Stage 4 Sinus Cancer Symptoms

Introduction:

Sinuses are mucous-lined hollow spaces that are present inside the bones of the face and skull. They are also described as air cavities. Paranasal sinuses are the types of sinuses that surround the nasal cavity. They are a group of four paired sinuses, including;

• Maxillary sinuses (largest of all paranasal air sinuses. It is located above the roots of maxillary teeth with proximity to the nasal cavity).

• Frontal sinuses (seen behind eyebrow ridges).

• Ethmoidal sinuses (located in the ethmoid bone).

• Sphenoidal sinuses (located within the body of sphenoid bone).

The main functions of paranasal air sinuses are:

• They help in lightening the skull by decreasing its weight.

• Increase voice resonance.

• Regulate intranasal pressure.

• Provide proper conditioning to the inspired air (that is, warming and humidifying the inspired air).

What Is Sinus Cancer?

Sinus cancer refers to cancer that starts in the paranasal air sinus. It is a rare type of cancer that can be cured if diagnosed early. The five-year survival rate is 58 % in paranasal air sinus cancer. Sinus cancer most commonly affects the nasal cavity and paranasal sinuses, including the maxillary sinus, ethmoid sinus, etc. They are more common in men. More than half of the sinus cancers are seen in patients older than 55 years of age.

What Are the Different Types of Sinus Cancer?

Based on the different types of cells involved, sinus cancer is classified into the following:

• Squamous cell carcinoma (common skin cancer that affects squamous cells).

• Mucosa cell carcinoma (cancer that affects mucous cells).

• Adenoid cystic cell carcinoma (cancer that occurs in the glands that make saliva).

• Acinic cell carcinoma (cancer involving minor salivary glands).

• Sinonasal undifferentiated carcinoma (cancer that affects paranasal sinuses or nasal cavity).

Based on the location, sinus cancer is classified as:

• Nasal cavity cancer.

• Maxillary sinus cancer - It is the most common type of paranasal air sinus cancer.

• Ethmoidal sinus cancer - It is a rare paranasal sinus cancer that develops in the ethmoid sinus.

What Are the Causes of Sinus Cancer?

The risk factors for sinus cancer include lifestyle and environmental factors such as,

• Cigarette smoking.

• Exposure to chemicals and workplace exposures like wood dust from carpentry, leather dust, nickel and chromium dust, etc.

• Exposure to radium (a radioactive element).

• Human papillomavirus infection (HPV).

• Exposure to radiation therapy.

What Are the Stages of Sinus Cancer?

The different stages of sinus cancer are given by the American Joint Committee on Cancer (AJCC). It is differentiated based on three concepts:

• The Extent of Tumor Growth or Invasion:

It is categorized based on queries like where the tumor is located and how much it has grown into nearby structures.

• Lymph Node Involvement:

It is categorized based on whether there is lymph node involvement? How many lymph nodes are affected? And whether the spread of cancer to the lymph nodes is ipsilateral or contralateral?

• Metastasis:

This categorization depends on; whether there is any metastasis? And which are the structures affected by metastasis?

Stages of Sinus Cancer:

• Stage 0 (Tis N0 M0): This stage is also referred to as carcinoma in situ. In this stage, abnormal cells are detected in the inner lining of the maxillary sinus or nasal cavity, or ethmoid sinus. No lymph node involvement or metastasis is seen in this stage.

• Stage 1 (T1 N0 M0): In this stage, the tumor invades any one of the maxillary sinuses, ethmoid sinuses, or the nasal cavity. Cancer might spread to the bone too. No lymph node involvement or metastasis is seen in this stage.

• Stage 2 (T2 N0 M0): In this stage, tumor invasion is seen in more than one of the sinuses, both the nasal cavity and ethmoid sinus. Tumor spread is seen in the bone surrounding the maxillary sinus. No lymph node involvement or metastasis is seen in this stage.

• Stage 3: (T3 N0 M0): Tumor invades the palate, bottom of the eye socket, maxillary sinus, or cribriform plate. No lymph node involvement or metastasis is seen.

• T1 to T3 N1 M0: Tumor growth may or may not be seen outside the nasal cavity, in nearby structures, or ethmoid sinus. Ipsilateral lymph node involvement, which is not larger than three centimeters, is seen. No metastasis is seen.

• Stage 4:

Stage 4 a :

• T4a N0 or N1 M0: Tumor growth is seen in the frontal sinus, sphenoidal sinus, skin of cheek or nose, eye socket, pterygoid plates, etc. lymph node involvement may or may not be seen in this stage. If lymph node involvement is seen (N1), it is not larger than three centimeters across. No metastasis is seen. This stage is also known as a moderately advanced local disease (T4a).

