Tumors of The Sinus
The sinuses are important for many reasons. They humidify the air and act as airbags to help protect the brain from any trauma. Benign and malignant tumors of the sinuses destroy the lining tissue and the bone around it and no matter what the treatment is we cannot undo that. But most patients can still be very functional. Benign tumors are usually excised with surgery. Some rare tumors may occasionally be observed and followed closely in certain select patients. For cancers, the most common is squamous cell carcinoma. As for all squamous cell carcinomas, radiation and surgery are the treatment modalities that have the potential to cure them. Chemotherapy may help radiation work better in advanced cancers or non-surgical candidates. Squamous cell carcinoma of the sinuses is potentially curable in many cases as long as they have not spread outside the head and neck region. We perform imaging (PET scan, CT, MRI) to determine if it has.
Generally, cancers involving sinuses are treated with surgery and many receive postoperative radiation and chemotherapy as most present in an advanced stage. Radiation therapy is generally given daily as on outpatient five days a week for 6-8 weeks (exact amount determined by radiation oncology). Chemotherapy, if given, is done intermittently again on an outpatient basis. Surgery focuses on two things equally: removing the cancer and reconstruction. Much of the time we are able to remove these tumors through the mouth and nose and avoid external scars. Occasionally, there is a need to make incisions around the nose to access the tumor. Some may be removed endoscopically as well. Once the cancer is removed, we then focus on reconstruction. Some require only rearrangement of local tissues (local flaps). Others may involve grafts or flaps (tissue with a blood supply) from elsewhere in the body. When the maxilla is removed (maxillectomy) one can also use an obturator which is a removable denture like device that gives the patient nice form and good function. Sometimes it is necessary to remove some lymph nodes from the neck or parotid region (neck dissection and parotidectomy respectively) due to risk of spread to these areas. The cure rate obviously will improve as the cancer is picked up earlier.
Immunotherapy has had an increasing but not perfectly well-defined role as an adjunctive treatment. Most patients are able, once healed, to eat by mouth and speak.