Surgical Procedures: Surgery and Staging for Nasal Cancer

What is Nasal Cancer?

Nasal cancer is when there are cancer cells in your nasal cavity (nose) or paranasal sinus cavity (around the nose).

Your nose opens into the nasal cavity. This cavity has two separate nasal passages (openings) that help with:

• Breathing.
• Filtering air that you breathe in.
• Adding moisture and warmth to the air you breathe in.
• Speaking.
• Signaling the brain to recognize smells.

“Paranasal” means “near the nose.” The paranasal sinuses are hollow, air-filled cavities (holes) in the bones of the head, near the nose. These sinuses make mucous. Each sinus has a name:

• Frontal.
• Maxillary.
• Ethmoid.
• Sphenoid sinuses.

There are different types of nasal and paranasal sinus cancer, named for the cells they affect, such as:

• Squamous cell cancer (most common).
• Melanoma.
• Sarcoma.
• Inverting papilloma.
• Midline granulomas.

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Imaging: Radiology tests can look inside your body to look at the cancer and see if it has spread. These tests can include:

• Chest X-ray.
• CAT scan (CT scan).
• Magnetic resonance imaging (MRI).
• Positron emission tomography scan (PET).
• Bone scan.

Procedures: Procedures are used to get a biopsy of the abnormal area. A biopsy takes cells from the cancer, or a piece of the cancer, to see what type of cancer it is and how it behaves. A doctor called a pathologist looks at the sample under a microscope.

The procedures used for biopsy include:

• Fine-needle aspiration (FNA):A thin needle removes fluid or tissue for further testing.
• Incisional biopsy:Part of an abnormal looking piece of tissue is removed for testing.
• Excisional biopsy:The whole area of abnormal tissue/tumor is removed for testing.
• Nasoscopy: A thin, lighted tube with a camera looks inside the nose. A biopsy may be done if abnormal tissue is found.
• Laryngoscopy: A thin, lighted tube with a camera looks at the larynx (voice box). A biopsy may be done if needed.

The type of biopsy used depends on how deep the tumor/abnormal area is.

Paranasal sinus and nasal cancer spreads to other parts of the body through the tissue, lymph, and blood systems. Staging of paranasal sinus and nasal cancer is described as stage 0 (also called carcinoma in situ) to stage 4. There is no standard system of staging for sphenoid and frontal sinus cancers.

Surgery may be used to treat sinus or nasal cancer. The procedure you have depends on many factors, like where the tumor is and how big it is. Your provider will talk to you about the procedure you will have.

Surgical procedures to treat nasal cancer are:

• Wide local excision: The cancer and part of the healthy nearby tissue is removed.
• Nasal septum removal: Part or all of the septum is removed (The septum is the bone and cartilage the separates your right nostril from your left nostril).
• Nasal cavity wall removal: The wall of the nasal cavity may be removed if it has been affected by the tumor.
• Nose removal: Part or all of the nose is removed. Reconstructive surgery and a prosthesis (implant) may be needed.
• Endoscopic surgery: A surgical tool attached to a thin tube is placed through the nasal cavity. This is less invasive than an incision (cut).

Surgical procedures to treat paranasal sinus cancer are:

• Endoscopic surgery: The cancer is removed using surgical tools attached to a thin tube, placed into the sinus.
• Maxillectomy: Part or all of the hard palate (roof of the mouth) is removed.
• Craniofacial resection: Used in the treatment of cancer of the ethmoid, frontal, and sphenoid sinuses. The tumor is removed through incisions in the face and skull.

In some cases, a neck dissection may be needed to remove lymph nodes. Your provider will talk to you about the surgery you will have.

What are the risks of having paranasal sinus or nasal cancer surgery?

As with any surgery, there are risks and possible side effects. These can be:

• Infection.
• Bleeding.
• Pneumocephalus (Air surrounding the brain).
• Leaking of cerebrospinal fluid (CSF) into the nose.
• Diabetes insipidus (Increased thirst and an increase in the amount of urine being made).
• Loss of smell.
• Facial nerve injury/facial numbness.
• Epiphora (Chronic tearing of the eyes).
• Loss of sight/visual changes.
• Mucocele (Collection of mucus in the frontal sinus).

Before surgery, your provider will talk to you about any other risks, based on your health and the surgery you are having.

What is recovery like?

Recovery from surgery to treat paranasal sinus and nasal cancers depends on the type of procedure done.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about changes in your activity level and nutritional (diet) needs you may have, depending on the surgery you had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.