Sinus cancer: symptoms, causes, age and prognosis

“sinus cancer is a malignant tumor that originates in the sinuses“, defines Dr. Antoine Moya-Plana, ENT surgeon at Gustave Roussy. The sinuses are the air cavities in the bones of the skull and face. There are different cranial sinuses which are lined with mucous membranes and communicate with the nasal cavitieseach of which can be reached:

• the frontal sinuses on each side of the forehead above the orbits,
• the maxillary sinuses at the level of the cheeks,
• the ethmoid sinusesbetween the two orbits,
• the sphenoid sinuses near the bone of the same name.

“Most often the tumor grows in the maxillary sinus, which can lead to sinusitis-like pain“, informs the ENT surgeon. These are cancers that take a very long time to be symptomatic. “Since the sinuses are hollow cavities, the tumor must be large to become symptomatic“, says Dr. Moya-Plana.

Sinus cancers are relatively rare: they represent 3% of ENT tumours, according to Dr. Antoine Moya-Plana. “Unlike other ENT cancers which consist essentially of squamous cell carcinomas, there are a multitude of different histological types in sinus tumors“.

The average age of onset for sinus cancer is 60 years old.with large differences depending on the histological type.

Sinus cancer is not related to tobacco use.

Sinus cancers are more common among people who work in certain professional settings:

• in the presence of tannins (wood and leather workers),
• in the presence of dust (textile industry),
• in the presence of nickel,
• in the presence asbestos
• in the presence of cutting oil…

Unlike other ENT tumours, no other risk factor has been clearly identified for sinus cancers. “We know this cancer is not related to smoking“, says Dr. Antoine Moya-Plana.

THE signs of sinus cancer are not specific to this disease and are very commonplace: stuffy, runny or bleeding nose. “What should alert is the persistence of these symptoms for more than three weeks and their unilateral character“, informs Dr. Antoine Moya-Plana. When the tumor is very advanced, sinus cancer can be revealed by:

• a swollen cheek,
• a swollen eyelid,
• a decrease in visual acuity,
• a deformation of the palate depending on the location of the tumor.

The diagnosis of sinus cancer is suspected from the symptoms evoked by the patient and an ENT examination. “The diagnosis is made with a biopsy carried out in consultation when the tumor is easily accessible with a fibroscope (which makes it possible to visualize the interior of the sinuses directly with a mini camera) or in the operating room if necessary. Biopsies can be analyzed by a national network of pathologists as it can be difficult to see what histological subtype of sinus tumor is“specifies our interlocutor. An imaging assessment is carried out in the event of a cancerous tumor diagnosis: scanner, MRI, PET scan to see the location of the tumor and whether it is localized or metastatic.

The treatment of sinus cancer is adapted to each patient, to the nature of the tumour, but also to the results of the extension assessment which made it possible to classify the tumor according to its evolution. “For most sinus tumors, treatment consists of surgery followed by radiotherapysays Dr. Antoine Moya-Plana. Tumor excision margins are not the same depending on the histological type of tumor. For some tumours, chemotherapy is added before or after surgery. Chemotherapy products differ according to the histological type of sinus cancer“. The problems of chemotherapy and radiotherapy are not the same depending on whether the tumor is located in the maxillary sinus or in the ethmoid sinus. “Sinus cancers being rare cancers, it is better that they are taken care of in expert centers which have expertise in terms of surgery, radiotherapy and chemotherapy for sinus cancers, recommends Dr. Antoine Moya-Plana. With the ENT rare tumors networkthe REFCOR, we try to collect all the cases of cancer of the sinuses to enact therapeutic reference frames for care.“

Good to know : people whose sinus cancer has an occupational origin must see the occupational physician for professional recognition and possibly job accommodation.

According to the figures revealed by our interlocutor, 80% of sinus cancers are diagnosed at an advanced stage (T3, T4). The 5-year survival is very variable according to the extension but also according to the histological type of the tumour. Globally, the survival of carpenters sinus cancer (adenocarcinoma) is 70% at 5 years, the survival of squamous cell carcinoma of the sinuses by 50% at 5 years.

In high-risk occupations, it is advisable to protect yourself from high dust levels in your workplace by implementing appropriate protection systems (mask, suction system, room ventilation, etc.). “These people should benefit from regular follow-up. On the other hand, for the other tumors of the sinuses, no etiology being known, no prevention is possible.“, he concludes.

Thanks to Dr Antoine Moya-Plana, ENT surgeon at Gustave Roussy.