• T1 - 4a N2 M0: Tumor growth may or may not have been seen in the ethmoid sinus or structures outside the nasal cavity.

The cancer spreads to the ipsilateral lymph nodes of the neck, and the tumor size is larger than three centimeters but not greater than six centimeters across.

(or)

Cancer invasion into multiple lymph nodes on the same side of the neck, and tumor size is not larger than six centimeters across.

(or)

Cancer invasion to at least a single lymph node on the opposite side of the neck and tumor growth is not larger than six centimeters.

(or)

The cancer spreads to ipsilateral lymph node involvement, and the tumor growth is three centimeters or lesser. No metastasis is seen in this stage.

Stage 4b:

• T4b Any N M0: In this stage, the tumor invades the brain, tissues covering the brain, cranial nerves, eye socket, or nasopharynx. This stage is also known as a very advanced local disease. Lymph node involvement may or may not be seen. Metastasis is not seen in this stage.

(or)

• AnyT N3 M0: Cancer spread to at least a single lymph node that is not greater than 6cm across

(or)

The cancer spreads to a single ipsilateral lymph node on the same side of the tumor that is larger than three centimeters.

(or)

Multiple lymph node involvements are seen either on the same or opposite side of the tumor.

Stage 4c:

• AnyT AnyN M1: Cancer spread is seen in structures outside the nasal cavity or ethmoidal sinus. Lymph node involvement may or may not see. Metastasis is seen in this stage.

What Are the Signs and Symptoms of Stage 4 Sinus Cancer?

The signs and symptoms of stage 4 sinus cancer include:

• Persistent blockage or congestion of sinuses.

• Nasal blockage.

• Postnasal drip.

• Loss of smell.

• Nose bleeding.

• Blurred vision.

• Watery eyes.

• Alterations in voice and breathing.

• Decreased mouth opening.

• Loosening of teeth.

At a later stage, the following symptoms are seen:

• Eye pain.

• Numbness and pain over face, teeth, and ears.

• Swollen glands in the neck.

• Double vision or partial loss of vision.

• Tumor growth in the face, the roof of the mouth, and the nose.

When to Consult a Doctor?

If you experience any sinus cancer-related symptoms and if it becomes persistent and gets alleviated, then do consult your doctor.

How Is It Diagnosed?

Doctors may carry out the following tests to diagnose and delineate stage 4 sinus cancer from other cancers. That include:

• Medical history and physical examination.

• Getting examined by an otolaryngologist (a specialized doctor who is an expert in treating diseases of the nose, ear, and eyes) to know more details about the condition.

• Imaging tests like X-rays, MRI (magnetic resonance imaging), PET (positron emission tomography) scan, etc.

• A bone scan is suggested if there is any bone metastasis.

• A biopsy helps in giving a definitive diagnosis. It determines how aggressively the cancer has spread and helps differentiate the different stages of sinus cancer.

How to Treat Stage 4 Sinus cancer?

The treatment options for treating stage 4 sinus cancer include:

• Surgery :

• For treating small and benign tumors, an open external ethmoidectomyis carried out. Tumors in the maxillary sinus are treated by this method.

• Open craniofacial resectionis carried out in treating advanced cancer stages where the cancer spread involves the skull or brain, frontal sinus, and ethmoid sinus.

• Lymph node dissection is carried out if cancer has spread into the lymph nodes.

• Radiation Therapy:

• It kills cancer cells using high-energy X-rays. In stage 4 sinus cancer, chemoradiotherapy (acombination of chemotherapy and radiation therapy)is suggested.

• Chemotherapy:

This therapy uses anticancer drugs to kill cancer cells. It is of two types;

1. Adjuvant Chemotherapy: After surgery, chemotherapy is carried out to treat the condition better. This is known as adjuvant chemotherapy.
2. Neoadjuvant Chemotherapy: It is carried out before surgery, and very often it is used together with radiation therapy.

Some of the other treatments include,

1. Immunotherapy - This uses medicines to improve the patient's immune system to kill cancer cells more effectively.
2. Targeted Drug Therapy - Therapy in which drugs specifically kill cancer cells and are different from traditional chemotherapy.

Conclusion:

Stage 4 sinus cancer symptoms should be diagnosed earlier, and it should be treated according to the treatment options suggested by specialized doctors like otolaryngologists. Do consult your doctor if you find any suspicious sinus cancer-related symptoms in your body.