Nasal Cavity and Paranasal Sinus Cancer

ON THIS PAGE: You will find a drawing of the nasal cavity and paranasal sinuses. Use the menu to see other pages.

The next section in this guide is Risk Factors and Prevention . It describes the factors that may increase the chance of developing nasal cavity or paranasal sinus cancer and what people can do to lower their risk. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for nasal cavity and paranasal sinus cancers, including risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

Screening information for nasal cavity and paranasal sinus cancers

It is always important to receive regular health and dental screenings. This is particularly important for people who routinely drink alcohol, currently use tobacco products, or have used tobacco products in the past.

People who use alcohol and tobacco should receive a general physical examination at least once a year, even if they do not have any symptoms . This is a simple, quick office visit in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using 1 or more of the diagnostic procedures described in Diagnosis .

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems nasal cavity and paranasal sinus cancers can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How nasal cavity and paranasal sinus cancers are diagnosed

This section describes options for diagnosing nasal cavity or paranasal sinus cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

Physical examination

To make the diagnosis, a complete medical history and physical examination are necessary. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and/or mirror for a clearer view.

Signs of nasal cavity or paranasal sinus cancer are often very similar to symptoms of chronic or allergic sinusitis. The physical examination is important, and doctors may perform 1 or more of the tests listed below to reach a diagnosis. There are no specific blood or urine tests that can be performed to help make an early diagnosis of nasal cavity or paranasal sinus cancer.

Other diagnostic tests

In addition to a physical examination, the following tests may be used to diagnose nasal cavity or paranasal sinus cancer:

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

• Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth or nose to examine the head and neck areas. Sedation is the use of medication to help a person become more relaxed, calm, or sleepy. This examination has different names depending on the area of the body that is examined, such as laryngoscopy, which examines the larynx; pharyngoscopy, which examines the pharynx; or nasopharyngoscopy, which examines the nasal cavity and nasopharynx.

  In some cases, a diagnosis of paranasal sinus cancer will be made during endoscopic surgery for what is believed to be benign chronic sinusitis. Before completing the surgery, the surgeon should take a sample of healthy-looking tissue for a biopsy to test for benign chronic sinusitis. This procedure is called a frozen section examination. For more information about surgery, see the Types of Treatment section.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. An x-ray can show if the sinuses are filled with something other than air. If they are, the issue is usually not cancer but, instead, an infection that is treatable. If that treatment doesn’t work to clear the sinuses, then other specialized x-ray tests may be done to identify the blockage. Signs of cancer on an x-ray may be followed up with a computed tomography scan, also called a CT scan (see below).

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. CT scans are very useful in identifying cancer of the nasal cavity or paranasal sinus.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the eye in its socket and the part of the brain near the sinuses. MRI can be used to measure a tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Bone scan. A bone scan may be done to see if cancer has spread to the bones. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears lighter to the camera, and areas of injury, such as those caused by cancer, stand out on the image.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with nasal cavity or paranasal sinus cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for nasal cavity and paranasal sinus cancers. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How nasal cavity and paranasal sinus cancers are treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team .

For nasal cavity or paranasal sinus cancer, the team may include:

• Medical oncologist: A doctor who treats cancer using chemotherapy, immunotherapy or other medications, such as targeted therapy.

• Radiation oncologist: A doctor who specializes in treating cancer using radiation therapy.

• Surgical oncologist: A doctor who treats cancer using surgery.

• Neurosurgeon: A doctor who specializes in surgery on the brain and spinal cord. If a tumor in the skull or facial area needs to be removed, a neurosurgeon should also be part of this team.

• Otolaryngologist: A doctor who treats ear, nose, and throat problems.

• Dentist: A doctor who specializes in preventing and treating conditions and diseases in the mouth and oral cavity.

• Maxillofacial prosthodontist: A specialist who performs restorative surgery in the head and neck areas.

• Physical therapist: A health care professional who helps patients improve their physical strength and ability to move.

• Speech-language pathologist (SLP): This professional, also called a speech therapist, specializes in communication and swallowing disorders. An SLP helps patients regain speaking, swallowing, and oral motor skills after cancer treatment that affects the head, mouth, and neck.

• Psychologist/psychiatrist: These mental health professionals address the emotional, psychological, and behavioral needs of the person with cancer and those of their family.

Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Nasal cavity and paranasal sinus cancers can often be cured, especially if found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, eats, sees, and breathes.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for nasal cavity and paranasal sinus cancers because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for nasal cavity or paranasal sinus cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. The 4 main treatment options are surgery, radiation therapy, chemotherapy, and immunotherapy. Your treatment plan may include 1 of these treatments or a combination of them.

• Surgery

• Radiation therapy

• Chemotherapy

• Immunotherapy

• Physical, social, and emotional effects of cancer

• Metastatic nasal cavity and paranasal sinus cancer

• Remission and the chance of recurrence

• If treatment does not work

Surgery

Surgery is frequently used to remove a tumor in the paranasal sinus or nasal cavity. During the operation, a surgical oncologist will remove the tumor and some surrounding healthy tissue, called a margin.

