This information is about cancer of the paranasal sinus. You may find it helpful to read it alongside our general information about cancers of the head and neck, which discusses the treatments and their effects in more detail.

The spaces within the bones, behind the nose and cheeks, are called the paranasal sinuses. Each space, or sinus, is lined with cells that produce mucus to prevent the lining of the nose from drying out, and moisten the air that we breathe. When a person talks, the voice echoes through the sinuses, giving it an individual tone.

Cancer of the paranasal sinuses is rare in the West, but more common in countries such as Japan or South Africa. Less than 600 new cases of paranasal sinus cancer are diagnosed in the UK each year. This type of cancer can occur at any age, but it is very rare in people under 40. Men are twice as likely to be diagnosed with it than women.

This is a rare type of cancer and, like many other forms of cancer, the exact causes are unknown. People who use snuff for many years, or those who work in the wood or furniture industry and are exposed to wood dust, are more likely to develop paranasal sinus cancer. Smoking has also been found to increase the risk of developing cancer in this area of the body.

Paranasal sinus cancer is not infectious and cannot be passed on to other people. It is not caused by an inherited faulty gene, so other members of your family are not likely to develop it.

The symptoms can vary depending on which sinuses are affected. The most common symptoms include:

• blocked sinuses which do not clear
• pain behind the nose or in the upper teeth
• swelling around the eyes.

Other symptoms may include:

• numbness of the cheek, upper lip, upper teeth or side of the nose
• persistent nosebleeds
• headaches
• speech changes
• double vision.

These symptoms may occur due to conditions other than cancer, and most people with these symptoms will not have paranasal sinus cancer. However, like most cancers, paranasal sinus cancer is most likely to be cured when diagnosed at an early stage. Therefore, any of the above symptoms should be reported to your GP if they do not improve over a few days.

Your GP will examine you and arrange for any further tests that may be necessary. You will need to be referred to a hospital specialist for these tests, and for expert advice and treatment. The doctor at the hospital will take your full medical history, carry out a physical examination, and take blood samples to check your general health. The following tests are commonly used to make a firm diagnosis:

X-rays These may be taken to show the size and position of the cancer.

CT (computerised tomography) scan This is a sophisticated type of x-ray that builds up a detailed three-dimensional picture of the inside of the body. The scan is painless but takes about 10 minutes. It may be used to find the exact site of the cancer, or to check for any spread of the cancer. Most people who have a CT scan are given a drink or injection that enables particular areas to be seen more clearly. Before having the injection or drink, it is important to tell the person doing this test if you are allergic to iodine or have asthma.

MRI (magnetic resonance imaging) scan This scan uses magnetism instead of x-rays to form a series of cross-sectional pictures of the inside of the body. During the scan, you will be asked to lie on the couch inside a metal cylinder. You will usually be given an injection of a liquid that enables the pictures to be seen more clearly. The test can take up to an hour and is completely painless. If you don't like enclosed spaces you may find the machine claustrophobic. The machine is also quite noisy, but you will be given earplugs or headphones to wear.

Nasopharyngoscopy In this procedure a fine tube with a light at the end (nasendoscope) is guided through the nose into the sinus area. If an abnormal area is seen, a small piece of tissue will be taken to examine under a microscope for cancer cells (biopsy). This may be carried out under a local or general anaesthetic. This test can be uncomfortable and you may be given an anaesthetic spray beforehand to numb your nose and throat. You will then be asked not to eat or drink anything for about an hour afterwards, until your throat has lost the numb feeling.

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site. Knowing the particular type, and the stage, of the cancer helps the doctors to decide on the most appropriate treatment for you.

Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph glands or nodes that are linked by fine ducts containing lymph fluid. Your doctors will usually look at the lymph nodes close to the paranasal sinuses in order to assess the stage of your cancer.

The most commonly used staging system is called the TNM system.

• T refers to the tumour size
• N refers to whether or not lymph nodes are affected
• M refers to whether or not the cancer has spread to other parts of the body (metastases).

