Paranasal sinus cancer
- Kerstin M Stenson, MD, FACS
Kerstin M Stenson, MD, FACS
- Professor of Otolaryngology
- Chief, Head and Neck Cancer Program, Rush University Medical Center
- Department of Otolaryngology/Head and Neck Surgery
- Daniel J Haraf, MD
Daniel J Haraf, MD
- University of Chicago
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
A range of malignancies can develop in the paranasal (maxillary, ethmoid, sphenoid, frontal) sinuses (figure 1). Adenocarcinoma and squamous cell carcinoma of the maxillary sinus and ethmoid sinus are the most common of these tumors.
The epidemiology, clinical presentation, diagnosis, and management of these tumors are discussed here. Tumors arising in the nasal cavity are discussed separately. (See "Cancer of the nasal vestibule" and "Tumors of the nasal cavity".)
EPIDEMIOLOGY AND RISK FACTORS
Cancers arising in the paranasal sinuses are rare, constituting approximately 3 percent of head and neck malignancies . The majority of these tumors arise in the maxillary sinuses, and most of the remainder start in the ethmoid sinuses. Cancers of the sphenoid and frontal sinuses are extremely rare. Paranasal sinus cancers are more frequent in males than females .
Factors associated with paranasal sinus cancers include [1,2]:
●Occupational exposures − Including leather, textile, wood dust, and formaldehyde.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Llorente JL, López F, Suárez C, Hermsen MA. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol 2014; 11:460.
- IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Arsenic, metals, fibres, and dusts. IARC Monogr Eval Carcinog Risks Hum 2012; 100:11.
- Calderón-Garcidueñas L, Delgado R, Calderón-Garcidueñas A, et al. Malignant neoplasms of the nasal cavity and paranasal sinuses: a series of 256 patients in Mexico City and Monterrey. Is air pollution the missing link? Otolaryngol Head Neck Surg 2000; 122:499.
- Zheng W, McLaughlin JK, Chow WH, et al. Risk factors for cancers of the nasal cavity and paranasal sinuses among white men in the United States. Am J Epidemiol 1993; 138:965.
- Kim JY, Yoon JK, Citardi MJ, et al. The prevalence of human papilloma virus infection in sinonasal inverted papilloma specimens classified by histological grade. Am J Rhinol 2007; 21:664.
- Alos L, Moyano S, Nadal A, et al. Human papillomaviruses are identified in a subgroup of sinonasal squamous cell carcinomas with favorable outcome. Cancer 2009; 115:2701.
- Feng YF, Wu QL, Zong YS. Correlation of immunophenotype of sinonasal non-Hodgkin's lymphoma to Epstein-Barr virus infection. Ai Zheng 2007; 26:1170.
- Mitarnun W, Suwiwat S, Pradutkanchana J. Epstein-Barr virus-associated extranodal non-Hodgkin's lymphoma of the sinonasal tract and nasopharynx in Thailand. Asian Pac J Cancer Prev 2006; 7:91.
- Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 2012; 34:877.
- Youlden DR, Cramb SM, Peters S, et al. International comparisons of the incidence and mortality of sinonasal cancer. Cancer Epidemiol 2013; 37:770.
- Cantù G, Bimbi G, Miceli R, et al. Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment. Arch Otolaryngol Head Neck Surg 2008; 134:170.
- Guntinas-Lichius O, Kreppel MP, Stuetzer H, et al. Single modality and multimodality treatment of nasal and paranasal sinuses cancer: a single institution experience of 229 patients. Eur J Surg Oncol 2007; 33:222.
- Comprehensive Management of Head and Neck Tumors, 2nd, Thawley SE, Panje WR, Batsakis JG, et al (Eds), WB Saunders, Philadelphia 1999.
- Loevner LA, Sonners AI. Imaging of neoplasms of the paranasal sinuses. Neuroimaging Clin N Am 2004; 14:625.
- Das S, Kirsch CF. Imaging of lumps and bumps in the nose: a review of sinonasal tumours. Cancer Imaging 2005; 5:167.
- Kraus DH, Lydiatt WM, Patel SG, et al. Nasal Cavity and Paranasal Sinuses. In: American Joint Committee on Cancer, 8th, Amin MB (Ed), Springer, New York 2017. p.137.
- Homma A, Hayashi R, Matsuura K, et al. Lymph node metastasis in t4 maxillary sinus squamous cell carcinoma: incidence and treatment outcome. Ann Surg Oncol 2014; 21:1706.
- Cummings Otolaryngology-Head and Neck Surgery, 4th, Cummings CW Jr, Haughey BH, Thomas JR (Eds), Mosby, St. Louis 2004.
