Sinuses are cavities (spaces) or small tunnels. They are called paranasal because they're around or near the nose. The nasal cavity opens into a network of sinuses:

• Maxillary sinuses are in the cheek area, below the eyes on either side of the nose.
• Frontal sinuses are above the inner eye and eyebrow area.
• Sphenoid sinuses sit deep behind the nose, between the eyes.
• Ethmoid sinuses are made up of many sieve-like sinuses formed of thin bone and mucous tissues. They're above the nose, between the eyes.

The sinuses are filled with air. When you have a cold or sinus infection the sinuses can become blocked (obstructed) and fill with mucus and pus, which can be uncomfortable.

The nasal cavity and paranasal sinuses do many things:

• They help filter, warm, and moisten the air you breathe.
• They give your voice resonance.
• They lighten the weight of the skull.
• They provide a bony framework for the face and eyes.

The nasal cavity and the paranasal sinuses are lined by a layer of mucus-producing tissue (mucosa). The mucosa has many types of cells, including:

• Squamous epithelial cells, which are flat cells that line the sinuses and make up most of the mucosa
• Glandular cells such as minor salivary gland cells, which make mucus and other fluids
• Nerve cells, which are responsible for sensation and the sense of smell in the nose
• Infection-fighting cells (which are part of the immune system), blood vessel cells, and other supporting cells

Other types of cells in the nasal cavity and paranasal sinuses, including bone and cartilage cells, can also become cancer.

Nasal cavity and paranasal sinus cancers

Any of the cells that make up the mucosa can become cancer, and each type of cancer behaves or grows differently.

• Squamous epithelial cells can become squamous cell carcinomas. This is the most common type of cancer in the nasal cavity and paranasal sinuses. It makes up a little over half of cancers of these areas.
• Minor salivary gland cells can turn into adenocarcinomas, adenoid cystic carcinomas, and mucoepidermoid cancers. These also are common nasal and paranasal sinus cancers.
• Undifferentiated carcinoma is another type of cancer that can come from mucosa cells. This is a fast-growing cancer in which the cells look so abnormal that it’s hard to tell what type of cell the cancer started in.
• Cells that give the skin its tan or brown color are called melanocytes. Melanoma is a type of cancer that starts in these cells. It can grow and spread quickly. These cancers usually are found on sun-exposed areas of the skin but can form on the lining of the nasal cavity and sinuses or other areas inside the body.
• Esthesioneuroblastoma is a cancer that starts in the olfactory nerve (the nerve for the sense of smell). This cancer is also called olfactory neuroblastoma. It usually starts in the roof of the nasal cavity and involves a structure called the cribriform plate. The cribriform plate is a bone deep in the skull, between the eyes, and above the ethmoid sinuses. These tumors can sometimes be mistaken for other types of tumors, like undifferentiated carcinoma or lymphoma.
• Lymphomas (cancers starting in immune system cells called lymphocytes) can occur in the nasal cavity and paranasal sinuses. One type of lymphoma seen in this area, T-cell/natural killer cell nasal-type lymphoma, was previously called lethal midline granuloma. See Non-Hodgkin Lymphoma for information about the diagnosis and treatment of lymphomas.
• Sarcomas are cancers of muscle, bone, cartilage, and fibrous cells that can start anywhere in the body, including the nasal cavity and paranasal sinuses. Information about sarcomas can be found on some of our other pages.

Each of these types of cancer has a distinct behavior and outlook. They cannot all be treated the same way. Many of them rarely affect the nasal cavity and paranasal sinuses, so they've been hard to study. Because of this, doctors must base treatment decisions on their experience with similar cancers in other parts of the head and neck.

Other growths found in the nasal cavity and paranasal sinuses

Some growths in the nasal cavity and paranasal sinuses are not cancers, but they could still cause problems.

Nasal polyps

Nasal polyps are abnormal growths inside the nasal cavity or paranasal sinuses. Polyps usually have a teardrop shape and a smooth surface. Most nasal polyps are benign (not cancer) and are caused by some type of chronic (long-lasting) inflammation in the nose. Using exams and tests, doctors can often tell benign polyps from cancer. But in some cases, polyps need to be closely checked to be sure. Small polyps that aren't causing problems might not need treatment. Larger polyps that cause problems might need to be treated with medicine or surgery.

