21st Century Adult Cancer Sourcebook: Paranasal Sinus and Nasal Cavity Cancer - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Paranasal Sinus and Nasal Cavity Cancer Patient Information
Chapter 2A: Paranasal Sinus and Nasal Cavity Cancer Health Professional
Chapter 3A: Paranasal Sinus and Nasal Cavity Cancer Background Information
Chapter 4A: Paranasal Sinus and Nasal Cavity Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Paranasal Sinus and Nasal Cavity Cancer Patient Information
Paranasal Sinus and Nasal Cavity Cancer Treatment
Patient Version
Last Modified: 09/08/2011
General Information About Paranasal Sinus and Nasal Cavity Cancer
Key Points for This Section
* Paranasal sinus and nasal cavity cancer is a disease in which malignant (cancer) cells form in the tissues of the paranasal sinuses and nasal cavity.
* Different types of cells in the paranasal sinus and nasal cavity may become malignant.
* Being exposed to certain chemicals or dust in the workplace can increase the risk of developing paranasal sinus and nasal cavity cancer.
* Possible signs of paranasal sinus and nasal cavity cancer include sinus problems and nosebleeds.
* Tests that examine the sinuses and nasal cavity are used to detect (find) and diagnose paranasal sinus and nasal cavity cancer.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Paranasal sinus and nasal cavity cancer is a disease in which malignant (cancer) cells form in the tissues of the paranasal sinuses and nasal cavity.
Paranasal sinuses
"Paranasal" means near the nose. The paranasal sinuses are hollow, air-filled spaces in the bones around the nose. The sinuses are lined with cells that make mucus, which keeps the inside of the nose from drying out during breathing.
There are several paranasal sinuses named after the bones that surround them:
* The frontal sinuses are in the lower forehead above the nose.
* The maxillary sinuses are in the cheekbones on either side of the nose.
* The ethmoid sinuses are beside the upper nose, between the eyes.
* The sphenoid sinuses are behind the nose, in the center of the skull.
Nasal cavity
The nose opens into the nasal cavity, which is divided into two nasal passages. Air moves through these passages during breathing. The nasal cavity lies above the bone that forms the roof of the mouth and curves down at the back to join the throat. The area just inside the nostrils is called the nasal vestibule. A small area of special cells in the roof of each nasal passage sends signals to the brain to give the sense of smell.
Together the paranasal sinuses and the nasal cavity filter and warm the air, and make it moist before it goes into the lungs. The movement of air through the sinuses and other parts of the respiratory system help make sounds for talking.
Different types of cells in the paranasal sinus and nasal cavity may become malignant.
The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma. This type of cancer forms in the squamous cells (thin, flat cells) lining the inside of the paranasal sinuses and the nasal cavity.
Other types of paranasal sinus and nasal cavity cancer include the following:
* Melanoma: Cancer that starts in cells called melanocytes, the cells that give skin its natural color.
* Sarcoma: Cancer that starts in muscle or connective tissue.
* Inverting papilloma: Benign tumors that form inside the nose. A small number of these change into cancer.
* Midline granulomas: Cancer of tissues in the middle part of the face.
Being exposed to certain chemicals or dust in the workplace can increase the risk of developing paranasal sinus and nasal cavity cancer.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for paranasal sinus and nasal cavity cancer include the following:
* Being exposed to certain workplace chemicals or dust, such as those found in the following jobs:
* Furniture-making.
* Sawmill work.
* Woodworking (carpentry).
* Shoemaking.
* Metal-plating.
* Flour mill or bakery work.
* Being infected with human papillomavirus (HPV).
* Being male and older than 40 years.
* Smoking.
Possible signs of paranasal sinus and nasal cavity cancer include sinus problems and nosebleeds.
These and other symptoms may be caused by paranasal sinus and nasal cavity cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:
* Blocked sinuses that do not clear, or sinus pressure.
* Headaches or pain in the sinus areas.
* A runny nose.
* Nosebleeds.
* A lump or sore inside the nose that does not heal.
* A lump on the face or roof of the mouth.
* Numbness or tingling in the face.
