How Do I Choose the Best Sinus Treatment?

The incidence of malignant tumors in the nasal cavity and sinuses ranks third in malignant tumors in the otolaryngology department, second only to nasopharyngeal and laryngeal cancer. The male to female incidence ratio is (2 to 3): 1. Nasal cavity and sinus cancers mostly occur between the ages of 40 and 60, and sarcomas are more common in young people. Malignant tumors of the nasal cavity and sinuses, except for the early ones, are often combined. The tumor has spread extensively from the primary site to adjacent tissues at the time of consultation. Nasal and sinus malignancies have similarities in etiology, pathological type, clinical manifestations, and treatment, so they are often discussed together. Nasal and sinus malignancies are often late when diagnosed, so treatment is tricky and the prognosis is poor.

Basic Information

English name

carcinoma of nasal covity and nasal sinuses

Visiting department

ENT

Multiple groups

40 to 60 years old

Common locations

Nasal cavity, sinuses

Common causes

Chronic chronic inflammatory stimulation; benign tumor malignancy; exposure to carcinogens or radiation; human papilloma virus infection; etc.

Common symptoms

Nasal congestion, nosebleeds or bloody snot, pain and numbness, tears and diplopia, decreased vision, ear tightness, hearing loss, difficulty opening, anemia, weight loss, etc.

Causes of Nasal Sinus Cancer

1. Chronic chronic inflammation.

2. Malignant transformation of borderline or benign tumors. Inverted papilloma and pleomorphic adenoma have a certain rate of malignancy.

3. Exposure to carcinogens or radioactive radiation.

4. Viral infection, human papilloma virus infection may be related to the occurrence of nasal and sinus cancer.

5. Immune function is low, especially the function of cellular immunity and immune surveillance is the internal cause of tumorigenesis.

6. Trauma, a history of trauma commonly reported in patients with sarcoma.

Clinical manifestations of nasal and sinus cancer

1. Stuffy nose. Malignant tumors in the nasal cavity are early symptoms, and malignant tumors in the sinuses are late symptoms. It is characterized by progressive nasal congestion on one side, which develops rapidly; in the later stage, persistent nasal congestion, and may be bilateral.

2. Nosebleeds or bloody nose.

3. Pain and numbness. When the tumor is located at the base of the maxillary sinus, it often compresses the upper alveolar nerve or invades the alveolar and often has toothache symptoms. The tumor develops to the face or the orbital floor. Due to the involvement of the infraorbital nerve, swelling and pain in the suborbital and cheeks on one side, or numbness in the cheeks, upper lip, and upper teeth on one side may occur. When the tumor penetrates the posterior maxillary sinus and invades the pterygopalatine fossa, severe "sphenopalatine neuralgia" can occur, which is manifested as burr-like pain in the root of the affected side, in the orbit, cheeks, and upper alveolar region, and can penetrate the ear. And temporal radiation. In the later stage, the tumor often incurs intolerable pain due to the invasion of the orbital or skull base.

4. Tears, diplopia, and decreased vision. Nasolacrimal ducts, orbits, eye muscles, optic nerves, or ocular motor nerves are involved, causing tears, eye movements, movement disorders, diplopia, vision loss, and even blindness.

5. When the sphenoid sinus tumor involves the neurovascular in the optic foramen and supraorbital fissure, it causes deep orbital pain, numbness of the orbital skin, ptosis, narrowing of the fissure, fixation of the eyeball, diplopia and blindness, etc., which is called orbital apex synthesis Sign.

6. Ear symptoms. Tumor invasion of the eustachian tube leads to symptoms of secretory middle ear inflammation such as ear tightness and hearing loss.

7. Difficult to open mouth. When the tumor invades the pterygopalatine fossa, infratemporal fossa, and temporal fossa, it can affect the inner and outer wings, masseter muscles, and temporal muscles, and the jaw joint is restricted, which makes it difficult to open the mouth.

8. Cachexia. Manifestations include failure, anemia, and reduced constitution. At this time, cervical lymph nodes and distant metastases, intracranial complications, and arterial aggressive bleeding often occur.

Nasal sinus cancer examination

Front and back rhinoscopy

Anterior rhinoscopy shows that new organisms in the nasal cavity are often cauliflower-shaped, with a wide base, often accompanied by ulcers and necrotic tissue on the surface, which are prone to bleeding. Perform a post-nasal examination on the patient to observe whether the posterior nostril area, the top of the nasopharynx, and the eustachian tube have been involved.

2. Nasal cavity and sinus endoscopy

Using fiber nasopharyngology or nasal endoscopy, the primary site, size, shape, and opening of the sinuses can be observed. For those suspected of having maxillary sinus malignancies, nasal endoscopes can be inserted directly into the sinuses for observation, and then biopsies can be obtained under direct vision. For sphenoid sinus, frontal sinus, and ethmoid sinus lesions, nasal endoscopy can also be used, as long as you can see the collapse of the nasal top, the inward movement of the nasal cavity, the middle turbinate, the ethmoid, the middle nasal passage and the olfactory fissure. Secretions also help diagnosis.