Papillomas

Papillomas are warts that can grow inside the nasal cavity or paranasal sinuses and destroy healthy tissue. They usually have a bumpy surface. Papillomas are not cancer, but sometimes a squamous cell carcinoma will start in a papilloma. Because of the risk of cancer, papillomas in the nasal cavity and paranasal sinuses are removed by surgery.

Inverting papilloma. This is a type of papilloma that is classified as a benign tumor, but it tends to act more like a cancer. It tends to recur (come back) and can grow into nearby tissues. Inverted papillomas are often treated with the same type of surgery that's used for cancer.

Research on prevention of and better treatment for nasal cavity and paranasal sinus cancers is now being done at many medical centers, university hospitals, and other institutions across the nation. Doctors and patients are urged to contact the nearest cancer center to find out what clinical trials are going on in their community.

Genetics

Little is known about the gene changes in nasal cavity and paranasal sinus cancer because this cancer is so rare. Still, scientists have found some changes in the genes of some head and neck cancer cells that may be what change normal cells into cancer cells. But more research is needed to clearly identify these changes and link them to nasal cavity and nasopharyngeal cancers.

Understanding these gene changes may help doctors find better ways to diagnose these cancers. It may also lead to treatments that work better and have fewer side effects than those used today.

Treatment

Surgery

Surgeons are looking at new ways to remove these cancers while doing as little damage as possible to nearby normal tissues. Researchers are also looking for better ways to combine surgery with other cancer treatments to get better outcomes.

Selective lymph node dissection is another research interest. Studies have suggested that even patients who do not appear to have cancer in their lymph nodes have better outcomes when surgery is done to check the nodes close to the cancer compared to patients who have no lymph node treatment or elective neck radiation. More research is needed to know which patients should be offered these options.

Studies are looking at the possibility of reconstruction, or rebuilding the effected bony parts of the face, and how to best do it. Bone and tissue grafts, as well as man-made materials are being studied.

Radiation therapy

Doctors are always looking better ways to focus radiation on tumors more precisely to get more radiation to the tumor while limiting damage to nearby areas. This is especially important for head and neck tumors like nasal cavity and paranasal sinus cancers, where there are many important structures (like the eyes and brain), blood vessels, and nerves close to the tumor.

Research looking at whether proton therapy (which uses proton beams instead of x-rays) could work better than IMRT. (IMRT is the type of radiation most often used today.) Proton therapy could allow doctors to give higher doses of radiation to the cancer with less damage to the tissues the rays pass through. This might also cause fewer side effects, like mouth pain, eating problems, and weight loss.

Different radiation schedules are also being studied. For instance, instead of giving one large dose of radiation each day, there may be less damage to the eyeball and optic nerve if radiation is split into 2 smaller doses each day. This is called hyperfractionation and needs to be studied more.

Improvements in radiation have also led doctors to test repeating radiation treatments for cancers that come back after the initial course of treatment.

Chemotherapy

Doctors are looking at how chemotherapy can be used with other treatments to improve outcomes, especially for bigger cancers that may have already spread. Induction chemotherapy -- chemo given before surgery and/or radiation -- is of special interest because studies suggest that it may help preserve the eyeball in people with advanced disease. It's also been linked to longer survival.

Intra-arterial chemo (putting drugs right into the blood vessels feeding the tumor) for advanced cancers is another area of interest. Research has suggested that this might help reduce damage to the nearby tissues -- especially the eyeball. Still, there are a lot of side effects seen with this treatment, and more research is needed to know if it helps.

More research is needed to know when to use chemotherapy and which chemo drug combinations are best for these cancers.

Targeted therapies

Clinical trials are studying several targeted therapies that block the action of the substances (such as growth factors and growth factor receptors) that cause head and neck cancers to grow and spread. Cetuximab is already used in some cases, and pembrolizumab and bevacizumab are also being studied. Many studies are testing combinations of targeted therapies plus chemo or radiation. As has been the case with many other kinds of cancer, targeted therapies may prove to be a great advancement in the treatment of nasal cavity and paranasal sinus cancers.

