SINONASAL MALIGNANCIES
Sinonasal malignant tumors are rare tumors that constitute about 3% of tumors in the upper respiratory tract. Only a fraction arises at the nasal cavity and majority of the rest arise from paranasal sinuses (maxillary sinus, ethmoid sinus, frontal and sphenoid sinus). Their proximity to vital structures such as the brain, optic nerves, and internal carotid artery pose significant challenges for their treatment and may be the source of significant morbidity to the patients.
Types of Sinonasal Malignancies
Types
These tumors may be epithelial tumors (squamous cell carcinoma, olfactory neuroblastoma etc), nonepithelial (like various types of sarcomas), mesenchymal or lymphoreticular.
Risk Factors
Risk factors for sinonasal malignancies include smoking and occupational exposure to soft and hard wood dust, heavy metals.
Symptoms
Patients with sinonasal malignancies can present with symptoms of nasal blockage, headache and facial pain, running nose, bleeding from nose, loss of smell, feeling of a growth inside nose and in advanced stages swelling of cheek, broadening of nasal bridge, difficulties in vision etc.
Diagnosis
Diagnosis typically involves biopsy from the lesion under endoscopic guidance, cross-sectional imaging (MRI or CT scans) of face and neck, distant metastatic workup (CT thorax or PET CECT scans).
Treatment
Surgery forms the mainstay of treatment for most of the sinonasal tumors. Surgery may be solely endoscopic (through the nose) or open approach (craniofacial resection) or a combination of both depending upon the extent of tumor. Radiation therapy is often required in advanced stages and in aggressive tumor histology. Radiation alone, without surgery is reserved for unresectable cases, in patients who are not fit for surgery and in certain lymphoreticular cancers. Chemotherapy may be considered before surgery in some cases to shrink the tumor and render it operable.
Prognosis
The prognosis of sinonasal tumors varies depending upon the tumor variety, stage of presentation, age of the patient and type of treatment. Usually patient needs to be on follow up lifelong and requires examination by an endoscope and if required an imaging (CT or MRI scan).