Paranasal sinus and nasal cavitycancer is a cancer that is caused by the appearance and invasion of malignant cells into the paranasal sinus which constructs the hollow and Oxygen-filled areas in bones of nose and tissue called nasal cavity which constructs the tissue above the bones of the mouth top and the front throat. Meanwhile, the major age group of the cancer is between 50–70 years old. It was also found that the number of male patients are twice larger than female patients. During the early phase of the cancer, the symptoms could be nasal obstruction, hyposima, etc. Other symptoms will also appear as further growth of malignant cells and invasion of into other human tissue such as palate, orbital floor continuing. The head X-rays test and neck MRI could make contribution to the diagnosis of the cancer while normal surgery, radiation therapy and chemotherapy can be utilized for the treatment of the cancer.
Signs and symptoms
Sometimes, people with nasal cavity or paranasal sinus cancer do not show any of these symptoms. In fact, these types of cancer are usually diagnosed in their later stages because early-stage cancer typically does not cause any symptoms. Nasal cavity or paranasal sinus cancer is often discovered when a person is being treated for seemingly benign, inflammatory disease of the sinuses, such as sinusitis. The signs and symptoms are generally caused by the neighbour structures like the paranasal sinus and nasal cavity. There are no obvious signs and symptoms before the invasion of the tumor into bony area occurred. During the progress of the cancer, the overall signs and symptoms could be sinus pressure and blocked sinus, sinus areas pain and headaches, Nosebleeds, ear pressure and pain, etc. Different symptoms will start to appear as the tumor start to invade into other body structures. symptoms such as proptosis, diplopia and other visual lesions would appear when tumor invade into the orbit. Symptoms such as trismus, facial swelling, toothache, mid-face or jaw numbness would occur as the tumor invades the infratemporal fossa, pterygopalatine fossae or masseteric space. Invasion to the cranial cavity may lead to headaches, nerve damage, and cerebrospinal fluid leak.
Risk factors
Cigarettes and tobacco products
s smoking is strongly related to the risk of getting nasal cancer, smokers would burden excess 20% risk of having nasal cancer. There is a positive relationship between the quantity of the smoked cigarettes, time period of smoking and the risk of having the cancer while the risk would decrease if smokers stop smoking. Though it was found that the risk of having cancer have no relationship with amount of consumption of cigarettes by spouses. However, based on the research in Japan, the passive smoking receivers would burden higher risks of having the paranasal sinus and nasal cavity cancer. Furthermore, the direct contact with tobacco powder such as gum and buccal mucosa would also largely increase the possibility of getting the cancer.
Environmental factors
It was found that the environmental factors can be seen as one of the main causes of paranasal sinus and nasal cavity cancer. exposure to textile dust, wood dust, nickel and leather might also cause the paranasal sinus and nasal cavity tumor. Meanwhile, it is also risky to exposure to the radium fumes, formaldehyde fumes and other fumes products used for producing furnitures and shoes. People who exposure to the air pollution is also the high risk group of getting the cancer.
Alcohol
It was supported that the alcohol consumption could increase the risk of the cancer. However, there is no evidence for the specific impacts of alcohol to histologic different types of the paranasal sinus and nasal cavity cancer. a large amount of the consumption of salted food and smoked food may also increase the risk of getting paranasal sinus and nasal cavity cancer. Meanwhile, infection of human papillomavirus can be considered as the lead factors of paranasal sinus and nasal cavity cancer. The increase of risk of the cancer may also occur due to the chronic nasal conditions.
Diagnosis
Physical test
Initially, an overall physical test will be implemented by the doctor. to check patient health situation and find signals of the cancer such as lump. The patient past medical records will also provide essential information to the doctor. Meanwhile, the examination of unusual areas around face will be implemented by doctor small long-handed mirror. However, blood test or urine test cannot make contribution to the diagnosis of the paranasal sinus and nasal cavity cancer.
X-rays
X-rays will be utilized to identify the unusual part in the patient sinus such as treatable infection rather than air. The CT scan should be applied for further detection of the signals of cancer. The head and neck X-rays will also involved in the diagnosis of the paranasal sinus and nasal cavity cancer.
As the imaging plays a pivotal role in diagnosing the cancer cells. The CT scan and MRL should be used in the diagnosis process to extend the investigation of the cancer. The coronal CT scan could make more contribution to the identification of the damage level of bone especially in the area of cribriform plate. MRI technology can be seen as a more efficient method to identify the tumor located in the soft issue and fluid. Meanwhile, The MRI technology could make contribution to the determinations of tumor size.