PDT

Photodynamic therapy or PDT uses drugs and light to treat small cancers that can be reached with lasers. Researchers are looking at how this treatment might be used to treat recurrent esthesioneuroblastoma and other paranasal sinus tumors that come back after treatment.

Because nasal cavity and paranasal sinus cancers are rare, nearly all clinical trials include patients with other types of head and neck cancer as well. Although these studies are not specific to nasal cavity and paranasal sinus cancers, doctors will be able to apply the results when choosing treatment for patients with nasal cavity and paranasal sinus cancers.

Nasal cavity and paranasal sinus cancers are usually found because of signs or symptoms a person is having. The doctor will take a history and examine the patient. If cancer is suspected, the patient will be sent to see a specialist and tests will be done to be sure of the diagnosis.

Medical history and physical exam

Your doctor will ask questions about your medical history and the problems you've been having. A physical exam will be done so the doctor can look for signs of nasal cavity or paranasal sinus cancer, as well as other health problems.

During the exam, the doctor will carefully check the parts of your nose and sinuses that are causing problems. He or she will also check for numbness, pain, swelling, and/or firmness in your face and the lymph nodes in your neck. The doctor will look for changes in the symmetry of your eyes and face (both sides should be much the same), vision changes, and any other problems.

The doctor might also examine your nasal cavity with a headlight and small mirrors or even look inside your nose with a special tool called a nasal endoscope. (This is a thin, flexible tube that allows the doctor to see into your nasal passages.)

If your doctor thinks you might have cancer of the nasal cavity or paranasal sinuses, you'll be sent to see an otolaryngologist (a doctor who specializes in diseases of the ear, nose, and throat; also called an ENT doctor). This doctor will carefully examine your nasal passages and the rest of your head and neck. This might include an exam of your throat, tongue, and mouth which can be done with small mirrors and a light or with a fiber-optic scope – a thin, flexible, lighted tube that's put in through your mouth or nose.

Imaging tests

Imaging tests use x-rays, magnetic fields, or other means to create pictures of the inside of your body. Imaging tests are not used to diagnose nasal cavity or paranasal sinus cancers, but they may be done for a number of reasons both before and after a cancer diagnosis, including:

• To help look for a tumor if one is suspected
• To see if a tumor can be safely biopsied without causing a lot of bleeding (covered below)
• To learn how far cancer may have spread (metastasized)
• To see if the cancer can be removed with surgery
• To help see if treatment is working
• To look for signs that the cancer has come back after treatment (recurred)

X-rays

X-rays can show if there's any fluid or masses in the sinuses. (They should be filled with air.) This would suggest that something is wrong, but it may not be a tumor. Most of the time, an abnormal-looking sinus x-ray means there's an infection. Sinus x-rays are not often done because many doctors prefer to do a computed tomography (CT) scan instead.

If you've been diagnosed with nasal cavity or paranasal sinus cancer, a chest x-ray might be done to find out if the cancer has spread to your lungs, which is the most common site of spread other than lymph nodes.

CT (computed tomography) scan

A CT scan uses x-rays to make detailed 3-D cross-sectional images of the inside of your body. This test is very useful in identifying cancers of the nasal cavity and paranasal sinuses. Bony details show up well on a CT scan and it can show if a tumor has destroyed the bone around it. A chest CT might also be used to see if the cancer has spread to the lungs.

Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues and organs in the body.

MRI (magnetic resonance imaging) scan

MRI scans use radio waves and strong magnets instead of x-rays to make pictures of your insides. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. They are better than CT scans in telling whether a change is fluid or a tumor. Sometimes they can help the doctor tell the difference between a tumor that's not cancer and one that is. They can also show if a tumor has spread into nearby soft tissues, like the eyeball, brain, or blood vessels.