- Bogaerts S, Vander Poorten V, Nuyts S, et al. Results of endoscopic resection followed by radiotherapy for primarily diagnosed adenocarcinomas of the paranasal sinuses. Head Neck 2008; 30:728.
- Jansen EP, Keus RB, Hilgers FJ, et al. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys 2000; 48:27.
- http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site (Accessed on September 18, 2014).
- Robbins KT, Ferlito A, Silver CE, et al. Contemporary management of sinonasal cancer. Head Neck 2011; 33:1352.
- Kim HJ, Lee TH, Lee HS, et al. Periorbita: computed tomography and magnetic resonance imaging findings. Am J Rhinol 2006; 20:371.
- Suárez C, Ferlito A, Lund VJ, et al. Management of the orbit in malignant sinonasal tumors. Head Neck 2008; 30:242.
- Eisen MD, Yousem DM, Loevner LA, et al. Preoperative imaging to predict orbital invasion by tumor. Head Neck 2000; 22:456.
- Lund VJ, Stammberger H, Nicolai P, et al. European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; :1.
- Iannetti G, Valentini V, Rinna C, et al. Ethmoido-orbital tumors: our experience. J Craniofac Surg 2005; 16:1085.
- Carrau RL, Segas J, Nuss DW, et al. Squamous cell carcinoma of the sinonasal tract invading the orbit. Laryngoscope 1999; 109:230.
- Howard DJ, Lund VJ, Wei WI. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience. Head Neck 2006; 28:867.
- Van Tuyl R, Gussack GS. Prognostic factors in craniofacial surgery. Laryngoscope 1991; 101:240.
- McCaffrey TV, Olsen KD, Yohanan JM, et al. Factors affecting survival of patients with tumors of the anterior skull base. Laryngoscope 1994; 104:940.
- Tiwari R, van der Wal J, van der Waal I, Snow G. Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy. Head Neck 1998; 20:193.
- Imola MJ, Schramm VL Jr. Orbital preservation in surgical management of sinonasal malignancy. Laryngoscope 2002; 112:1357.
- Essig GF, Newman SA, Levine PA. Sparing the eye in craniofacial surgery for superior nasal vault malignant neoplasms: analysis of benefit. Arch Facial Plast Surg 2007; 9:406.
- Snyderman CH, Carrau RL, Kassam AB, et al. Endoscopic skull base surgery: principles of endonasal oncological surgery. J Surg Oncol 2008; 97:658.
- Tabaee A, Nyquist G, Anand VK, et al. Palliative endoscopic surgery in advanced sinonasal and anterior skull base neoplasms. Otolaryngol Head Neck Surg 2010; 142:126.
- Su SY, Kupferman ME, DeMonte F, et al. Endoscopic resection of sinonasal cancers. Curr Oncol Rep 2014; 16:369.
- Higgins TS, Thorp B, Rawlings BA, Han JK. Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled-data analysis. Int Forum Allergy Rhinol 2011; 1:255.
- Futran ND, Mendez E. Developments in reconstruction of midface and maxilla. Lancet Oncol 2006; 7:249.
- Solero CL, DiMeco F, Sampath P, et al. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations. Neurosurgery 2000; 47:1296.
- Ganly I, Patel SG, Singh B, et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27:445.
- Ganly I, Gross ND, Patel SG, et al. Outcome of craniofacial resection in patients 70 years of age and older. Head Neck 2007; 29:89.
- Kassam AB, Prevedello DM, Carrau RL, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114:1544.
- Kono Y, Prevedello DM, Snyderman CH, et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol 2011; 32:77.
- Brizel DM, Light K, Zhou SM, Marks LB. Conformal radiation therapy treatment planning reduces the dose to the optic structures for patients with tumors of the paranasal sinuses. Radiother Oncol 1999; 51:215.
- Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol 2014.
- Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005; 61:856.
- Hoppe BS, Stegman LD, Zelefsky MJ, et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting--the MSKCC experience. Int J Radiat Oncol Biol Phys 2007; 67:691.
- Madani I, Bonte K, Vakaet L, et al. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys 2009; 73:424.
- Licitra L, Locati LD, Cavina R, et al. Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer. Ann Oncol 2003; 14:367.
- Lee MM, Vokes EE, Rosen A, et al. Multimodality therapy in advanced paranasal sinus carcinoma: superior long-term results. Cancer J Sci Am 1999; 5:219.
- Hoppe BS, Nelson CJ, Gomez DR, et al. Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 2008; 72:763.
- Hanna EY, Cardenas AD, DeMonte F, et al. Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 2011; 137:78.
