Advances in Nasal Cavity and Paranasal Sinus Cancer Treatment
New drug and radiation therapies offer better outcomes for these rare cancers.
By Chris Iliades, MD
Medically Reviewed by Pat F. Bass III, MD, MPH
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The head and neck cancers of the nasal cavity and paranasal sinuses start inside the nose or the paranasal sinuses, the air-filled cavities inside the cheekbones and above and behind the nasal cavity. Recent advances in treatment offer a better outcome for people with these rare cancers.
"What's new about nasal cavity and paranasal sinus cancer is that radical surgery is no longer the main treatment," says Jan Akervall, MD, PhD, a head and neck cancer specialist at Beaumont Hospitals in Royal Oak, Mich. "Years ago, we would surgically remove these cancers with big margins of normal tissue. Many times this meant sacrificing an eye or creating a large facial defect. Today, we use a combination of therapies and try to save as much function as possible. We can do as well or better with combinations of minimally invasive surgery, radiation, and chemotherapy."
Nasal Cavity and Paranasal Sinus Cancer: Causes and Prevention
Nasal cavity and paranasal sinus cancers are related to all types of tobacco use and heavy consumption of alcohol. This may account for about 85 percent of these and other head and neck cancers. The most effective prevention is to avoid tobacco products.
Another cause of nasal cavity and paranasal sinus cancer is exposure to irritating particles in the workplace. These include dusts from working with wood, leather, metals, asbestos, and flour. Wearing a protective mask if you are exposed to any of these workplaces is another way of preventing nasal cavity and paranasal sinus cancer.
Most recently, the human papillomavirus (HPV) has been found to be a risk factor for head and neck cancer. Although HPV is primarily linked to mouth and throat cancer, there is some research suggesting it may be a factor in nasal cavity and paranasal sinus cancer. "As smoking and alcohol use decrease, HPV will become a more important cause of some head and neck cancers," says Dr. Akervall.
Since HPV also causes cervical cancer, and there is now a vaccine to prevent cervical cancer, it seems likely that HPV vaccination may also help prevent many types of head and neck cancers in the future.
Nasal Cavity and Paranasal Sinus Cancer: The Benefits of Targeted Treatment
New ways of treating nasal cavity and paranasal sinus cancers with radiation therapy — high energy directed at the cancer to stop it from growing — have replaced deforming surgical procedures. Radiation therapists can now use computer technology to focus on tumor cells while doing a better job of avoiding unaffected, non-cancerous facial structures. These new techniques, known as intensity-modulated radiotherapy or IMRT, allow doctors to get better treatment results with fewer side effects.
The drug cetuximab (Erbitux) has recently been approved for head and neck cancers. It blocks the activity of a substance called epidermal growth factor, which is needed for some cancer cells to grow. "The use of triple drug therapy, including the new drug cetuximab, has allowed us to continue to treat even more advanced cases of head and neck cancers. In the past, patients who were not cured by surgery and did not respond to radiation therapy would have been out of options," notes Akervall.
Nasal Cavity and Paranasal Sinus Cancer: The Future
"The big breakthrough for treating head and neck cancers will probably not be a single discovery, but a better combination of the different kinds of therapy we are using," says Akervall.
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