Both CT and MRI scans help find cancers of the nasal cavities and paranasal sinuses and learn more about them. For instance, a CT scan can tell if the cancer is growing into bone, and an MRI can show the size and type of cancer. Both can show if it has spread to lymph nodes in the neck.

PET (positron emission tomography) scan

A PET scan uses a form of radioactive sugar that's injected into your blood. (Because cancer cells use glucose at a higher rate than normal cells, they will absorb more of the radioactive sugar.) A special scanner is then used to create pictures of the places where the radioactivity collected in your body. A PET scan is often done along with a CT scan using a machine that can do both scans at the same time (called a PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the detailed images from the CT scan. Though these cancers rarely spread, a PET scan gives helpful information about your whole body.

A PET scan may be used to look for possible areas of cancer spread, especially if there's a good chance that the cancer is more advanced. (Meaning it's bigger and more likely to have spread.) This test also can be used to help see if a change seen on another imaging test is or isn't cancer.

Biopsy

A biopsy is a procedure in which a doctor takes out a small piece of tissue (a sample) to be checked with a microscope. It's the only way to know for sure if you have nasal cavity or paranasal sinus cancer. If cancer is found, testing in the lab can also show what kind of cancer it is and how aggressive it is (how fast will it grow and spread). This information is needed to help plan the best treatment.

Doctors look closely at where the tumor is and the blood vessels around it when deciding where and how to do a biopsy.

Often, biopsies are done in the doctor’s office or clinic. Drugs are used to numb the area. If the tumor is in a hard-to-reach place or may bleed a lot, the biopsy will be done in the operating room. Many types of biopsies can be used to diagnose nasal cavity or paranasal sinus cancer.

Fine needle aspiration (FNA) biopsy

In this type of biopsy, the doctor puts a thin, hollow needle right into a tumor or lymph node to take out cells and/or a few drops of fluid. The doctor may repeat this 2 or 3 times to take several samples. The cells can then be checked under a microscope to see if they look like cancer.

An FNA biopsy is often used in patients with swollen lymph nodes in the neck. In these patients, FNA biopsy can show if the lymph node swelling is from cancer or if it's a response to an infection. If someone who has already been diagnosed with nasal cavity or paranasal sinus cancer has enlarged neck lymph nodes, a fine needle biopsy can tell if the lymph node swelling is caused by the spread of cancer.

Incisional and excisional biopsies

These types of biopsies remove more of the tumor using minor surgery. They're the more common types of biopsies done for nasal and paranasal sinus tumors. Biopsies of tumors in the nose may be done using special tools that are put into the nose. Biopsies of tumors that are deeper within the skull may require a more involved procedure (see below).

For an incisional biopsy, the surgeon cuts out a small piece of the tumor. For an excisional biopsy, the entire tumor is removed. In either case, the biopsy sample is then sent to the lab for testing.

Endoscopic versus open biopsy

For tumors deeper within the skull, how the biopsy is done depends on where it is and how big it is.

Endoscopic biopsy: Some tumors that are deep in the nasal passages may be reached using an endoscope – a thin, flexible lighted tube. Long, thin surgical tools can be passed through the endoscope to get a biopsy sample.

Open (surgical) biopsy: For tumors inside the sinuses, the doctor may have to cut through the skin next to the nose and through the underlying bones to reach them. These operations are covered in more detail in Surgery for Nasal Cavity and Paranasal Sinus Cancer.

Anesthesia for biopsies

Anesthesia is the use of drugs to help control pain during medical procedures. The type of anesthesia used depends on how the biopsy will be done.

Local anesthesia (numbing medicine) is often used for an incisional biopsy or needle biopsy. The drug can be injected into the skin and nearby tissues or even put right on the inside of the nose to numb the area while the biopsy is done.

Sedation (where you are made very drowsy) or general anesthesia (where you are in a deep sleep) may be needed for endoscopic biopsies. General anesthesia is needed for procedures that cut through the sinus bones.

See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the tissue sample is used in the lab to diagnose diseases, and what the results will tell you.

For most nasal cavity or paranasal sinus cancers, surgery to remove the cancer (and some of the surrounding bone or other nearby tissues) is a key part of treatment. Often, surgery is used with other treatments, like radiation therapy and/or chemotherapy to get the best results.

