Treatment options for nasal and sinus cancer

Early diagnosis of nasal and paranasal sinus cancer means that it will be easier to control. It is also possible to cure it at this stage. Surgery alone will cure some types, but others will respond better to a combination of treatments.

Planning your treatment

Your doctor will plan your treatment according to:

  • the type of cancer you have
  • whether the cancer has spread (the stage)
  • what the cells look like under a microscope (the grade)
  • your general health

Surgery

Surgery is a common treatment for nasal cavity and paranasal sinus tumours. The type of operation you have will depend on the position of the cancer and its size. Most surgery is performed under general anaesthetic. During surgery, your surgeon will examine the area around the tumour and remove a margin of normal tissue. This lowers the risk of the cancer coming back.

They might also remove some of the lymph nodes during the procedure to find out whether it has spread. Sometimes the cancer can spread to lymph nodes in your neck. You might have all the nodes on one or both sides of your neck removed when this happens. Your doctor may call this operation a modified radical or radical neck dissection.

Radiotherapy

Radiotherapy on its own can treat some types of nasal cavity and paranasal sinus cancers. This is usually when the cancer hasn't spread. It will cure most people with small tumours of the nose (nasal cavity).

An advantage is that you don't have any tissue removed, so it causes less of a change to your appearance.

Your doctor may recommend that you have radiotherapy if you have an operation first. This will get rid of any remaining cancer cells and lowers the risk of the cancer coming back. 

Sometimes radiotherapy is combined with chemotherapy to make the treatment more effective. Radiotherapy with chemotherapy (chemoradiotherapy) or chemotherapy on its own can help to shrink advanced cancers Open a glossary item before surgery. Advanced cancers are not easy to treat with surgery alone. 

Chemotherapy

You might have chemotherapy for any of the following reasons:

  • before or after surgery or radiotherapy
  • to treat some cancers that have spread to other parts of the body
  • if your cancer has come back after surgery and radiotherapy
  • during a course of radiotherapy (chemoradiotherapy) for locally advanced cancer

Because nasal and paranasal sinus cancers are rare, there have been no large trials on the use of chemoradiotherapy compared to treatment with radiotherapy alone. Trials like this have been carried out for the more common head and neck cancers.

Having chemoradiotherapy has shown slightly better outcomes for other types of squamous cell head and neck cancers compared to radiotherapy treatment alone, especially where the cancer is aggressive.

You may have chemoradiotherapy for these reasons if your doctor feels you are medically fit to tolerate it. Chemoradiotherapy has more side effects than radiotherapy alone.

Targeted drugs and immunotherapy

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack the cancer. They are called immunotherapies.

Targeted cancer drugs and immunotherapy are not part of the standard treatment for nasal and paranasal sinus cancer.

You might have these treatments if you have a nasal and paranasal sinus melanoma with changes (mutations) in the BRAF gene. This genetic change makes the melanoma cells produce too much BRAF protein, which can make melanoma cells grow.

Talk to your doctor if you want to know more about these treatments for nasal and paranasal sinus cancer.

If your cancer has spread

Surgery won't cure your cancer if it has already spread to another part of your body. It might help to control the cancer for a time and reduce symptoms.

A large cancer can start to block your airway. In these situations your doctor might recommend surgery to remove all or part of the cancer. This will make your breathing easier.

Your doctor may also suggest:

  • surgery and radiotherapy together
  • radiotherapy alone
  • chemotherapy alone or with radiotherapy (chemoradiotherapy)
  • newer treatments such as immunotherapy or targeted cancer drugs

Treatments that are still in development might be another option for you. This will mean taking part in a clinical trial. 

Palliative care

Your doctor is also likely to refer you to a palliative care team. They are health care professionals who specialise in people whose cancer isn't curable.

Some people assume that they are going to die very soon when their doctor suggests cancer is not curable. This is often not the case. It also doesn’t mean that the doctors who have been caring for you up until now won’t be involved in your care.

Palliative care means:

  • controlling any symptoms you have, such as pain, sickness or breathing problems
  • giving treatment that can shrink the cancer and control symptoms
  • supporting you with both physical care and psychological care
  • ensuring that you have the best possible care in place before going home from hospital

Deciding on treatment

Your specialist may advise surgery as the best treatment for you. This can be because of the stage or position of your cancer. Or they might suggest that radiotherapy is better. This can be with or without chemotherapy. You may have fewer problems after treatment. 

Your specialist may also suggest that surgery, radiotherapy and chemotherapy will be the best treatment combination for you.

In some situations, you may have a choice between types of treatment. Your doctor and specialist head and neck cancer nurse will be able to help you decide what is best for you.

You might want to get a second opinion before you have your treatment. This can give you more information. You might also feel more confident about your treatment plan. Most doctors are happy to refer you to another specialist for a second opinion.

Getting a second opinion doesn't mean that the second doctor will take over your care. Your original specialist will usually still manage your treatment.

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