 

Yes, nasal cancer is relatively rare, accounting for a small proportion of all head and neck cancers. Despite its rarity, it’s important to be aware of the symptoms and risk factors, especially if you have a history of exposure to certain environmental hazards, such as wood dust, chemicals, or tobacco smoke.

**What causes undifferentiated sinus cancer?**

 

Compared to other types of head and neck cancer, information about the causes of undifferentiated sinus cancer is still limited. However, it is noted that some patients have undergone previous radiation therapy for another cancer in the same area of ​​the body.

**At what stage do sinus cancer symptoms appear?**

 

In the early stages of sinus cancer, the patient does not show any symptoms. However, as the tumor increases in size and presses on nearby parts such as the nose, eyes, ears and mouth, in addition to spreading to other areas, the symptoms become more noticeable.

**Similar conditions to sinus cancer**

 

Some of the symptoms of sinus cancer are similar to other more common conditions and diseases, including:

- Chronic sinusitis

- Nasal polyps

- Nasal polyps

- Deviated septum

- Colds and flu

- Allergies

- Migraines

**How ​​fast does nasal cancer grow?**

 

The rate at which nasal cancer grows varies depending on several factors, such as the type of cancer cells, the location of the tumor, and the person’s general health. In general, nasal cancer can be slow or fast-growing, so it is important to monitor any unusual symptoms and seek medical advice early.

**How ​​does undifferentiated sinus cancer look under a microscope?**

 

When examined under a microscope, undifferentiated sinus cancer is made up of cells that do not resemble healthy cells. These cells are known as undifferentiated, as they lack the signs of maturation or “differentiation” that are normally seen in different types of cells in the body. Large numbers of mitotic cells (where cancer cells divide to form new tumor cells) and areas of necrosis (cell death) may also be observed.

**Is endoscopic sinusectomy safe?**

 

Yes, this procedure is safe and has a high success rate, especially if the tumor is diagnosed at an early stage.

Is sinus tumor removal worth doing?

 

Yes, it can be life-saving in cases of cancerous tumors, and it helps patients regain their physiological functions.

What are the causes of nasopharyngeal cancer?

 

Nasopharyngeal cancer is usually associated with a genetic mutation that occurs during the embryonic development of the individual, in addition to some factors that increase the risk of developing the disease, including:

- Previous infection with a virus known as "Epstein-Barr", which is a virus that is transmitted from person to person through cough or sneeze droplets, and it settles in some blood cells found in the tissues of the throat for many years.

- Following a diet rich in meat and fish treated with salt.

- Working in jobs that require constant exposure to hardwood dust or the chemical formaldehyde.

- Smoking excessively.

**Types of nasal cancer**

There are several types of nasal cancer, which start in the lining of the space behind the nose (nasal cavity) or in the adjacent air cavities (sinuses).

Cancer is made up of several types.

Each part of the nasal cavity and sinuses is made up of several layers of cellular tissue, each layer containing different types of cells.

Different types of cells can give rise to different types of cancers. Understanding these differences helps doctors determine the best treatment for cancer.

**Cancerous and noncancerous tumors**Tumors are collections of abnormal cells that may be fixed or growing. Nasal and sinus tumors are among the most common in this category, and they can be:

- Noncancerous (benign)

- Cancerous (malignant)

There are several types of non-cancerous tumors in these areas, including:

**Papillomas**

**Adenomas**

**Fibromas**

**Angiofibromas and hemangiomas**, which are growths that occur in small blood vessels.

Papillomas are warts and are not cancerous, and have a lower risk, but they can turn into squamous cell carcinoma in some cases.

Nasal polyps appear on the sides of the nose and are often associated with chronic sinusitis, which is mainly caused by inflammation. Chronic sinusitis refers to long-term inflammation of the sinuses. After the diagnosis is confirmed, these polyps are usually treated with medication or surgery, and they usually do not turn into cancerous or malignant tumors. Although they usually do not become cancerous, over time, these tumors can grow deep into the surrounding tissue and spread, which can cause damage to other parts of the body.

There are several types of cancerous and non-cancerous tumors in the nose and sinuses, many of which are very rare. Here are some common types of cancers of the nose and surrounding areas

**Squamous cell carcinoma** Squamous cells are soft skin cells that line the mouth, nose, throat, and thyroid gland. The term “cancer” refers to a type of malignant tumor, so squamous cell carcinoma is a type of cancer that begins in these cells.

Squamous cell carcinoma (SCC) is the most common head and neck cancer, accounting for more than 60 out of every 100 cases (60%) of nasal cancers.

**Other types of nasal cavity and sinus cancer**

 

Although squamous cell carcinoma is the most common, it is not the only type of cancer that can occur in the nose and sinuses.