The nasal cavity and paranasal sinuses are close to many important nerves, blood vessels, and other structures. The brain, eyes, mouth, and carotid arteries (arteries that supply blood to the brain) are also close by, making surgical planning and surgery itself difficult. The goal of surgery in these areas is to take out the entire tumor and a small amount of normal tissue around it while keeping appearance and function (such as breathing, speech, chewing, and swallowing) as normal as possible. Rebuilding and/or repairing the area around the tumor is an important part of the surgery plan.

Because of the complex nature of these operations and the fact that these cancers are rare, it’s very important to have a surgeon who has experience treating these cancers.

When removing the cancer, the surgeon also tries to take out a rim (margin) of surrounding normal tissue. The tissue that's removed will be checked with a microscope to see if there are cancer cells at the edges. If the edges don’t have cancer cells, the cancer is said to have been removed with negative or clear margins. Negative margins mean that it's less likely that any cancer was left behind. If the edges do have cancer cells, the margins are said to be positive. Positive margins mean that it's more likely that some cancer was left behind. Often this means more treatment, such as more surgery or radiation.

Nasal cavity cancers

Nasal cavity cancers are often removed in a procedure called wide local excision. This means removing the tumor plus an edge of normal tissue around it. The goal is to remove enough tissue so that no cancer cells remain.

If the tumor is in the middle dividing wall of the nasal cavity (the nasal septum), sometimes the entire septum or a large portion of it will be taken out.

If the tumor is in the lateral (side) wall of the nasal cavity, this wall may need to be removed by a procedure called a medial maxillectomy. To do this, the surgeon will usually cut through the skin along the side or edge of the nose and fold the external nose toward the opposite side to see and work on the tumor. Then the side of the nasal cavity can be removed by cutting the bone and soft tissue as needed. Sometimes, if the cancer is in a certain spot, the surgeon can reach the tumor by cutting under the upper lip instead. This approach has the advantage of avoiding any cuts, and maybe scars, on the skin. Ask your head and neck surgeon how your surgery will be done.

If the cancer has reached the skin or deeply invades the tissue of the external nose, part (or all) of the nose may need to be removed. There are many ways to rebuild a nose using tissue from the face or other areas. In some cases, a cosmetic prosthesis (made of artificial materials) may be used to make a new nose.

Paranasal sinus cancers

Operations for paranasal sinus tumors vary, depending on the tumor type, location, size, and growth into other parts of the head and neck.

If the tumor is small and/or it's not cancer (benign) and is only in the ethmoid sinuses, an external ethmoidectomy may be done. The surgeon will cut through the skin on the upper side of the nose next to the upper eyelid. Bone on the inner side of the orbit (eye socket) and nose will be removed to reach tumors inside the ethmoid sinuses.

If the tumor also has grown into the maxillary sinus, a maxillectomy may be done. The type of maxillectomy depends on where the tumor is and whether it has grown into nearby tissues. The surgeon may make an incision (cut) along the side of the nose from the eyebrow or upper eyelid down to or through the upper lip. Or the incision may be made under the upper lip. The bones around the maxillary sinus are cut so that the entire tumor and some surrounding tissue can be taken out in one piece. This operation might remove bone from the hard palate (the roof of the mouth), upper teeth on one side of the mouth, part or all of the orbit (eye socket), part of the cheekbone, and/or the bony part of the upper nose.

If the cancer is a higher stage, has spread into the base of the skull or brain, or is in the ethmoid sinuses, frontal sinuses, and/or the sphenoid sinuses, an operation called a craniofacial resection may be done. This operation is a lot like a maxillectomy except that the surgeon may also remove upper parts of the eye socket and the front base of the skull. This is a major operation that's usually done by a surgical team that includes an otolaryngologist (head and neck surgeon) and a neurosurgeon (a surgeon who operations on the brain, spinal cord, and other nerves).

