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Malignant tumors of the sinonasal tract comprise less than 1% of all cancers. These tumors are a diagnostic and therapeutic challenge because they often present with symptoms that mimic common inflammatory sinonasal diseases.
Symptoms
Nasal obstruction (most common symptoms), necl lymphadectomy, nasal discharge-congestion-epistaxis-disturbance of smell, fasial-orbital-auditory symptoms
Causative factors
Nickel, aflatoxin, mustard gas, volatile hydrocarbons (for SCCA)
Wood dust, woodworking, furniture making (for adenocarcinoma)
Physical examination
Periorbital edema, proptozis, middle ear effusion, nasal cavity mass, cranial nerve deficits
Diagnostic Nasal Endoscopy
- Evaluation of the extent of tumor and the potential vascular natüre of the tumor
- Evaluate for ease and safety of biopsy
Imaging
CT has advantages for defining bone invasion and the initial anatomy of the tumor. Soft tissue disease in areas of high contrast in tissue density limits this imaging model. However, MR has more advantages in soft tissue imaging. PET/CT is not very useful for primary site disease evaluation due to low anatomic resolution and close proximity of sinüs cancers to the high metabolic area of the brain.
Treatment
Treatment of benign tumors ranges from observation, to partial resection for obstructive sinonasal disease, to complete resection with margins. Radiation is reserved for symptomatic in nonsurgical candidates or for radiation-sensitive tumors.