* Swelling or other trouble with the eyes, such as double vision or the eyes pointing in different directions.
* Pain in the upper teeth, loose teeth, or dentures that no longer fit well.
* Pain or pressure in the ear.
Tests that examine the sinuses and nasal cavity are used to detect (find) and diagnose paranasal sinus and nasal cavity cancer.
The following tests and procedures may be used:
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
* Physical exam of the nose, face, and neck: An exam in which the doctor looks into the nose with a small, long-handled mirror to check for abnormal areas and checks the face and neck for lumps or swollen lymph nodes.
* X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* Nasoscopy: A procedure to look inside the nose for abnormal areas. A nasoscope is inserted into the nose. A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
* Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
* Where the tumor is in the paranasal sinus or nasal cavity and whether it has spread.
* The size of the tumor.
* The type of cancer.
* The patient's age and general health.
* Whether the cancer has just been diagnosed or has recurred (come back).
Paranasal sinus and nasal cavity cancers often have spread by the time they are diagnosed and are hard to cure. After treatment, a lifetime of frequent and careful follow-up is important because there is an increased risk of developing a second kind of cancer in the head or neck.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
benign tumor (beh-NINE TOO-mer)
* A growth that is not cancer. It does not invade nearby tissue or spread to other parts of the body.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cavity (KA-vih-tee)
* A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
connective tissue (kuh-NEK-tiv TIH-shoo)
* Supporting tissue that surrounds other tissues and organs. Specialized connective tissue includes bone, cartilage, blood, and fat.
cure (kyoor)
* To heal or restore health; a treatment to restore health.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
ethmoid sinus (ETH-moyd SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). Ethmoid sinuses are found in the spongy ethmoid bone in the upper part of the nose between the eyes. They are lined with cells that make mucus to keep the nose from drying out.
follow-up (FAH-loh-up)
* Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
frontal sinus (FRUN-tul SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two, large frontal sinuses in the frontal bone, which forms the lower part of the forehead and reaches over the eye sockets and eyebrows. The frontal sinuses are lined with cells that make mucus to keep the nose from drying out.
human papillomavirus (HYOO-mun PA-pih-LOH-muh-VY-rus)
* A type of virus that can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of human papillomavirus can cause cervical cancer. Human papillomavirus may also play a role in some other types of cancer, such as anal, vaginal, vulvar, penile, oropharyngeal, and squamous cell skin cancers. Also called HPV.
infection (in-FEK-shun)
* Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
inverted papilloma (in-VER-ted PA-pih-LOH-muh)
* A type of tumor in which surface epithelial cells grow downward into the underlying supportive tissue. It may occur in the nose and/or sinuses or in the urinary tract (bladder, renal pelvis, ureter, urethra). When it occurs in the nose or sinuses, it may cause symptoms similar to those caused by sinusitis, such as nasal congestion. When it occurs in the urinary tract, it may cause blood in the urine.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
maxillary sinus (MAK-sih-LAYR-ee SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two large maxillary sinuses, one in each of the maxillary bones, which are in the cheek area next to the nose. The maxillary sinuses are lined with cells that make mucus to keep the nose from drying out.
melanocyte (meh-LAN-oh-site)
* A cell in the skin and eyes that produces and contains the pigment called melanin.
melanoma (MEH-luh-NOH-muh)
* A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
mucus (MYOO-kus)
* A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.
nasal (NAY-zul)
* By or having to do with the nose.
nasoscope (NAY-zoh-skope)
* A thin tube-like instrument used to examine the inside of the nose. A nasoscope has a light and a lens for viewing and may have a tool to remove tissue. Also called rhinoscope.
nasoscopy (nay-ZOS-koh-pee)
* Examination of the inside of the nose using a nasoscope (or rhinoscope). A nasoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Also called rhinoscopy.
paranasal sinus (PAYR-uh-NAY-zul SY-nus)
* One of many small hollow spaces in the bones around the nose. Paranasal sinuses are named after the bones that contain them: frontal (the lower forehead), maxillary (cheekbones), ethmoid (beside the upper nose), and sphenoid (behind the nose). The paranasal sinuses open into the nasal cavity (space inside the nose) and are lined with cells that make mucus to keep the nose from drying out during breathing.
paranasal sinus and nasal cavity cancer (PAYR-uh-NAY-zul SY-nus ... NAY-zul KA-vuh-tee KAN-ser)
* Cancer that forms in tissues of the paranasal sinuses (small hollow spaces in the bones around the nose) or nasal cavity (the inside of the nose). The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma (cancer that begins in flat cells lining these tissues and cavities).