**Adenoma** Adenomas are the second most common cancer of the nose and sinuses, affecting about 20 out of every 100 people (20% of nasal cancers). The paranasal and ethmoid sinuses are the most common sites for adenocarcinoma, which starts from cells in the glands (such as the mucous glands) and cells lining the nose and sinuses (epithelium).

The incidence of adenocarcinomas has declined in men in recent years, as the disease used to occur mainly in the nasal passages of people working in the woodworking industry. With the advancement of industries and the use of masks, this condition has become less common.

**Cystic adenocarcinomas** Cystic adenocarcinomas account for about 5 to 10 out of every 100 (5 to 10%) of cancers of the nose and surrounding areas, most often in the maxillary sinus, followed by the nasal cavity.

**Lymphomas** Lymphomas are cancers that arise in the lymph nodes, which are most common in the neck area. Painless swelling of the lymph nodes is the most common symptom of lymphoma. Lymphoma of the sinuses and surrounding areas accounts for about 6 out of every 100 (6%) of sinus cancers.

**Plasmacytoma**Plasmacytoma is a tumor made up of plasma cells. Although closely related to myeloma, multiple myeloma is usually absent. Of all plasmacytoma cases in the head and neck, 44 out of 100 (44%) occur in the sinuses.

**Skin cancer**Melanoma occurs as a result of the proliferation of cells responsible for producing the pigment that gives skin its color. These tumors can develop in many areas such as the head and neck, as well as in any part of the skin, or inside the nose and mouth (oral cavity), or in the sinuses and surrounding areas. Nasal and paranasal melanomas account for less than 5% of all nasal cancers. These types of melanomas behave differently from cutaneous melanomas.

**Olfactory neuroblastoma** Olfactory neuroblastomas are rare tumors that occur in the nasal cavity. They are more common than adenoid cystic carcinomas and melanomas. These tumors arise in the layer of cells (lining) responsible for the sense of smell in the upper part of the nose.

**Neuroendocrine cancer** Neuroendocrine tumors of the sinuses and surrounding areas are rare, accounting for about 5% of all nasal and surrounding cancers. These tumors arise from specialized cells called neuroendocrine cells, which produce hormones.

A rare type of neuroendocrine tumor called a neuroendocrine cell tumor can occur in the ethmoid sinuses and maxillary sinuses, and may occur after treatment for retinoblastoma.

**Sarcomas** Sarcomas arise from cells that make up soft tissue, and also account for about 5% of cancers of the sinuses and surrounding areas. There are several types of sarcomas in these areas, including:

- Fibromas

- Undifferentiated pleomorphic sarcoma

- Malignant tumor

- Rhabdomyosarcoma

Depending on the type of symptoms, these types of cancer can appear in the nose and sinuses. Therefore, it is necessary to see a doctor for diagnosis and treatment, to avoid the spread of the disease to other parts of the body.

**Diagnosis of nasal cancer**

 

The process of diagnosing nasal cancer begins with a comprehensive physical examination by a health care provider, who will inquire about the symptoms you are experiencing. Based on your specific condition, the health care professional will suggest appropriate tests, which may include:

- **Nasal endoscopy**: This procedure involves the use of a flexible, thin tube equipped with a camera and a small light. The health care provider inserts the endoscope into the nasal passages and sinuses to visually examine the area.

- **Blood tests**: A small sample ofBlood is analyzed in the laboratory to detect any signs of cancer.

- **Imaging tests**: Various imaging techniques such as magnetic resonance imaging (MRI), X-rays, or computed tomography (CT) may be used. These tests provide detailed images of the nasal area, which helps determine the presence of tumors and their extent.

- **Biopsy**: During a biopsy, a healthcare provider takes a small sample of tissue from the tumor. The collected sample is sent to a laboratory for comprehensive analysis and a final diagnosis.

What is the pathological stage (pTNM) of undifferentiated sinonasal cancer?

 

The pathological stage of undifferentiated nasal cancer is based on the TNM system, an internationally recognized system originally developed by the American Joint Committee on Cancer. This system relies on information regarding the primary tumor (pT), lymph nodes (pN), and distant metastases (pM) to determine the complete pathological stage (pTNM). A pathologist examines the tissue taken from the patient and assigns each part a stage number. In general, a higher number indicates more advanced disease and worse prognosis.

Tumor stage (pT) for tumors that originate in the nasal cavity or sinuses

These tumors are classified into stages ranging from 1 to 4, with the stage depending on how far the tumor has spread outside the nasal cavity or ethmoid sinus.

- T1: The tumor is confined to the nasal cavity or ethmoid sinus and has not spread to the surrounding bone.

- T2: The tumor has spread outside the nasal cavity or ethmoid sinus.