Endoscopic surgery

In this type of surgery, the surgeon uses an endoscope (a thin, flexible lighted tube that's put into the nose to reach the nasal cavity or sinus) to see and remove the tumor. This way, the surgeon doesn't have to cut through skin and bone to open up the whole cavity. This reduces normal tissue damage. In general, recovering from this type of surgery takes less time. And for some of these cancers, long-term outcomes for endoscopic surgery are as good as, and maybe even better than, other surgeries used to treat these cancers.

Endoscopic surgery is most often used for small tumors. For larger tumors, it may be used to help try to control the tumor in people who are not healthy enough for a bigger operation. Usually it's combined with radiation treatment.

Endoscopic surgery may also be used along with some of the more invasive surgeries listed above. In this case, it may help limit damage to healthy tissues. It also may help the doctor better see the area to try to be sure all of the cancer has been taken out. (You may hear this called endoscopic-assisted surgery.)

Endoscopic approaches to remove nasal and sinus cancers are becoming more common as more surgeons are trained in these techniques. These approaches are best performed by teams of experienced surgeons at specialized centers. Some medical centers (and surgeons) have more experience than others with endoscopic surgery for nasal and sinus cancers. If you're considering endoscopic surgery as a part of your treatment, be sure to ask about your surgeon’s training and experience, which are key to successful endoscopic surgery.

Removing lymph nodes

Cancers of the nasal cavity or paranasal sinuses sometimes spread to the lymph nodes in the neck. Depending on the stage and location of the cancer, these lymph nodes may need to be removed in an operation called a neck dissection.

There are several types of neck dissection procedures.Their goals are to remove lymph nodes known to or likely to contain cancer. The amount of tissue removed depends on the cancer’s size and the extent of spread to lymph nodes.

• A partial or selective neck dissection removes only a few lymph nodes.
• A modified radical neck dissection removes most lymph nodes on one side of the neck between the jawbone and collarbone, as well as some muscle and nerve tissue.
• A radical neck dissection removes nearly all nodes on one side of the neck as well as even more muscles, nerves, and veins.

The most common side effects of any neck dissection are numbness of the ear, weakness in raising the arm above the head, and weakness of the lower lip. These develop when nerves are damaged. After a selective neck dissection, the weakness of the arm and lower lip usually go away after a few months. But if a nerve is removed as part of a radical neck dissection or because of tumor spread, the weakness will be permanent. After any type of neck dissection, physical therapists can teach the patient exercises to improve neck and shoulder movement.

While some swelling is normal after surgery, it should go away over time. When lymph nodes are removed, it changes how fluid drains from the head, face, and neck. The fluid might not be able to drain like it should. This can cause swelling in these areas called lymphedema. This side effect can develop anytime after lymph node dissection, even many years later.

Possible risks and side effects of surgery

All surgery has some risks, including blood clots, infections, complications from anesthesia, and pneumonia. These risks are generally low, but are higher in more complicated operations.

Pain is a common side effect of surgery. It's also common to have nasal drainage and crusting. Sometimes it smells bad. This usually starts getting better about 6 months after surgery, but may last longer if you're getting radiation. 

Surgery for cancers that are large or hard to reach may be very complicated, in which case side effects may include infection, nose bleeds, scarring, problems eating and talking, and vision changes. Surgery also can be disfiguring, especially if bones in the nose or face need to be removed.

Because these cancers tend to not cause problems until they're quite large, they often involve the eye or orbit (the bone and tissue around the eye) by the time they are noticed or cause symptoms. Most of the time the eye can be saved, but sometimes the entire orbit and eyeball needs to be removed to give the best chance for cure.

Because the changes that result are so visible, these surgeries can have a major effect on how people view themselves. The surgeon will take into account how the face will look and function after surgery. But, depending on the extent of the operation needed, you may look different after surgery. This can range from a simple scar on the side of your nose to major changes if nerves, parts of bones, or other structures need to be removed. It’s important to talk with your doctor about these changes before the surgery. Your doctor might be able to help you prepare for them. He or she can also give you an idea about your options, such as reconstructive surgery, tissue grafts, or a prosthesis (man-made replacement). For example, an obturator is a custom-made prosthesis used to help restore function in the nose and mouth. An obturator that replaces the roof of the mouth can help you speak and swallow normally. Noses can be made out of plastic, tinted to match the skin, and attached to the face. All of these things can be a great help to a person’s self-esteem.