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
* An exam of the body to check for general signs of disease.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
recur
* To come back or to return.
respiratory system (RES-pih-ruh-TOR-ee SIS-tem)
* The organs that are involved in breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs. Also called respiratory tract.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
sarcoma (sar-KOH-muh)
* A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
sphenoid sinus (SFEE-noyd SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two large sphenoid sinuses in the sphenoid bone, which is behind the nose between the eyes. The sphenoid sinuses are lined with cells that make mucus to keep the nose from drying out.
squamous cell (SKWAY-mus sel)
* Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh)
* Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
throat (throte)
* The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Stages of Paranasal Sinus and Nasal Cavity Cancer
Key Points for This Section
* After paranasal sinus and nasal cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the paranasal sinuses and nasal cavity or to other parts of the body.
* There are three ways that cancer spreads in the body.
* There is no standard staging system for cancer of the sphenoid and frontal sinuses.
* The following stages are used for maxillary sinus cancer:
* Stage 0 (Carcinoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
* The following stages are used for nasal cavity and ethmoid sinus cancer:
* Stage 0 (Carcinoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
After paranasal sinus and nasal cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the paranasal sinuses and nasal cavity or to other parts of the body.
The process used to find out if cancer has spread within the paranasal sinuses and nasal cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
* X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
* Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an opening in the body, such as the nose or mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. Sometimes a substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
* Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
There is no standard staging system for cancer of the sphenoid and frontal sinuses.
The following stages are used for maxillary sinus cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed in the mucous membranes of the maxillary sinus.
Stage II
In stage II, cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.
Stage III
In stage III, cancer has spread to any of the following:
* Bone at the back of the maxillary sinus.
* Tissues under the skin.
* The eye socket.
* The base of the skull.
* The ethmoid sinuses.
or
Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:
* The lining of the maxillary sinus.
* Bones around the maxillary sinus, including the roof of the mouth and the nose.
* Tissues under the skin.
* The eye socket.
* The base of the skull.
* The ethmoid sinuses.
Stage IV
Stage IV is divided into stage IVA, IVB, and IVC.
Stage IVA
In stage IVA, cancer has spread either:
* to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
* to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
* to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
and cancer has spread to any of the following:
* The lining of the maxillary sinus.
* Bones around the maxillary sinus, including the roof of the mouth and the nose.
* Tissues under the skin.
* The eye socket.
* The base of the skull.
* The ethmoid sinuses.
or
Cancer has spread to any of the following:
* The front of the eye.
* The skin of the cheek.
* The base of the skull.
* Behind the jaw.
* The bone between the eyes.
* The sphenoid or frontal sinuses.
and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
Stage IVB
In stage IVB, cancer has spread to any of the following:
* The back of the eye.
* The brain.
* The middle parts of the skull.
* The nerves in the head that go to the brain.
* The upper part of the throat behind the nose.
* The base of the skull.
and cancer may be found in one or more lymph nodes of any size, anywhere in the neck.
or
Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.
Stage IVC
In stage IVC, cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.
The following stages are used for nasal cavity and ethmoid sinus cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.
Stage II
In stage II, cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.
Stage III
In stage III, cancer has spread to any of the following:
* The eye socket.
* The maxillary sinus.
* The roof of the mouth.
* The bone between the eyes.
or
Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:
* The nasal cavity.
* The ethmoid sinus.
* The eye socket.
* The maxillary sinus.
* The roof of the mouth.
* The bone between the eyes.
Stage IV
Stage IV is divided into stage IVA, IVB, and IVC.
Stage IVA
In stage IVA, cancer has spread either:
* to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
* to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
* to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
and cancer has spread to any of the following:
* The nasal cavity.
* The ethmoid sinus.