Tumour size (T)

• T1 The cancer only affects the paranasal sinus.
• T2 The cancer has begun to spread into the bones around the sinus.
• T3 The cancer is affecting any of the following; the eye socket, the tissues under the skin, base of the skull, the maxillary sinuses (in the cheek bones), the ethmoid sinuses (in the bridge of the nose) or the bones near the maxillary sinuses.
• T4 The tumour may be affecting the eye and other sinuses. It may also have spread to other parts of the body.

Lymph nodes (N)

• N0 None of the lymph nodes are affected.
• N1 The cancer has spread to one lymph node in the neck, on the same side as the tumour. The affected node is 3cm or smaller in size.
• N2a Only one lymph node is affected, and the node is between 3–6cm in size.
• N2b More than one lymph node is affected, on the same side as the tumour. None of the nodes is larger than 6cm in size.
• N2c Lymph nodes on both sides of the neck are affected. None of the nodes are larger than 6cm in size.
• N3 The affected lymph nodes are larger than 6cm in size.

Metastases (M)

• M0 The cancer has not spread to other parts of the body.
• M1 The cancer has spread to other parts of the body.

Grading

Grading refers to the appearance of the cancer cells under the microscope, and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.

Paranasal sinus cancers can start in different types of cells within the sinuses. The type of treatment given will depend on a number of things, including the position and stage of the cancer, the type of cancer, the grade, and your general health. The following treatments may be used alone or in combination with one another. Your doctor will discuss with you the most appropriate treatment for your situation.

Surgery

Surgery may be used, depending on the position of the cancer and whether or not there has been any spread into the surrounding area of lymph nodes. Surgery can sometimes be quite extensive, and in some cases skin grafts or flaps are needed.

Modern prostheses (false facial parts) can be used to give a good appearance after the surgery, if necessary. It can be difficult to prepare for and cope with this kind of surgery. However, help is available from specialist health professionals and support organisations.

Radiotherapy

Radiotherapy may be used to treat paranasal sinus cancers. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal tissue.

Depending on the type of radiotherapy treatment that you receive, you may have some side effects. These may include feeling sick (nausea) and vomiting, eye irritations (conjunctivitis), dry eyes and headaches. These symptoms can often be relieved, so it is important to tell your doctor if they occur, so that they can prescribe appropriate medicines. The side effects generally start to reduce a couple of weeks after the treatment has ended.

Hair loss only occurs where the treatment beam enters and leaves the body. Sometimes hair loss in these areas may be permanent. However, in many cases, the hair will start to grow back a few weeks after the treatment finishes.

Chemotherapy

This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Although chemotherapy is helpful for many cancers, it is not very effective for paranasal sinus cancer and is only used occasionally.

You may be offered chemotherapy as part of a cancer research trial. Before any trial is allowed to take place it must have been approved by an ethics committee, which checks that the trial is in the interest of patients.

You may be asked to take part in a clinical trial. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it involves. You may decide not to take part, or to withdraw from a trial, at any stage. You will then receive the best standard treatment available.

After your treatment is completed, you will have regular check-ups and possibly scans or x-rays. These will probably continue for several years. If you have any problems, or notice any new symptoms between these times, let your doctor know as soon as possible.

You are likely to experience a number of different emotions, from shock and disbelief to fear and anger. These feelings may be overwhelming and difficult to control, particularly if you have experienced changes in your appearance and feel self-conscious. These feelings are quite natural and it is important for you to be able to express them.

Each individual has their own way of coping with difficult situations; some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. You may wish to contact our cancer support service for information about counselling in your area.

This section has been compiled using information from a number of reliable sources, including:

• Improving Outcomes in Head and Neck Cancers. National Institute for Health and Clinical Excellence (NICE). November 2004.
• Oxford Textbook of Oncology (2nd edition). Eds Souhami et al. Oxford University Press, 2002.
• Cancer and its Management (5th edition). Eds Souhami and Tobias. Oxford Blackwell Scientific Publications, 2005.
• The Textbook of Uncommon Cancers (3rd edition). Eds Raghavan et al. Wiley, 2006.
• Cancer: Principles and Practice of Oncology (7th edition). Eds DeVita et al. Lippincott, Williams and Wilkins, 2005.

For further references, please see the general bibliography.