Our sinuses are not just cavities hidden inside our face: They are like resonance chambers for our voice, cleaning stations for our breath, and even small guardians of our immune system. However, the mucosal cells of these wonderful structures can also multiply uncontrollably and turn into a serious disease called “sinus cancer.” Chronic congestion, nasal discharge, or facial pain that you neglect thinking it’s a cold or sinusitis may actually be an important warning sign.

What is Sinus Cancer?

Sinus cancer describes malignant tumors that occur in the mucosa of the paranasal sinuses (maxillary, ethmoid, frontal, and sphenoid sinuses) surrounding the nasal cavity or in the cells lining these structures. Although very rare, it requires attention because it has the potential to spread rapidly when diagnosed. The main subtypes are:

  • Squamous Cell Carcinoma (SCC):
    The most common type; begins as scaling, ulceration, or thickening in the sinus mucosa.
  • Adenocarcinoma:
    Originates from glandular cells, usually encountered in the maxillary sinus. It is associated with occupational dust exposure such as wood, leather, or corn flour dust.
  • Mucoepidermoid Carcinoma:
    A moderately aggressive form where different surface cells are found together.
  • Olfactory Neuroblastoma (Esthesioneuroblastoma):
    A rare tumor originating from cells that enable smell in the upper part of the ethmoid sinus.
  • Melanoma and Lymphoma:
    Malignant transformation of pigment-producing cells or lymphocytes in the sinus mucosa is also very rare but has a more aggressive course.

Since it may not show symptoms in the early stage, sinus cancer is usually diagnosed at an advanced stage. Therefore, persistent complaints that appear like sinusitis must be examined under specialist supervision.

What Causes Sinus Cancer? (Risk Factors)

  • Occupational Dust Exposure:
    Dust inhaled in wood, leather, cotton, flour, corn flour, or textile workshops can cause chronic irritation and DNA damage in the sinus mucosa.
  • Chronic Infection and Inflammation:
    Untreated sinusitis and polyposis accelerate cell renewal, preparing the ground for mutation.
  • Tobacco Products:
    Carcinogenic substances in cigarette smoke directly affect the nasal cavity and sinus mucosa.
  • Family History and Genetic Predisposition:
    Upper respiratory tract tumor history is associated with some gene mutations.
  • Radiation Exposure:
    Radiotherapy previously applied to the head-neck region can lead to cancer development in sinus tissue years later.
  • Viral Agents:
    Epstein-Barr virus and some HPV types can rarely trigger malignant transformation in the sinus mucosa.

Who is at Risk for Sinus Cancer?

  • Wood, Leather, or Textile Workers – Those with dust exposure without protective masks
  • Chronic Sinusitis and Polyp Patients – Cases showing resistance to long-term treatment
  • Smokers and Those with Long-term Passive Exposure
  • Those Who Have Received Previous Radiotherapy Treatment – Patients who received radiation to the head-neck region
  • Individuals 50 Years and Older – Repair mechanisms weaken with advancing age
  • Those with Family Cancer History

If you belong to one of these groups or if your complaints that you think are sinusitis have not resolved for more than 12 weeks, you must be examined by an ENT specialist.

Diagnosis and Evaluation Process

1. Clinical Examination and Nasal Endoscopy

The ENT specialist directly observes the nasal cavity and sinus openings with a fine-tipped endoscope; initially determines the location and size of the tumor.

2. Imaging Methods

  • Computed Tomography (CT): Evaluates bone wall erosion and sinus enlargement.
  • Magnetic Resonance Imaging (MRI): Provides information about soft tissue spread, nerve-vascular invasion, and brain proximity.
  • PET-CT: Used for metastasis screening; shows distant organ involvement.

3. Biopsy and Pathology

Under local anesthesia, tissue sample is taken under endoscopic guidance. The pathology report clarifies the tumor type (squamous, adeno, mucoepidermoid, etc.), grade, and aggressiveness potential.

4. Multidisciplinary Evaluation

ENT, medical oncology, radiation oncology, radiology, and plastic-reconstructive surgery specialists come together to create a patient-specific treatment plan.