* The eye socket.
* The maxillary sinus.
* The roof of the mouth.
* The bone between the eyes.
or
Cancer has spread to any of the following:
* The front of the eye.
* The skin of the nose or cheek.
* Front parts of the skull.
* The base of the skull.
* The sphenoid or frontal sinuses.
and cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
Stage IVB
In stage IVB, cancer has spread to any of the following:
* The back of the eye.
* The brain.
* The middle parts of the skull.
* The nerves in the head that go to the brain.
* The upper part of the throat behind the nose.
* The base of the skull.
and cancer may be found in one or more lymph nodes of any size, anywhere in the neck.
or
Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.
Stage IVC
In stage IVC, cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
bone scan (bone skan)
* A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
carcinoma in situ (KAR-sih-NOH-muh in SY-too)
* A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
cavity (KA-vih-tee)
* A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
centimeter (SEN-tih-MEE-ter)
* A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
endoscope (EN-doh-SKOPE)
* A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.
endoscopy (en-DOS-koh-pee)
* A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
ethmoid sinus (ETH-moyd SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). Ethmoid sinuses are found in the spongy ethmoid bone in the upper part of the nose between the eyes. They are lined with cells that make mucus to keep the nose from drying out.
frontal sinus (FRUN-tul SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two, large frontal sinuses in the frontal bone, which forms the lower part of the forehead and reaches over the eye sockets and eyebrows. The frontal sinuses are lined with cells that make mucus to keep the nose from drying out.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph vessel (limf ...)
* A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
* The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
maxillary sinus (MAK-sih-LAYR-ee SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two large maxillary sinuses, one in each of the maxillary bones, which are in the cheek area next to the nose. The maxillary sinuses are lined with cells that make mucus to keep the nose from drying out.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
MRI
* A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
mucous membrane (MYOO-kus MEM-brayn)
* The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucous membrane make mucus (a thick, slippery fluid). Also called mucosa.
nasal (NAY-zul)
* By or having to do with the nose.
nerve (nerv)
* A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
paranasal sinus (PAYR-uh-NAY-zul SY-nus)
* One of many small hollow spaces in the bones around the nose. Paranasal sinuses are named after the bones that contain them: frontal (the lower forehead), maxillary (cheekbones), ethmoid (beside the upper nose), and sphenoid (behind the nose). The paranasal sinuses open into the nasal cavity (space inside the nose) and are lined with cells that make mucus to keep the nose from drying out during breathing.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
scanner (SKA-ner)
* In medicine, an instrument that takes pictures of the inside of the body.
sphenoid sinus (SFEE-noyd SY-nus)
* A type of paranasal sinus (a hollow space in the bones around the nose). There are two large sphenoid sinuses in the sphenoid bone, which is behind the nose between the eyes. The sphenoid sinuses are lined with cells that make mucus to keep the nose from drying out.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 maxillary sinus carcinoma in situ (... MAK-sih-LAYR-ee SY-nus KAR-sih-NOH-muh in SY-too)
* Abnormal cells are found in the innermost lining of the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue.
stage 0 nasal cavity and ethmoid sinus carcinoma in situ (... NAY-zul KA-vih-tee … ETH-moyd SY-nus KAR-sih-NOH-muh in SY-too)
* Abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue.
stage I maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Cancer has formed in the mucous membranes of the maxillary sinus.
stage I nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Cancer is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.
stage II maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.
stage II nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.
stage III maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Cancer (1) has spread to any of the following: bone at the back of the maxillary sinus, tissues under the skin, the eye socket, the base of the skull, and/or the ethmoid sinuses; or (2) has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following: the lining of the maxillary sinus, bones around the maxillary sinus (including the roof of the mouth and the nose), tissues under the skin, the eye socket, the base of the skull, and/or the ethmoid sinuses.
stage III nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Cancer (1) has spread to any of the following: the eye socket, maxillary sinus, roof of the mouth, and/or the bone between the eyes; or (2) has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following: the nasal cavity, ethmoid sinus, eye socket, maxillary sinus, roof of the mouth, and/or the bone between the eyes.