- T3: The tumor has spread to the wall or floor of the orbit (the cavity that contains the eye), the maxillary sinus, the palate (roof of the mouth), or the lamina operculum (the upper area of ​​the nasal cavity).

** Tumor stage (pT) for tumors that originate in the maxillary sinus**

 

These tumors are classified into stages ranging from 1 to 4, with the stage depending on how far the tumor has spread outside the maxillary sinus.

- **T1**: The tumor is confined to the maxillary sinus and has not spread to the surrounding bone.

- **T2**: The tumor has spread outside the nasal cavity or ethmoid sinuses.

- **T3**: The tumor has spread to the bone in the back of the maxillary sinus, tissue under the skin, the floor or wall of the orbit (the cavity that contains the eye), the pterygoid fossa, or the ethmoid sinuses.

- **T4**: The tumor has spread to the eye, the skin of the nose or cheek, the cranial cavity (the space that contains the brain), the pterygoid plates (the bones below the cranial cavity), or the sphenoid or frontal sinuses.

**Nodal stage (PN) for tumors that arise in the nasal cavity or sinuses**

 

These tumors are given a nodal stage ranging from 0 to 3 based on three main features:

The number of lymph nodes that contain cancer cells.

The size of the tumor.

Whether the lymph nodes that contain cancer cells are on the same side (ipsilateral) or on the opposite side (contralateral) of the tumor.

The nodal stage will be higher if any of the tumors are larger than 3 cm, if more than one lymph node contains cancer cells, if cancer cells are present in lymph nodes on both sides of the neck, or if any of the lymph nodes appear to extend outside the nodes.

If no cancer cells are found in any of the lymph nodes examined, the nodal stage is considered N0.

If no lymph nodes are presented for pathological examination, the nodal stage cannot be determined and is listed as NX.

**Metastatic stage (pM) of undifferentiated sinonasal cancer***

 

Undifferentiated sinonasal cancer at metastatic stage (pM) is graded as 0 or 1 based on the presence of cancer cells in distant sites in the body (such as the lungs). The metastatic stage cannot be determined unless tissue from a distant site is presented for pathological examination. Because this tissue is rare, the stage of metastasis cannot be determined and is noted.

**Treatment**

**Surgery**

The goal of nasal and paranasal tumor surgery is to completely remove the tumor. The surgeon may also remove some of the tissue surrounding the tumor to ensure that all of the tumor cells are removed. Surgeons can access nasal and paranasal tumors by:

- Making an incision in the nose or mouth to reach the tumor. This incision near the nose or mouth allows surgeons to access the nasal cavity or sinuses, where the surgeon removes the tumor and any affected areas, such as nearby bones.

- Inserting instruments through the nose. In some cases, the surgeon can access the tumor using a nasal endoscope. The endoscope tube is inserted through the nose, and special instruments are then used to remove the tumor through this tube.

Nasal and paranasal tumors are located near vital structures in the head, including the brain, eyes, and nerves responsible for vision. Therefore, surgeons seek to minimize potential damage to these areas.

### Alternative Treatments for Nasal and Paranasal Cancers **

 

Cancers in the nose and surrounding areas may require additional treatments to control cancer cells. Options include:

#### Radiation therapy Radiation therapy uses powerful beams of energy to kill cancer cells. This energy can come from sources such as X-rays or protons. During radiation therapy sessions, beams of energy are directed to specific areas of the body to destroy cancer cells there.

Radiation therapy may be used after surgery to eliminate any remaining cancer cells. In cases where surgery is not possible, radiation and chemotherapy may be started at the same time, especially if the cancer has grown larger or spread.

#### Chemotherapy Chemotherapy uses powerful drugs that aim toDestroying cancer cells. It is often used after surgery to get rid of any remaining cancer cells. Chemotherapy can also be combined with radiation therapy at the same time, which enhances the effectiveness of radiation.

#### Immunotherapy is a treatment method that relies on the use of drugs that enhance the body's immune system's ability to fight cancer cells. The immune system plays its role in fighting diseases by targeting germs and abnormal cells that should not be present in the body. However, cancer cells are able to survive by camouflaging themselves and hiding from the immune system. Immunotherapy helps enhance the body's ability to recognize and eliminate these cells.

Immune system cells** recognize and eliminate cancer cells. Immunotherapy can be used in cases of cancer spreading to other areas of the body, especially when other treatments have not worked.

**What is sinus tumor removal?**

 

The surgical removal of sinus tumors depends on the location of the tumor and its stage of development, which means that the size of the tumor and whether or not it has spread play an important role in determining the procedure.