- Kang JH, Cho SH, Kim JP, et al. Treatment outcomes between concurrent chemoradiotherapy and combination of surgery, radiotherapy, and/or chemotherapy in stage III and IV maxillary sinus cancer: multi-institutional retrospective analysis. J Oral Maxillofac Surg 2012; 70:1717.
- Airoldi M, Garzaro M, Valente G, et al. Clinical and biological prognostic factors in 179 cases with sinonasal carcinoma treated in the Italian Piedmont region. Oncology 2009; 76:262.
- Abu-Ghanem S, Horowitz G, Abergel A, et al. Elective neck irradiation versus observation in squamous cell carcinoma of the maxillary sinus with N0 neck: A meta-analysis and review of the literature. Head Neck 2015; 37:1823.
- Bristol IJ, Ahamad A, Garden AS, et al. Postoperative radiotherapy for maxillary sinus cancer: long-term outcomes and toxicities of treatment. Int J Radiat Oncol Biol Phys 2007; 68:719.
- Myers LL, Nussenbaum B, Bradford CR, et al. Paranasal sinus malignancies: an 18-year single institution experience. Laryngoscope 2002; 112:1964.
- Blanco AI, Chao KS, Ozyigit G, et al. Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys 2004; 59:51.
- Harbo G, Grau C, Bundgaard T, et al. Cancer of the nasal cavity and paranasal sinuses. A clinico-pathological study of 277 patients. Acta Oncol 1997; 36:45.
- Dulguerov P, Jacobsen MS, Allal AS, et al. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001; 92:3012.
- Dirix P, Nuyts S, Geussens Y, et al. Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2007; 69:1042.
- Bhattacharyya N. Factors affecting survival in maxillary sinus cancer. J Oral Maxillofac Surg 2003; 61:1016.
- Chen AM, Daly ME, El-Sayed I, et al. Patterns of failure after combined-modality approaches incorporating radiotherapy for sinonasal undifferentiated carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2008; 70:338.
- Mendenhall WM, Hinerman RW, Malyapa RS, et al. Inverted papilloma of the nasal cavity and paranasal sinuses. Am J Clin Oncol 2007; 30:560.
- Melroy CT, Senior BA. Benign sinonasal neoplasms: a focus on inverting papilloma. Otolaryngol Clin North Am 2006; 39:601.
- Lawson W, Patel ZM. The evolution of management for inverted papilloma: an analysis of 200 cases. Otolaryngol Head Neck Surg 2009; 140:330.
- Guillemaud JP, Witterick IJ. Inverted papilloma of the sphenoid sinus: clinical presentation, management, and systematic review of the literature. Laryngoscope 2009; 119:2466.
- Dragonetti A, Gera R, Sciuto A, et al. Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification. Rhinology 2011; 49:207.
- Proulx GM, Caudra-Garcia I, Ferry J, et al. Lymphoma of the nasal cavity and paranasal sinuses: treatment and outcome of early-stage disease. Am J Clin Oncol 2003; 26:6.
- Hausdorff J, Davis E, Long G, et al. Non-Hodgkin's lymphoma of the paranasal sinuses: clinical and pathological features, and response to combined-modality therapy. Cancer J Sci Am 1997; 3:303.
- Logsdon MD, Ha CS, Kavadi VS, et al. Lymphoma of the nasal cavity and paranasal sinuses: improved outcome and altered prognostic factors with combined modality therapy. Cancer 1997; 80:477.
- Laskin JJ, Savage KJ, Voss N, et al. Primary paranasal sinus lymphoma: natural history and improved outcome with central nervous system chemoprophylaxis. Leuk Lymphoma 2005; 46:1721.
- Samstein RM, Carvajal RD, Postow MA, et al. Localized sinonasal mucosal melanoma: Outcomes and associations with stage, radiotherapy, and positron emission tomography response. Head Neck 2016; 38:1310.
- Thompson LD, Wieneke JA, Miettinen M. Sinonasal tract and nasopharyngeal melanomas: a clinicopathologic study of 115 cases with a proposed staging system. Am J Surg Pathol 2003; 27:594.
- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL PRESENTATION
- DIAGNOSIS AND STAGING
- Initial evaluation
- SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA
- General approach to management
- - Management of the orbit
- - Endoscopic resection
- - Reconstruction
- - Complications
- Radiation therapy
- - Contemporary RT techniques
- - Complications
- Management of the neck
- Recurrent and metastatic disease
- Posttreatment follow-up
- OTHER TUMOR TYPES
- Adenoid cystic carcinoma
- Sinonasal undifferentiated carcinoma
- Inverted papilloma
- Olfactory neuroblastoma
- SUMMARY AND RECOMMENDATIONS