Sinus Cancer Patient Guide

This guide has been prepared to inform patients diagnosed with sinus (paranasal sinus) cancer and th

This guide has been prepared to inform patients diagnosed with sinus (paranasal sinus) cancer and their relatives throughout the process.

This document is for general information purposes only; For personal medical decisions, be sure to consult your ear, nose and throat / head and neck surgery specialist.

Contents

1. Introduction: What is Sinus Cancer?3

• Introduction: What is Sinus Cancer?3

2. Risk Factors4

• Risk Factors4

3. Signs and Symptoms5

• Signs and Symptoms5

4. Diagnostic Process6

• Diagnostic Process6

5. Staging and Prognosis7

• Staging and Prognosis7

6. Treatment Options: Surgery8

• Treatment Options: Surgery8

7. Treatment Options: Radiotherapy and Chemotherapy9

• Treatment Options: Radiotherapy and Chemotherapy9

8. Post-Operative Process10

• Post-Operative Process10

9. Nutrition and Quality of Life11

• Nutrition and Quality of Life11

10. Psikososyal Destek12

• Psikososyal Destek12

11. Tracking and Control Process13

• Tracking and Control Process13

12. Pre-Surgery Checklist14

• Pre-Surgery Checklist14

13. Post-Surgery Checklist15

• Post-Surgery Checklist15

1. Introduction: What is Sinus Cancer?

• Introduction: What is Sinus Cancer?

Paranasal sinuses are air-filled spaces located within the facial bones and connected to the nasal cavity. They consist of four pairs of sinuses: the frontal sinus in the forehead area, the ethmoid sinus between the eyes, the maxillary sinus in the cheek area and the more deeply located sphenoid sinus. Sinus cancer occurs as a result of the uncontrolled proliferation of the cells lining these spaces.

Sinus cancers are very rare tumors and most commonly arise from the maxillary sinus. Due to its proximity to the eye, brain and skull base, the location of the disease directly affects diagnosis, treatment and prognosis. The most common type is squamous cell carcinoma; Less commonly, adenocarcinoma and other tumor types may also be seen.

Because the symptoms of sinus cancer are often confused with benign conditions such as sinusitis, diagnosis can often be delayed.

2. Risk Factors

• Risk Factors

Various risk factors have been identified that play a role in the development of sinus cancer. Occupational exposures, in particular, play an important role in this type of cancer.

Use of cigarettes and all kinds of tobacco products

Long-term occupational exposure to wood and leather dust (carpentry, furniture, leather processing)

Exposure to industrial chemicals such as nickel, chromium, formaldehyde

High risk HPV (Human Papilloma Virus) infection

Chronic sinusitis and long-term intranasal inflammation

3. Signs and Symptoms

• Signs and Symptoms

Early symptoms of sinus cancer can often be confused with chronic sinusitis or allergic conditions. Therefore, complaints that are unilateral and do not respond to treatment should be evaluated carefully.

Early Findings

Unilateral, prolonged nasal congestion

Bleeding or foul-smelling nasal discharge

Feeling of pressure or mild pain in the face

Later Period Findings

Significant facial swelling or asymmetry

Upper toothache, loose teeth or swelling in the upper jaw Visual impairment, double vision or eye deviation

Feeling of numbness in the face

Swelling or palpable mass in the neck

Having one or more of these symptoms does not directly mean cancer; However, it is recommended to consult a specialist for complaints that last longer than 2-3 weeks, are unilateral, and do not respond to treatment.

4. Diagnostic Process

• Diagnostic Process

The diagnosis of sinus cancer is made through a phased evaluation process. This process aims to both confirm the presence of the disease and determine the extent of its spread.

4.1 Endoskopik Muayene

4.1 Endoskopik Muayene

The inside of the nose and sinus openings are examined in detail with the help of a thin instrument with a camera on its tip (nasal endoscope). This procedure can be easily performed under office conditions and also allows biopsy to be taken from suspicious tissue.

4.2 Biyopsi

4.2 Biyopsi

A small piece taken from the suspicious tissue is examined in the pathology laboratory. A definitive diagnosis can only be made with a biopsy result.