**Types of Sinus Removal and How They Are Performed**

 

The type of sinus tumor removal surgery depends on the type, location, and size of the tumor, as well as whether it has spread to other areas of the neck and neck. These surgeries are classified as follows:

1. **Ethmoid sinus tumor removal** This surgery is also known as external ethmoid sinus tumor removal, and can be performed if the tumor is located only in the ethmoid sinus and has not spread to surrounding tissue, or if the tumor is non-cancerous (as in the case of benign tumors).

The surgery involves making an incision in the skin of the upper part of the nose near the upper eyelid. The surgeon then removes the bone located on the inside of the nose and some of the tissue surrounding the eye socket, allowing him to access and remove the tumor inside the ethmoid sinus.

**2. Maxillary sinus tumor removal** Maxillary sinus tumor removal surgery can be performed if there is cancer in this sinus. During this surgery, the surgeon removes all or part of the upper jawbone, depending on the location of the tumor and whether it has spread.

There are several types of maxillary sinus tumor removal surgeries, which are:

- **Partial maxillary sinus tumor resection**: where the surgeon leaves one or more of the bone walls.

- **Complete maxillary sinus tumor resection**: where the surgeon removes the entire maxillary bone.

- **Radical maxillary sinus tumor resection**: where the surgeon removes the entire maxillary bone in addition to some of the surrounding tissues.

The surgeon can perform this operation in two ways:

 

1. By making an incision along the side of the nose, starting from the eyebrow or upper eyelid to the upper lip.

2. By making an incision inside the mouth to avoid a large scar on the face.

### 3. Craniofacial resection

The craniofacial resection is performed by the surgeon in two cases:

1. When the tumor is in an advanced stage and has spread to the ethmoid and sphenoid sinuses, affecting surrounding tissues such as the base of the skull or the brain.

2. In case of a cancerous tumor confined to the sphenoid sinuses only.

Craniofacial resection is similar to maxillary sinus tumor resection, but it may also involve removing the upper parts of the eye socket and the front of the skull base, depending on the stage of tumor development.

This is a complex procedure that requires a specialized surgical team, which may include a head and neck surgeon and a neurosurgeon, a surgeon who specializes in operations related to the brain, spinal cord, and nerves.

After any of these operations, radiation or chemotherapy may be necessary.

**Endoscopic sinus tumor resection** An endoscope is a thin, flexible tube inserted through the nose to access the nasal cavity or sinuses.

The surgeon uses the endoscope to view the affected area (with a camera) and remove the tumor, whether benign or malignant, using surgical instruments or a laser beam.

Endoscopic sinus tumor resection is suitable for small tumors as well as larger tumors that are located in the center of the sinus without spreading to surrounding tissue. This endoscopic procedure is also a good option for patients whose health condition does not allow them to undergo open surgery.

In this procedure, the surgeon does not need to make any incisions in the skin, which means there are no scars on the face after surgery, and it does not require bone removal to open the cavity completely, which reduces damage to healthy tissue.

Thanks to these advantages, the recovery period after endoscopic sinus tumor removal is shorter compared to the recovery period after open surgery. The long-term results of endoscopic surgery are similar to those of other types of surgery.

**Endoscopic Sinus Tumor Removal** An endoscope is a thin, flexible tube that is inserted through the nose to access the nasal cavity or sinuses.

The surgeon uses the endoscope to view the affected area with a camera, and removes the tumor, whether benign or malignant, using surgical instruments or a laser beam.

Endoscopic sinus tumor removal is suitable for small tumors as well as larger tumors that are located in the center of the sinus without spreading to surrounding tissue. This endoscopic procedure is also a good option for patients whose health condition does not allow them to undergo open surgery.

In this procedure, the surgeon does not need to make any incisions in the skin, which means there are no scars on the face after surgery, and it does not require removing bone to open the cavity completely, which reduces the damage that may be caused to healthy tissue.

Thanks to these advantages, the recovery period isRecovery after endoscopic sinus tumor removal is shorter than after open surgery. The long-term results of endoscopic surgery are similar to those of other types of surgery, and may be better.

Before performing sinus tumor removal surgery, the doctor should explain the patient's condition and answer any questions related to the surgery.

The patient should undergo some blood tests and allergy tests.

He should also undergo some medical examinations such as MRI and CT scan.

If the patient suffers from any chronic diseases, he should inform the doctor.

If the patient is a smoker, he should stop smoking for a month before the surgery.

In addition, the patient should refrain from eating and drinking starting the night before the surgery.

**Risks and complications of endoscopic sinus tumor removal**

 

There are many possible side effects after endoscopic sinus tumor removal, which can be summarized as follows:

The operation may lead to changes in the senses of smell and taste, in addition to effects on speech and hearing, as well as on the process of chewing and swallowing. Although changes such as swelling and burning in the face and neck are temporary and disappear as the patient begins to recover, there are permanent changes that may affect the patient's abilities and appearance. In these cases, specialists are available who can provide support and assistance.