To learn more, see Cancer Surgery.

Chemotherapy (chemo) uses anti-cancer drugs that are put into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has metastasized (spread) to organs beyond the nasal cavity and paranasal sinuses.

The best way to use chemo to treat nasal cavity and paranasal sinus cancers is not clear. But it may be used in these ways:

• Before surgery (often along with radiation therapy) to try to shrink the tumor and make easier to take it all out ( with negative margins). This is called neoadjuvant chemotherapy. It may also be called induction chemotherapy.
  • Neoadjuvant chemo may be used to try to save the eyeball if the cancer has spread there.
  • It may also be used before surgery to quickly ease symptoms the tumor is causing.
• After surgery (often along with radiation therapy) to help lower the chance the cancer will come back. This is called adjuvant chemotherapy.
• As the main treatment (often along with radiation therapy) for cancers that are too big or have spread too far into nearby tissues to be completely removed with surgery.
• It may be used to control cancer growth and spread when it has metastized (spread) to other parts of the body and cannot be treated with surgery or radiation. (Because these cancers rarely metastasize, this use is based on results that have been seen with other kinds of head and neck cancers.) This is called palliative care.

Chemoradiation

Chemoradiation (also called chemoradiotherapy) is chemotherapy given at the same time as radiation. This has been shown to shrink some of these tumors more than either treatment alone. It's also may help delay cancer recurrence (coming back after treatment) in some types of cancer (carcinomas; see below).

Chemo drugs commonly used

Chemo for nasal cavity and paranasal sinus cancers may include a combination of several drugs. These cancers are rare, so there aren’t many studies to help doctors decide the best way to treat them. Often, doctors treat them with the same drugs that are used for other, more common, cancers of the head and neck.

The most common types of nasal cavity and paranasal sinus cancers, squamous cell carcinoma, adenocarcinoma, and adenoid cystic carcinoma, can be grouped together as carcinomas. Some of the chemo drugs used to treat carcinomas include:

• Cisplatin
• Carboplatin
• 5-fluorouracil (5-FU)
• Docetaxel (Taxotere^®)
• Paclitaxel (Taxol^®)
• Methotrexate

The drugs used depend on many things, including the type of cancer, the extent of the cancer, the person’s overall health, and whether chemo is combined with radiation therapy. Cisplatin is the drug most often given with radiation. It's often combined with 5-FU and/or docetaxel. New chemo drugs and combination treatments are also being studied and used.

The targeted therapy drug, cetuximab, may also be given with chemo in certain cases.

Different chemo drugs are used for sarcomas and melanomas. Information about chemotherapy for sarcomas may be found in Sarcoma: Adult Soft Tissue Cancer. Chemo for melanoma is covered in Melanoma Skin Cancer.

Side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be damaged by chemo, which can lead to side effects. Side effects depend on the specific drugs used, the doses, and the length of treatment. Common short-term side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• Mouth sores
• Diarrhea
• Constipation
• Low blood counts

Chemo often affects the blood-forming cells of the bone marrow, this can lead to:

• Increased chance of infection (from a shortage of white blood cells)
• Bleeding or bruising after minor cuts or injuries (from a shortage of blood platelets)
• Fatigue (from low red blood cell counts)

There are often ways to lessen these side effects, and they usually go away over time after treatment ends. Be sure to ask your doctor or nurse what can be done to help reduce side effects, and let them know when you do have side effects so they can be managed. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Some side effects continue long after treatment is stopped. For example, cisplatin can cause nerve damage (neuropathy). This can sometimes lead to hearing loss or problems in the hands and feet such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this gets better or goes away once treatment stops, but for some people, it can last a long time.

If your doctor plans treatment with chemo you should be sure to discuss which drugs will be used and the possible side effects. Once chemo is started, let your health care team know if you have side effects, so they can be treated.

To learn more, see the Chemotherapy section on our website.

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