Biopsy
The biopsy is the examination of a small part of the human tissue with the help of microscope. Only the biopsy could determine the final diagnosis of the paranasal sinus and nasal cavity cancer. The biopsy examination can be divided into different types of biopsy. The FNA biopsy can be implemented by a needle extract tissue or fluid. The incisional of biopsy aims to extract the likely malignant tissue in the patient body.
Bone scan
The main goal of bone scan is to investigate whether the cancer cells of paranasal sinus and nasal cavity has spread into the bone.
Nasoscopy
The nasoscopy will be utilized as the diagnosis method of paranasal sinus and nasal cavity cancer. The nasoscopy can be implemented by the insertion of a nasoscope into the patient nose and search for abnormal area insert the nose. The tissue might be extracted with the help of a special tool and examined by the microscope and search for the signals of the paranasal sinus and nasal cavity cancer.
Other diagnosis methods
The PET scan will also be implemented to detect the cancer cells inside the body. The positron emission tomograph with the help of FDG could provide valuable tumor information after the 6-week treatment. The laryngoscopy can be utilised to check the signs of cancer with a microscope inside the throat and voice box. The testing and analysis of tissues organs and cells called biopsy can be utilized to diagnosis the paranasal sinus and nasal cavity cancer.
Treatment
Various treatments could be implemented to cure the paranasal sinus and nasal cavity cancer. Generally, treatments methods three basic methods: surgery, radiation therapy and chemotherapy and proton therapy, etc.
Surgery
Surgery can be implemented in all stages of paranasal sinus and nasal cavity cancer. The main goal of the surgery is to remove the tissue of cancer and some healthy tissues around the malignant tissue. The following therapy may include chemotherapy and radiation therapy. The types of surgery can be divided into different types method. The implementation of matxillectomy would mainly aim to remove part or all of the part of hard palate. The vacancy of the removed area can be filled by the prostheses or soft tissue. The extend surgery called skull nose surgery could be also utilized in the treatment of paranasal sinus and nasal cavity cancer, more human tissue will be dislodged than the matxillectomy. Meanwhile, If a large part of the tissue was removed due to the surgery, the reconstructive surgery could be utilised to reconstruct the removed tissues by using artificial materials. When the doctor anticipate the cancer would spread to the neck, the neck dissection might be performed in order to remove the lymph nodes in the neck area, thereby stopping the paranasal sinus and nasal cavity cancer spread.
Proton therapy
According to the result of experiment which utilized proton therapy to cure the paranasal sinus and nasal cavity cancer were implemented started from January, 2007. the local diseases of 43 patients in total 48 patients were successfully controlled. One patient were cured with additional following surgery. However, the brisk skin reactions occurred to all the patients after the whole proton therapy but were cured after the four weeks of the completion of proton therapy. The 1 year survival rate is 94% while the 2-years survival rate is 73%.
Radiation therapy
The radiation therapy aims to destroy the cancer cells by using the huge-energy x rays. It could be said that the radiation therapy is an effective method for the paranasal sinus and nasal cavity cancer after the implementation of the surgery. The radiation therapy can also be seen as an alternative method for the patient who is unable to take the surgery. When it comes to the radiation therapy, the evolvement of the radiation therapy from conventional radiation therapy to the three-dimensional therapy and improved the accuracy of the distribution of the dose to the target tissues and made contributions the treatment of paranasal sinus and nasal cavity cancer. When compared to VMAT method, the radiation therapy provides a worse homogeneity and conformity for PTV. Meanwhile, the modern radiation therapy such as IMRT which enables the restrictions of radiation doses to the nearby healthy tissue shows normal ability to the tumor control rather than a less effective tumor control method. Toothy decay may caused by the radiation therapy. However, it may can be prevented by receiving a proper dentist treatment before the radiation therapy. The brisk skin reactions, redness of the skin may caused by the therapy.
Chemotherapy
Lastly, the chemotherapy can be defined as a treatment towards the cancer by using the medication to destroy the malignant cells. The chemotherapy is usually used before the surgery and radiation therapy or after the treatment of surgery and radiation therapy. The chemotherapy can be implemented by using the drugs to stop the spread of paranasal sinus and nasal cavity cancer. The chemotherapy could make contribution to destroy the cancer cells or stop them from division. The chemotherapy could have effect on the cancer cell of the whole body by injecting into vein or taken by patient. The chemotherapy could influence a specific area by placing it into a specific area. Evidence shows that the chemotherapy could make also contribution to the treatment of sinonasal cancer which is a sub-branch of the paranasal sinus and nasal cavity cancer. Infection, loss of hair might occur after the implementation of chemotherapy.
Other treatments
In some cases, thrond nasal cavity patient and it could be implemented throughout the whole process of cancer treatment.
