DONATENOSE AND PARANASAL SINUS CANCER
Signs and Symptoms of Nose and Paranasal Sinus Cancer
The paranasal sinuses are small hollow spaces in the bones of the head surrounding the nose. The nasal cavity is the hollow space behind the nose
Most Common Symptoms:
- Persistent nasal congestion not responding to general treatment
- Frequent headaches
- Facial pain
- Bleeding
- Swelling around the eyes
- Decreased sense of smell
- Loosening of teeth
- Numbness of the cheek and upper lip
- Double vision
- Swelling in the mouth, jaw, or neck
Types of Nose and Paranasal Sinus Cancer
- Maxillary cancer
- Ethmoid cancer
- Sphenoid cancer
- Frontal cancer
- Nasal cancers are also treated on same lines
Screening and Diagnosis of Nose and Paranasal Sinus Cancer
There is no screening program for PNS cancer. ENT surgeons should keep high index of
suspicion
- ORAL SYMPTOMS-30%- pain trismus, alveolar ridge fullness
- NASAL FINDINGS-50%-obstruction,bleeding,rhinorrhea
- EYE FINDINGS-25%-epiphora, proptosis,diplopia
- FACIAL SIGNS-asymmetry,paraesthesia
- CLASSICAL TRIAD OF ADVANCED DISEASE-facial asymmetry,nasal mass,tumor bulge in oral cavity
How do we Diagnose?
To find the cause of symptoms, a surgical oncologist evaluates a person’s medical history, performs a physical examination, and orders diagnostic tests. The examination and tests conducted may vary depending on the symptoms. Examination of a sample of tissue under the microscope is always necessary to confirm a diagnosis of cancer.
We insist on clinical examination and believe that a “Hand Scan is better than a CAT Scan”
- Physical examination may include visual inspection of the oral and nasal cavities, neck, throat, and tongue using a small mirror and/or lights. The surgical oncologist may also feel for lumps in the neck, lips, gums, and cheeks.
Myth: Biopsy or FNAC leads to the spreading of cancer.
- A biopsy is the removal of a small piece of tissue. A biopsy is the only sure way to tell whether a person has cancer.
- A nasopharyngoscope is inserted through the nose so that the surgical oncologist can see the nasal cavity and nasopharynx.
- Laboratory tests examine samples of blood, urine, or cells from the nodes.
- CT scan/Magnetic resonance imaging (or MRI) of the head and neck.
- PET scan in selected cases.
If the diagnosis of cancer is confirmed, the surgical oncologist will want to know the stage (or extent) of the disease. Staging is a careful attempt to find out whether cancer has spread and if so, to which parts of the body. Knowing the stage of the disease helps the surgical oncologist plan treatment.
Treatment of Nose and Paranasal Sinus Cancer
Surgeries Offered At RGCIRC
- Endoscopic Maxillectomy
- Open Maxillectomy
- Endoscopic Ethmoidectomy
- Open Ethmoidectomy
- Reconstruction with Free flaps or obturator
- Ant. Skull base surgery
Causes and Risk Factors of Nose and Paranasal Sinus Cancer
Exposure—Wood, Nickel-refining process.
Industrial fumes, leather tanning
Hard wood dust associated with adenocarcinomas
Cigarette and alcohol consumption
DO’s after Surgery
- Speak less to ensure proper healing of stitches in the mouth.
- Liquid diet with adequate salt has to be given at regular intervals of 2 hours.
- Feeding through tube should be given with patient in sitting or 300 head-up position. Each feed of around 300 ml should be given slowly over a period of 20 minutes.
- All medicines as prescribed in the discharge note along with medicines for chronic diseases like diabetes, hypertension, thyroid-related, and asthma should be continued as earlier.
- Oral hygiene with Betadine mouth wash in 1:1 ratio with water to be done alternately with Hydroxyl mouth wash in 1:1 ratio with water every 2 hourly.
- Nasal douching as advised with saline every 2 hours (in case of nasal endoscopic surgery).
- In the case of free flap reconstruction patient should sleep in a straight position and not turned to any side.
- Walking and moving around is a must.
- If the tracheostomy tube is there you may have to clean the inner cannula frequently preferably every 2-3 hourly.
- Keep the bib wet around the tracheostomy tube.
- Keep the cuff of the tracheostomy tube inflated with 5-7 ml air.
- Shoulder exercises as and when advised.
- Minimal blood-stained discharge from tracheostomy tube secretions is considered normal, don’t panic.
- Care of the drain and output charting as advised (you can see the video attached for reference).
- Care of the wound as advised.
DON'Ts after Surgery
- Avoid sudden exertion to the head and neck area while getting up from bed.
- Avoid room heaters if you have a tracheostomy tube.
- Avoid addictions.
- Avoid brushing your teeth.
Clinical Trials of Nose and Paranasal Sinus Cancer
Tumor Board/ Multispecialty Clinic Evaluation
Each and every Head & Neck cancer patient is evaluated by a special team of Surgical Oncologists (Head & Neck unit), Medical Oncologists, Radiation Oncologists, Onco-pathologists and Imaging Specialists. Depending on the age, general condition, type of pathology and stage of the disease, a custom-made treatment plan is charted out for each and every patient as per International Treatment Guidelines. (NCCN – National Comprehensive Cancer Network).
When to Contact the Treating Team?
- As per appointment.
- If the swelling around the neck wound or facial wound increases suddenly or within few hours.
- Fresh bleeding from neck wound or oral cavity or nose. Minimal blood-stained discharge from neck wound or during mouth wash or during nasal douching needs attention.
- If there’s difficulty in breathing or swallowing, fever.