stage IVA maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Stage IV maxillary sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVA, cancer (1) has spread to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters, and cancer has also spread to any of the following: the lining of the maxillary sinus, bones around the maxillary sinus (including the roof of the mouth and the nose), tissues under the skin, the eye socket, the base of the skull, and/or the ethmoid sinuses; or (2) has spread to any of the following: the front of the eye, skin of the cheek, base of the skull, behind the jaw, the bone between the eyes, and/or the sphenoid or frontal sinuses, and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
stage IVA nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Stage IV nasal cavity and ethmoid sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVA, cancer (1) has spread to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters, and cancer has also spread to any of the following: the nasal cavity, ethmoid sinus, eye socket, maxillary sinus, roof of the mouth, and/or the bone between the eyes; or (2) has spread to any of the following: the front of the eye, skin of the nose or cheek, front parts of the skull, base of the skull, and/or the sphenoid or frontal sinuses, and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
stage IVB maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Stage IV maxillary sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVB, cancer (1) has spread to any of the following: the back of the eye, brain, middle parts of the skull, nerves in the head that go to the brain, upper part of the throat behind the nose, and/or the base of the skull, and cancer may be found in one or more lymph nodes of any size, anywhere in the neck; or (2) is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.
stage IVB nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Stage IV nasal cavity and ethmoid sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVB, cancer (1) has spread to any of the following: the back of the eye, brain, middle parts of the skull, nerves in the head that go to the brain, upper part of the throat behind the nose, and/or the base of the skull, and cancer may be found in one or more lymph nodes of any size, anywhere in the neck; or (2) is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.
stage IVC maxillary sinus cancer (...MAK-sih-LAYR-ee SY-nus KAN-ser)
* Stage IV maxillary sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVC, cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.
stage IVC nasal cavity and ethmoid sinus cancer (...NAY-zul KA-vih-tee…ETH-moyd SY-nus KAN-ser)
* Stage IV nasal cavity and ethmoid sinus cancer is divided into stages IVA, IVB, and IVC. In stage IVC, cancer may be found anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.
staging (STAY-jing)
* Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
throat (throte)
* The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
Recurrent Paranasal Sinus and Nasal Cavity Cancer
Recurrent paranasal sinus and nasal cavity cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the paranasal sinuses and nasal cavity or in other parts of the body.
Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with paranasal sinus and nasal cavity cancer.
* Patients with paranasal sinus and nasal cavity cancer should have their treatment planned by a team of doctors with expertise in treating head and neck cancer.
* Three types of standard treatment are used:
* Surgery
* Radiation therapy
* Chemotherapy
* New types of treatment are being tested in clinical trials.
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with paranasal sinus and nasal cavity cancer.
Different types of treatment are available for patients with paranasal sinus and nasal cavity cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Patients with paranasal sinus and nasal cavity cancer should have their treatment planned by a team of doctors with expertise in treating head and neck cancer.
Treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. The medical oncologist works with other doctors who are experts in treating patients with head and neck cancer and who specialize in certain areas of medicine and rehabilitation. Patients who have paranasal sinus and nasal cavity cancer may need special help adjusting to breathing problems or other side effects of the cancer and its treatment. If a large amount of tissue or bone around the paranasal sinuses or nasal cavity is taken out, plastic surgery may be done to repair or rebuild the area. The treatment team may include the following specialists:
* Radiation oncologist.
* Neurologist.
* Oral surgeon or head and neck surgeon.
* Plastic surgeon.
* Dentist.
* Nutritionist.
* Speech and language pathologist.
* Rehabilitation specialist.
Three types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is a common treatment for all stages of paranasal sinus and nasal cavity cancer. A doctor may remove the cancer and some of the healthy tissue and bone around the cancer. If the cancer has spread, the doctor may remove lymph nodes and other tissues in the neck.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. The total dose of radiation therapy is sometimes divided into several smaller, equal doses delivered over a period of several days. This is called fractionation. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The thyroid gland may be tested before and after treatment.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Head and Neck Cancer 1 for more information.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI Web site 2.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
adjuvant therapy (A-joo-vunt THAYR-uh-pee)
* Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.