3.Sinus X-ray

X-ray films have certain significance in the diagnosis of malignant tumors of the nasal cavity and sinuses. X-ray tomography is helpful in the diagnosis of early suspicious cases. In the film, not only bone destruction is sometimes visible, but also the location and extent of the tumor can be displayed, and the three-dimensional outline of the tumor can be drawn.

4.CT and MRI examination

CT scan can more comprehensively and accurately show tumor size and extent of invasion, understand the damage of bone wall, and has a strong three-dimensional sense, which can be reconstructed in three dimensions. Therefore, it has become a routine auxiliary method for diagnosing sinus malignant tumors. MRI is superior to CT scans in some aspects. For example, when the tumor has invaded the skull base, orbit, or pterygopalatine fossa, it can better show the soft tissue invasion and understand the relationship between tumor and blood vessels.

5. Pathological examination and cell smear examination

The diagnosis of a tumor depends on the results of a pathological examination. When a sinus tumor is highly suspected, maxillary sinus puncture pathology or biopsy or smear of tumor tissue under nasal endoscopy can also be used.

6. Surgical exploration

Sinus exploration is feasible for patients who are negative for multiple biopsies and have a particularly difficult diagnosis but are indeed suspicious. Combining frozen examination during the operation is helpful to confirm the diagnosis.

7. Cervical lymph node biopsy

For lymphadenopathy in the neck and clinically determined whether it is a tumor metastasis, cervical lymph node aspiration cytology may cause tumor spread due to incision biopsy, so it should be avoided as much as possible.

Nasal sinus cancer diagnosis

Malignant tumors of the nasal cavity and sinuses can be diagnosed based on medical history, physical examination, auxiliary examination and pathological examination, and the diagnosis is based on the results of pathological examination.

Differential diagnosis of nasal cavity and sinus cancer

Malignant tumors of the nasal cavity and sinuses must be distinguished from benign cysts of the nasal cavity, abnormal proliferation of fibrous tissue of the maxilla, sinus fungal disease, and nasal papilloma. Nasal benign cysts develop slowly, bulging in the mucosa or subcutaneously, hemispherical, not easy to bleed, smooth on the surface, elastic to the touch, and clear boundaries with surrounding tissues. Tooth-derived cysts often show tooth deformities, missing teeth and periodontal disease, and X-ray films or CT scans show dilatation of the sinus wall. Patients with abnormal proliferation of maxillary bone fibrous tissue are younger, and more common in women. The main complaint is often painless bulging of the face, which gradually increases. No nosebleeds in general; nasal congestion, exophthalmos can occur. The X-ray film showed uniform damage, irregular edges, and the enlarged lesion area had a frosty glass-like or spot-like appearance with no obvious boundary with normal bone; this point could be distinguished from malignant tumors. Sinus mycosis patients have symptoms of nasal congestion, runny nose, and blood in the snot; or facial soft tissue bulge; necrotic tissue and cheese-like objects appear in the nasal cavity, with protruding eyes, paralysis of the eye muscles, and decreased vision. Sinus x-ray film: The shadow of the sinus cavity is blurred, with calcification or bone destruction. Medical examination or fungal culture can be confirmed. Nasal sinus papilloma is mulberry-shaped, which is often difficult to distinguish clinically from malignant tumors, and about 10% of them become cancerous, so routine biopsies are needed to identify them.

Nasal Sinus Cancer Treatment

The choice of treatment method must be fully considered according to the nature, size, range of invasion and overall condition of the patient. At present, it is generally accepted that the comprehensive treatment of nasal cavity and sinus malignant tumors, which is mainly surgical resection, has the best prognosis. Comprehensive therapy includes: surgery plus radiotherapy. chemotherapy plus surgery. Surgery plus radiotherapy plus chemotherapy. When there is lymph node metastasis, selective or radical cervical lymph node dissection is performed.

Nasal sinus cancer prognosis

Primary tumors in the lower nasal cavity and maxillary sinus have a better prognosis than those in the upper nasal cavity, ethmoid sinus, frontal sinus, and sphenoid sinus. Cancer has a better prognosis than sarcoma, of which adenoid cystic carcinoma has the best prognosis, and malignant melanoma has the worst prognosis. Comprehensive therapy is better than monotherapy. It has been reported that the 5-year survival rate of nasal and sinus malignant tumors reaches 52% to 65% in stages I and II, and 20% to 25% in stages III and IV.

Nasal sinus cancer prevention

Actively treat sinusitis. The anatomical location of the sinuses is hidden, and early symptoms are few. Suspicious patients should seek medical treatment as soon as possible.