Treatment by stage for nasal and sinus cancer

Stage means how far the cancer has grown. You can find a description of the stages of nasal cavity and paranasal sinus cancers in the treating nasal cavity and paranasal sinus cancer section of CancerHelp UK.

Stage matters because it plays a large part in deciding on treatment. Doctors will base their treatment decisions for nasal cavity and paranasal sinus cancers on the type and location of your tumour and the stage - its size and spread.

Stage1

If you have stage 1 maxillary sinus cancer, you are most likely to have surgery. The operation, called a maxillectomy involves removing the bone and tissue from the maxillary sinus. You may need to have radiotherapy after your operation to destroy any cancer cells that may still be there. You may need this if the surgeon

• Could not remove all the tumour or
• Could not remove a large enough ‘safety margin’ of healthy tissue from around the tumour

Stage 2

If you have stage 2 maxillary sinus cancer, you are most likely to have either

• Surgery alone (maxillectomy) or
• Radiotherapy before or after surgery

If you have either stage 1 or 2 maxillary sinus cancer and you are not fit enough to have surgery, you will probably have radiotherapy alone.

Stage 3

Treatment for stage 3 maxillary sinus cancer is surgery (radical or extended maxillectomy) and radiotherapy. You may have the radiotherapy before or after surgery.

Some people have radiotherapy or chemotherapy to shrink the cancer before surgery. This makes it easier for your surgeon to remove the cancer. You may hear this called ‘neoadjuvant treatment’.

If the cancer has spread to the lymph nodes, you will need an operation called a neck dissection or radiotherapy to get rid of any cancer cells in this area.

Stage 4

Radiotherapy is usually the treatment for stage 4 maxillary sinus cancer. If your sinuses are very blocked you may have surgery to relieve this before your radiotherapy. But this will not completely remove your cancer.

Using surgery to treat ethmoid sinus cancer is sometimes difficult. This is because these sinuses are very close to your eye sockets and the base of your skull. Operations tend to be more extensive than those for maxillary sinus cancer.

Stage 1 and 2

If you have a small stage 1 or 2 ethmoid sinus cancer, your doctor may be able to completely remove it with an operation called an ethmoidectomy. But you are more likely to have radiotherapy for these early stage cancers. This works just as well as surgery.

Stage 3 and 4

If you have these stages of ethmoid sinus cancer, you will have a combination of craniofacial surgery and radiotherapy. You will have the radiotherapy either before or after your surgery.

Because of where these sinuses are, they are very difficult to get to during surgery. Doctors will usually use radiotherapy to treat these cancers.

If you have cancer of the nasal cavity your treatment will depend on where the tumour is and its stage. If the cancer is in the tissue separating the two sides of the nose (your nasal septum) you will most likely have surgery.

For cancers elsewhere in the nasal cavity, radiotherapy works just as well as surgery. It is often the preferred treatment because it does not change the appearance of the nose as much as surgery. If the cancer is very advanced, your doctor may suggest both treatments, with radiotherapy before or after surgery.

This includes lymphomas, sarcomas and melanomas. Treatment for lymphomas of the nasal cavity and paranasal sinuses is the same as for other types of lymphoma. Look in the treating non Hodgkin’s lymphoma section of CancerHelp UK for information about radiotherapy and chemotherapy to treat this type of cancer.

If you have a melanoma or sarcoma of the nasal cavity or paranasal sinuses, you will most likely have surgery. Click on the links below to find out about

• Surgery for sarcoma
• Surgery for melanoma

Note - the above links will take you to different cancer sections on CancerHelp UK. If you want to return to this nasal and sinus cancer section, use the back button at the top left of your screen.

Your treatment depends on where the cancer has come back and the treatment you had first time round. Your doctors may choose a different treatment from what you had before. Unfortunately, once a nasal or sinus cancer has come back, it isn’t usually possible to cure it. But treatment can help to relieve symptoms.

If you had radiotherapy to treat maxillary or ethmoid sinus cancer or nasal cavity cancer the first time round, then this time you may have craniofacial surgery.

If you previously had surgery, this time you will have radiotherapy. If radiotherapy or surgery don’t help, you may then have chemotherapy alone or combined with biological therapy

If your cancer has come back in the sphenoid sinuses you can have chemotherapy.