Sinonasal Tumors
What are sinonasal tumors?
Sinonasal tumors are tumors that occur in the nasal cavity or nasal sinuses. These tumors are rare, making up only about three percent of tumors in the upper respiratory tract. They are twice as common in males than in females.
What are some possible causes of sinonasal tumors?
There are actually many different types of tumors that can form in the nose or sinuses. Some of these are listed below:
- Inverted papillomas
- Squamous cell carcinoma
- Transitional cell carcinoma
- Adenocarcinoma
- Adenoid cystic carcinoma
- Melanoma
- Neuroblastoma
- Sarcomas
- Lymphoma
- Plasmacytoma
- Giant cell tumor
- Metastatic carcinoma
Inverted papillomas are benign tumors by definition, but can cause problems when they expand and destroy bone. Five to twenty percent of these benign tumors may also transform to a malignant type if not treated. Otherwise, squamous cell carcinomas are the most common malignant type of tumor, followed by adenoid cystic carcinoma and adenocarcinoma. Most of the tumors originate from the maxillary sinuses. Less commonly, it stems from the nasal cavity, ethmoid sinuses or even more rarely, from the frontal or sphenoid sinuses.
What are the symptoms of sinonasal tumors and how are they diagnosed?
Patients with sinonasal tumors often present with vague symptoms, including nasal obstruction, nasal congestion and discharge, frequent bloody noses, headache, and/or facial pain. Patients can also have facial swelling, vision changes, or neurologic deficits. Some patients are asymptomatic.
Diagnosis begins with a thorough history and physical examination. Imaging studies such as CT scan and MRI are usually done to stage the tumor locally and to check for the presence of metastases, or spread. CT scans are better for examination of the bony structures of the sinuses and skull base. MRI is preferred for defining soft tissue details, such as invasion of the dura (lining of the brain), orbit, or brain itself. Biopsy of the tumor is necessary to make a final diagnosis. This can often be done in the office with topical or local anesthetic. Sometimes the biopsy needs to be done in a more controlled setting like an operating room, especially if there is a risk of bleeding.
How are sinonasal tumors treated?
Surgical therapy is the main treatment for most sinonasal tumors. Radiation may be used as well. Radiation may be used alone if the tumor cannot be removed surgically or in patients who cannot tolerate surgery. Combination therapy of surgery and radiotherapy with or without chemotherapy is given in specific situations.
Type of surgery will depend on the size and spread of the tumor and surgeon preference. Approaches can be external or endoscopic. Removal of sinonasal tumors can leave patients with facial disfigurement and speech and swallowing difficulties. Reconstructive surgery is often done to help with these problems, usually using tissue from elsewhere in the body.
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