Treatment options for nasal and sinus cancer

A team of health professionals decides what treatment you might need. They also decide what treatment options you have.

The most common treatments for nasal and paranasal sinus cancer are:

• surgery
• radiotherapy
• chemotherapy

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a head and neck cancer MDT. You might go to a different hospital if your local hospital doesn't have a specialist MDT.

The team usually includes:

Head and neck surgeons

There are different types of head and neck surgeons.

ENT doctors are specialists who treat ear, nose, throat and neck conditions. They are qualified surgeons and are also known as otorhinolaryngologists.

Maxillofacial surgeons train as both doctors and dentists. They specialise in conditions of the mouth, jaw, face and neck. They also do reconstructive surgery.

Plastic surgeons do reconstructive surgery. Plastic surgery is common after surgery to remove a cancer of the head or neck.

Neurosurgeons are surgeons who specialise in surgery to the brain and nervous system.

Oncologist

An oncologist is a doctor who specialises in treating cancer, most often with radiotherapy or chemotherapy.

Restorative dentist

A restorative dentist (prosthodontist) specialises in replacing lost tissues and teeth. They will assess your teeth and may recommend that you have some removed. This may be if the teeth are decaying or loose so they don't cause problems later.

The restorative dentist will tell you how to look after your mouth and teeth. Especially during and after your treatment. They may send you to a dental hygienist for more help. Keeping your teeth and mouth clean reduces the risk of infection.

The dentist will help to plan your recovery with your surgeon. They'll try to ensure you can speak and eat as well as possible afterwards. They may suggest using special false teeth or dental implants. Sometimes, you need a replacement part (prosthesis). This can be for missing teeth or after the loss of some of the structure in the mouth.

Some people with nasal or sinus cancer have surgery to remove part of their upper jawbone. The surgeon uses a piece of bone from another body part to replace the missing piece. A restorative dentist can then fit a prosthesis with teeth. It attaches to the new jawbone using dental implants. 

The hospital prosthetics department works closely with the surgeons and dentists. They help make your facial appearance as normal as possible after major surgery.

Head and neck clinical nurse specialist

A head and neck clinical nurse specialist specialises in cancers of the head and neck. They help to organise your care between doctors and other health professionals.

The specialist nurse also supports you in your treatment. They make sure you have the information you need so you can cope with treatment as well as possible.

Speech and language therapist

Speech and language therapists play an important role in helping you with:

• communication
• speech
• swallowing difficulties (dysphagia)

They will start supporting you before treatment. This continues during and after treatment.

Other healthcare professionals

You might also see an eye doctor (ophthalmologist). This is because nasal and sinus cancers can sometimes spread to the eyes or inside the skull.  

Other healthcare professionals may include:

• a head and neck radiologist
• a head and neck histopathologist
• a dietitian
• a prosthodontist
• social workers or benefits advisers who can tell you about benefits

The MDT may also include health professionals who look after people with advanced nasal and paranasal sinus cancer. They can help with symptom control. They include:

• the palliative care team
• a clinical nurse specialist for palliative care

Your treatment depends on:

• the type of nasal and paranasal sinus cancer
• where your cancer is
• how far it has grown or spread (the stage)
• your general health and level of fitness

If you’ve been diagnosed with advanced cancer

Deciding about treatment can be difficult when you have advanced cancer.

It helps to understand:

• what treatment can do for you
• how it might affect your quality of life
• what side effects does it have

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Treatment overview

The main treatments are:

• surgery
• radiotherapy
• chemotherapy

You have one or more of these treatments. This depends on the stage of your cancer and also how well the treatment works.

Surgery

Surgery is a common treatment for nasal cavity and paranasal sinus tumours. The type of operation you have will depend on the position of the cancer and its size. Most surgery is performed under general anaesthetic. During surgery, your surgeon will examine the area around the tumour. They remove a margin of normal tissue. This lowers the risk of the cancer coming back.

They might also remove some of the lymph nodes during the procedure to find out whether it has spread. Sometimes, the cancer can spread to lymph nodes in your neck. When this happens, you might have all the nodes on one or both sides of your neck removed. Your doctor may call this operation a modified radical or radical neck dissection.

Radiotherapy

Radiotherapy on its own can treat some types of nasal cavity and paranasal sinus cancers. This is usually when the cancer hasn't spread. It will cure most people with small tumours of the nose (nasal cavity).

An advantage is that you don't have any tissue removed, so it causes less of a change to your appearance.

Your doctor may recommend that you have radiotherapy if you have an operation first. This will get rid of any remaining cancer cells and lowers the risk of the cancer coming back. 

Sometimes radiotherapy is combined with chemotherapy to make the treatment more effective. To shrink an advanced cancer  before surgery, your doctor may suggest:

• radiotherapy with chemotherapy (chemoradiotherapy)
• chemotherapy on its own

Advanced cancers are not easy to treat with surgery alone. 

Chemotherapy

You might have chemotherapy for any of the following reasons:

• before or after surgery or radiotherapy
• to treat some cancers that have spread to other parts of the body
• if your cancer has come back after surgery and radiotherapy
• during a course of radiotherapy (chemoradiotherapy) for locally advanced cancer

There have been no large trials because nasal and paranasal sinus cancers are rare. This includes comparing chemoradiotherapy with radiotherapy alone. Trials like this have been carried out for the more common head and neck cancers.

Having chemoradiotherapy has shown slightly better outcomes for other types of squamous cell head and neck cancers. This is compared to radiotherapy treatment alone, especially where the cancer is aggressive.

You may have chemoradiotherapy for these reasons. But you must be medically fit to tolerate it. Chemoradiotherapy has more side effects than radiotherapy alone.

Targeted drugs and immunotherapy

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack the cancer. They are called immunotherapies.

Targeted cancer drugs and immunotherapy are not part of the standard treatment for nasal and paranasal sinus cancer.

You might have these treatments if you have a nasal and paranasal sinus melanoma. The melanoma must test positive for gene changes (mutations) in the BRAF gene. This genetic change makes the melanoma cells produce too much BRAF protein. This can make melanoma cells grow.

Talk to your doctor if you want to know more about these treatments for nasal and paranasal sinus cancer.

If your cancer has spread

Surgery won't cure your cancer if it has already spread to another part of your body. It might help to control the cancer for a time and reduce symptoms.

A large cancer can start to block your airway. In these situations your doctor might recommend surgery to remove all or part of the cancer. This will make your breathing easier.

Your doctor may also suggest:

• surgery and radiotherapy together
• radiotherapy alone
• chemotherapy alone or with radiotherapy (chemoradiotherapy)
• newer treatments such as immunotherapy or targeted cancer drugs

Treatments that are still in development might be another option for you. This will mean taking part in a clinical trial. 

Palliative care

Your doctor is also likely to refer you to a palliative care team. They are health care professionals who specialise in people whose cancer isn't curable.

Some people assume that they are going to die very soon when their doctor suggests cancer is not curable. This is often not the case. It also doesn’t mean that the doctors who have been caring for you up until now won’t be involved in your care.

Palliative care means:

• controlling any symptoms you have, such as pain, sickness or breathing problems
• giving treatment that can shrink the cancer and control symptoms
• supporting you with both physical care and psychological care
• ensuring that you have the best possible care in place before going home from hospital