Head & Neck

Based on the stage of the disease and your age, overall health, symptoms, previous treatments and preferences for quality of life, one or more of the following therapies may be recommended.

Surgery is frequently used to remove any stage of sinus and nasal cancer. It may be the only treatment needed for early-stage cancer. During surgery, the cancer will be removed along with an area of normal tissue around it and some surrounding bone or other nearby tissues. It may also be used if the cancer is found in the nasal cavity. If the tumor is found in the septum (dividing wall of the nose), the whole septum may be removed.

Many types of surgery are available. Your doctor will consider the location and stage of your cancer to choose the appropriate surgery for you.

Many early sinus and nasal cancers can be removed endoscopically (with a thin, lighted camera and instruments designed to pass through the nose) and do not require incisions on the face. However, many advanced tumors will require external incisions for adequate removal.

Medial maxillectomy may be used to treat a tumor in the side wall of the nasal cavity and may involve removing the side wall.

Maxillectomy may be done if the tumor has grown into the maxillary sinus. A maxillectomy may involve removal of bone from the roof of the mouth, part or all of the eye socket, part of the cheekbone, upper teeth and/or the bony part of the upper nose. In very advanced cancers that involve the eye itself, an exenteration, which includes removal of the eye, may be necessary.

Endoscopic ethmoidectomy may be used if the tumor is small and found only in the ethmoid sinuses. This involves the use of an endoscope (a thin, lighted camera) to reach the ethmoid sinuses through the nose. In some cases, it is necessary to make an incision (cut) between the nasal bridge and the eye to reach the ethmoid sinuses. This is called an external ethmoidectomy.

Craniofacial resection may be done if the cancer is found in the ethmoid sinuses, frontal sinuses and/or the sphenoid sinuses. This surgery is more extensive than a maxillectomy because it can include removal of the upper parts of the eye socket and front of the skull base.

A neck dissection (removal of lymph nodes in the neck) is often performed, regardless of whether the cancer is in the sinus or nasal cavity.

• A selective neck dissection involves removal of lymph nodes from a limited area of the neck.
• A modified radical neck dissection involves removal of most of the lymph nodes on one side of the neck between the jawbone and collarbone, in addition to some muscle and nerve tissue.
• A radical neck dissection involves removal of nearly all of the lymph nodes on one side of the neck and even more muscle, nerves and veins.

Reconstructive surgery may be needed after the primary surgery to restore functional ability and/or appearance. Missing tissue, skin or bone may be replaced during this surgery (see Reconstruction & Rehabilitation, page 23).

Radiation therapy may be the main treatment if your general health is too poor for surgery. It is generally used for cancers in the sphenoid sinuses because these areas are difficult to reach surgically. It can be used after surgery as adjuvant treatment. It may also be combined with chemotherapy (chemo- radiation). Radiation delivery methods vary by type and stage of cancer.

External-beam radiation therapy is delivered by a machine outside of the body. Types of this treatment include three-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT).

Internal radiation therapy, also known as brachytherapy, may be used.

Proton therapy uses protons instead of X-rays and may benefit some patients depending on the location of the tumor.

Drug therapy may be given alone or in combination with other therapies.

Chemotherapy may be given before surgery as neoadjuvant therapy or after surgery as adjuvant therapy. It may be combined with radiation therapy (chemoradiation). Chemotherapy for sinus and nasal cancers is usually given when the disease is advanced.

Immunotherapy in the form of immune checkpoint inhibitors may be part of your treatment plan if you have a certain type of recurrent or metastatic sinus and nasal cancer. The doctor will test for the tumor’s PD-L1 expression, which may indicate whether the tumor could respond to immunotherapy. If expression is more than 1 percent, the tumor is considered to be PD-L1 positive and immunotherapy alone may be used. If PD-L1 is negative, immunotherapy and traditional chemotherapy are often combined for patients who have recurrent/metastatic cancer.

Targeted therapy may be an option to treat certain types of sinus and nasal cancer. Targeted therapy in the form of epidermal growth factor receptor (EGFR) inhibitors may be used in combination with radiation therapy. Targeted therapy drugs may be used with or without chemotherapy and after surgery for advanced cancers.