Sinus Cancer Treatment Methods

1. Surgical Resection

  • Endoscopic Sinus Surgery: Minimally invasive; tumor is removed by entering through sinus openings.
  • Open Surgery (Caldwell-Luc, Endonasal-External Approaches): Preferred for larger tumors or those with bone invasion.

The goal is to excise the tumor along with surrounding healthy tissue while preserving function and aesthetics.

2. Radiotherapy

Applied as adjuvant treatment after surgery or as primary treatment when surgery is not possible. Advanced techniques like proton or IMRT (Intensity Modulated Radiotherapy) protect surrounding healthy tissues.

3. Chemotherapy and Immunotherapy

  • Platinum-Based Chemotherapies: In advanced stage or recurrence situations
  • Targeted Agents / Immunotherapy: Anti-EGFR antibodies, anti-PD-1/PD-L1 inhibitors are used in experimental or on-label protocols.

4. Combined Approaches

Surgery + radiotherapy or surgery + chemoradiotherapy is customized according to stage and tumor biology.

The Importance of Specialist Selection

In sinus cancer treatment, it is essential to both eliminate cancer and preserve facial function and aesthetics. The ideal team:

  • ENT Specialist / Head-Neck Surgery: Expert in endoscopic and open sinus surgery
  • Radiation Oncologist: Manages advanced techniques like IMRT, proton therapy
  • Medical Oncologist: Determines chemotherapy and immunotherapy protocols
  • Plastic-Reconstructive Surgeon: Provides repair in extensive resections
  • Radiologist & Pathologist: Clarifies diagnosis and staging

This interdisciplinary collaboration makes the “cure + quality of life” balance possible.

What Awaits the Patient on Treatment Day?

  • Preparation: Blood tests, EKG, anesthesia pre-consultation, and hospital admission procedures
  • Anesthesia: General anesthesia; comfortable sleep and painless intervention
  • Surgery: Endoscopic operation 2-3 hours, open approaches may take 3-5 hours
  • Reconstruction (If Necessary): Repair with flaps, grafts, or bio-materials
  • Recovery and Observation: A few hours in intensive care; stable patients are transferred to ward within 1-2 days

The team’s pre-operative joke “Now we’ll see your sinuses on the operating table instead of X-ray!” helps dispel tension.

Post-Treatment Recovery and Follow-up Process

  • 1-2 Weeks: Nasal tampons and dressings are removed; swelling, mild pain, and bleeding are normal. Cold compress and prescribed nasal sprays increase comfort.
  • 1-3 Months: Wound healing, mucosal regeneration, and sinus drainage are controlled with endoscopic examinations.
  • 6-12 Months: Recurrence and metastasis screening is performed with imaging (CT/MRI) or PET-CT.
  • Annual Check-ups: Every 3 months for the first 3 years, every 6 months in the 4th-5th years; thereafter, annual ENT examination is recommended.

Frequently Asked Questions

1. Will there be surgical scars?

There are no externally visible scars with endoscopic methods; a thin incision line may remain in open surgery, which fades over time.

2. What should I do if nasal congestion recurs?

Immediately consult an ENT specialist; delayed check-ups make it difficult to catch recurrence.

3. Does smell decrease after radiotherapy?

Temporary dryness and taste-smell changes may occur, usually improving within 6-12 months.

4. Does chemotherapy cause nausea?

Platinum-based agents can cause nausea and loss of appetite; supportive antiemetic medications are given.

5. What is the risk of recurrence?

Local control rate with surgery + radiotherapy in early stage is between 70-90%; regular follow-up ensures early detection of recurrence.

Conclusion and Take the First Step

Sinus cancer, although rare, is a condition that threatens quality of life and survival when overlooked. Early diagnosis, multidisciplinary treatment with the right specialist team, and disciplined follow-up are the keys to overcoming this challenge. If you have ongoing sinusitis symptoms or chronic congestion, don’t waste time and make an appointment with your ENT specialist. Take the first step today to breathe healthily and protect your face!