The goal of surgery is to remove all of the tumor and leave no trace of cancer in the healthy tissue, also called a negative margin. However, it is usually not possible to completely remove the cancer during an operation, so additional treatments may be necessary. This may include more than 1 operation to remove the cancer and to help restore the appearance and function of the affected tissues.

Common types of surgery for nasal cavity or paranasal sinus cancer include:

• Excision. During a surgical excision, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it, called a margin.

• Maxillectomy. This is a surgery that removes part or all of the hard palate, which is the bony roof of the mouth. Artificial devices called prostheses or, more recently, flaps of soft tissue with and without bone can be placed to fill gaps from this operation. A maxillectomy is sometimes recommended to treat paranasal sinus cancer. Occasionally, it is possible to save the eye on the side of the cancer.

• Craniofacial resection/skull base surgery. This is an extensive surgery often recommended for paranasal sinus cancer. During this operation, the surgeon removes more tissue than a maxillectomy. It requires the close cooperation of the health care team, particularly cooperation between a neurosurgeon and a head and neck surgeon.

• Endoscopic sinus surgery. This relatively new approach is less destructive to healthy tissue than traditional operations. Occasionally, it can be used for a nasal cavity or paranasal sinus tumor, especially if it is benign. The surgeon makes a small incision to remove the tumor using a thin, telescope-like tube inserted into the nasal cavity or sinus. As mentioned in Diagnosis , endoscopic sinus surgery is often used to treat chronic sinusitis, and cancer may be discovered during such surgery.

• Neck dissection. This is the surgical removal of lymph nodes in the neck area. If the doctor suspects the cancer has spread, a neck dissection may be performed, often at the same time as another surgery. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. The side effects are caused by injury to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away in a few months. Weakness will be permanent if a nerve is removed as part of a dissection.

• Reconstructive (plastic) surgery. If surgery requires removing large or specific areas of tissue, reconstructive surgery may be recommended. If an eye is removed, a specialist called a prosthodontist can provide an artificial replacement, called a prosthesis. When the upper jaw, called the maxilla, is removed, a prosthodontist may play a large role in the rehabilitation process.

Surgery for nasal cavity or paranasal sinus cancer has risks because the eyes, mouth, brain, and important nerves and blood vessels are usually located near the tumor. Surgery often causes swelling of the face, mouth, and throat, making it difficult to breathe. Sometimes a hole in the windpipe, called a tracheostomy, may be necessary to make breathing easier after surgery. If lymph nodes were removed, a type of swelling called lymphedema may occur due to lymph fluid build-up. It is important to talk with your surgeon(s) about which side effects to expect before having surgery, as well as your plan for recovery. This discussion should include both physical and emotional side effects. Learn more about the basics of cancer surgery .

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Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.

For nasal cavity and paranasal sinus cancers, radiation therapy is most often used in combination with surgery. It is given either before or after the operation. Radiation therapy may also be given along with chemotherapy (see below). For some types of tumors in the nasal cavity or paranasal sinus, radiation therapy may be the main treatment. It can also be an option if a person cannot have surgery or decides not to have surgery.

External-beam radiation therapy

The most common type of radiation treatment is called external-beam radiation therapy. External-beam radiation therapy is radiation given from a machine outside the body. An external-beam radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Specific types of external radiation therapy include:

• Intensity-modulated radiation therapy (IMRT). IMRT allows effective doses of radiation therapy to be delivered while reducing the damage to healthy cells.

• Proton therapy. Proton therapy is a type of radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Proton therapy may be used in nasal cavity or paranasal sinus cancer when the tumor is located close to the eye or central nervous system, which includes the brain and spinal cord.

Internal radiation therapy

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the tumor. The implant is left in place for several days while the person stays in the hospital.

Side effects of radiation therapy

Before beginning any type of radiation therapy, people should receive a thorough examination from a dentist experienced in treating people with head and neck cancer. Because radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning cancer treatment. After radiation therapy for nasal cavity or paranasal sinus cancer, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent cavities, also called dental caries. Read more about dental and oral health .

Radiation therapy to the head and neck may also cause redness or skin irritation in the treated area, dry mouth or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue, mouth sores, and sore throat. Other side effects may include pain or difficulty swallowing, loss of appetite due to a change in sense of taste, hearing loss due to buildup of fluid in the middle ear, and earwax buildup.

In addition, radiation therapy may cause a condition called hypothyroidism in which the thyroid gland, located in the neck, slows down. This causes people to feel tired and sluggish. Every patient who receives radiation therapy to the neck area should have their thyroid checked regularly.

Researchers are conducting many studies to find ways to reduce or better relieve the side effects of radiation therapy. Learn more about the basics of radiation therapy .

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Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team how to safely store and handle them.

The types of medications used for nasal cavity or paranasal sinus cancer include:

• Chemotherapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medication used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A person may receive 1 drug at a time or a combination of different drugs given at the same time.

Doctors frequently recommend chemotherapy before or after surgery for nasal cavity or paranasal sinus cancer. Chemotherapy may also be used in combination with radiation therapy. This is called concurrent chemoradiotherapy. Chemoradiotherapy is still being researched and should be done as part of a clinical trial. Chemotherapy may also be used to treat advanced cancer or to relieve certain symptoms. Some chemotherapy is available in clinical trials that may treat cancer at an earlier stage.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy .

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Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are 2 immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of people with recurrent or metastatic head and neck squamous cell carcinoma. Pembrolizumab can be used by itself if the tumor expresses a certain amount of the PD-L1 protein. Or it can be used in combination with chemotherapy regardless of the level of PD-L1 expressed by the tumor. Nivolumab can be used if the cancer continued to grow or spread during treatment with platinum-based chemotherapy.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Some patients can have very serious side effects from immunotherapy including lung, colon, or liver damage. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as immunotherapy, chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic nasal cavity or paranasal sinus cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Your treatment plan may include immunotherapy, chemotherapy, or a combination of surgery, radiation, and these medications. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, immunotherapy, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent nasal cavity and paranasal sinus cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about these head and neck cancers and how to treat them. Use the menu to see other pages.

Doctors are working to learn more about nasal cavity and paranasal sinus cancers, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Combined therapies. Most research for head and neck cancer focuses on combining different types of treatments to improve treatment effectiveness and the patient’s quality of life.

• Chemotherapy. As mentioned in the Types of Treatment section, clinical trials are testing new and current drugs in chemotherapy to treat different stages of nasal cavity and paranasal sinus cancers.

• Immunotherapy. As outlined in the Types of Treatment section, immunotherapy is another type of therapy using medication. Immunotherapy is being studied in the treatment of head and neck cancers in general, so talk with your doctor to see if there are clinical trials that include nasal cavity or paranasal sinus cancer.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current nasal cavity and paranasal sinus cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in nasal cavity and paranasal sinus cancer, explore these related items that will take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Listen to a podcast from an ASCO expert discussing highlights about head and neck cancer research from a 2022 scientific meeting.

• Visit the Cancer.Net Blog to review other research and news about head and neck cancers.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with head and neck cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Cancer rehabilitation may be recommended (see "Rehabilitation," below), and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. If it occurs, cancer recurrence most commonly happens within the first 2 or 3 years after diagnosis, so follow-up visits will be more frequent during the first 2 to 3 years.

Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given. Diagnostic examinations, such as CT scans, may be needed to watch for any signs of recurrence or to monitor how well the current treatment is working.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects, called late effects, may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Rehabilitation

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy and speech therapy to regain skills, such as talking and swallowing. Some people may need to learn new ways to eat or adjust to eating foods that have been prepared differently. Palliative care to manage symptoms and maintain nutrition during and after treatment may be recommended. Listen to a podcast about managing eating challenges after treatment.

After surgery, a prosthodontist can help with the restoration and rehabilitation of any oral cavity structures that were removed during surgery. Rehabilitation of physical changes resulting from a maxillectomy often requires a prosthesis. Many times when a maxillectomy is done, fluid will accumulate in the middle ear on the side of surgery. Surgery to the eardrum, called a myringotomy, to drain this fluid may be required.

Frequently, especially after craniofacial surgical resection, people will lose their sense of smell, called anosmia. It is important for these people to receive special coping strategies to adapt to this change, especially around the house and work area, in case of chemical spills, smoke from a fire, and other potentially harmful situations.

Prevention of tooth decay with fluoride treatments is very important to avoid losing existing teeth. Special eye care may also be necessary. If an eye was removed, rehabilitative services can help you cope with vision loss.

People who have received radiation therapy should protect the skin that received treatment from the sun. If radiation therapy included the neck, the thyroid gland should be regularly checked with blood tests.

People who have received treatment for nasal cavity or paranasal sinus cancer may look different, feel tired, and be unable to talk or eat the way they did before treatment. Many people experience depression . The health care team can help people cope with these physical and emotional changes and connect them with support services. Support groups may help people cope with changes following treatment.

Learn more about cancer rehabilitation.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of nasal cavity cancer or paranasal sinus cancer do I have?

• Where exactly is the tumor located?

• What stage and grade is the tumor? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of each treatment, both in the short term and the long term?

• Who will be part of my health care team, and what does each member do?

• Can you recommend an oncologic dentist before treatment begins?

• Should I see a speech-language pathologist before treatment?

• Should I see other specialists before treatment?

• Who will be leading my overall treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available to me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about having surgery

• What type of surgery do you recommend? Why?

• Who will perform my surgery? How much experience does the doctor or team have with this type of surgery?

• Will my surgery include a neck dissection? If so, what does this mean?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Will it be necessary to remove part of my teeth or part of the palate (roof of my mouth)? If so, is rehabilitation with a prosthesis available?

• Will it be necessary to have reconstruction done to replace lost tissue in the lower jawbone (mandible)?

• Will I lose my eye or my eyesight?

• Will anything happen to my sense of smell?

• What other types of side effects can I expect? What will be done to prevent or manage them?

• Who should I contact about any side effects I experience? And how soon?

• Will other types of treatment, including additional surgery, be necessary?

Questions to ask about having radiation therapy, chemotherapy, or immunotherapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will I need to have this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers some resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.