4.3 Imaging Methods

4.3 Imaging Methods

Computed Tomography (CT): Used to evaluate the involvement of bone structures and sinus walls Magnetic Resonance Imaging (MR): It is preferred in the evaluation of soft tissue, eye socket and brain neighborhood

PET-CT: Used to investigate distant organ spread (metastasis)

PET-CT: Used to investigate distant organ spread (metastasis)

4.4 Evreleme

4.4 Evreleme

After all diagnostic tests are completed, the disease is staged according to the internationally accepted TNM system. This staging is the main guide in determining the treatment plan and evaluating whether critical structures such as the skull base and eyes can be preserved.

5. Staging and Prognosis

• Staging and Prognosis

The TNM system consists of three basic components: T (size of the tumor and its spread to neighboring structures), N (regional lymph node involvement) and M (distant organ metastasis). The combination of these components allows the disease to be classified from Stage 0 to Stage IV.

The sinus (maxillary, ethmoid, frontal or sphenoid) where the tumor begins directly affects the prognosis. While tumors originating from the maxillary sinus are more common, ethmoid sinus tumors may require a different treatment approach due to their proximity to the eye and skull base.

Prognosis varies from person to person; The most accurate information should be obtained from the physician team carrying out the treatment.

6. Treatment Options: Surgery

• Treatment Options: Surgery

Surgery is one of the cornerstones of sinus cancer treatment. Different surgical approaches can be applied depending on the size and location of the tumor.

Endoskopik Cerrahi

In limited and early stage tumors, it may be possible to remove the tumor using endoscopic methods through the nose. This method can shorten recovery time because it does not require external incisions.

Open Surgery (Maxillectomy)

For larger or advanced-stage tumors, maxillectomy, which requires removal of part or all of the upper jaw bone, may be performed.

Skull Base Surgery and Reconstruction

If the tumor is close to the skull base or involves this area, skull base surgery may be required, in which the ear, nose, throat and neurosurgery teams work together. After extensive resections, reconstructive surgery techniques or prosthetic (obturator) applications can be used to preserve facial structure and functions.

7. Treatment Options: Radiotherapy and Chemotherapy

• Treatment Options: Radiotherapy and Chemotherapy

Radyoterapi

It is aimed to destroy cancer cells by using high energy rays. Since the sinuses are very close to the eyes and brain, radiotherapy planning is done very precisely to protect these organs. Common side effects include dry eyes, decreased salivary gland function, and skin irritation.

Kemoterapi

In advanced disease or in cases with a high risk of recurrence, it can be used together with radiotherapy (chemoradiation) or to shrink the tumor before surgery.

Treatment combination; It is individually planned by a multidisciplinary team according to the stage of the disease, location and proximity to adjacent critical structures (eye, brain).

8. Post-Operative Process

• Post-Operative Process

The recovery process after sinus cancer surgery varies depending on the extent of surgery and affected structures.

Protection of Facial, Eye and Palate Functions

Depending on the location of the tumor, tissues around the eyes, palate or facial bones may be affected by surgery. In these cases, it is important to evaluate vision, chewing and speech functions and, if necessary, to rehabilitate them.

Prosthesis (Obturator) Use

When part of the upper palate or jawbone is removed, a specially prepared prosthesis (obturator) can be used to close the opening between the mouth and nasal cavity. This prosthesis helps preserve speech and swallowing functions.

Healing Process

Recovery time varies from person to person; Support can be provided with regular wound care, prosthesis control and physical therapy when necessary.

9. Nutrition and Quality of Life

• Nutrition and Quality of Life

Suggestions for Chewing and Swallowing Difficulties

Prepare food in small pieces or soft consistency Patients using dentures may prefer to eat soft foods until their dentures fit properly

Choose small and frequent meals

Coping with Loss of Smell and Taste

Try to support the appetite by paying attention to the visual presentation and texture of the meals Try to stimulate the taste perception by trying different spices and aromas Dietitian support is important to both ensure adequate nutrition and improve quality of life.

10. Psikososyal Destek

• Psikososyal Destek

Sinus cancer treatment can place a significant emotional burden on both the patient and the family, especially when it involves changes in facial appearance or impact on visual function. Changes in body perception can lead to anxiety, sadness and social withdrawal.

Do not hesitate to seek psychological counseling and professional support when necessary Joining support groups for head and neck cancer patients may be helpful in sharing similar experiences Involving family members in the process is supportive for both the patient and their relatives Social workers can provide guidance on practical and financial issues during the treatment process

11. Tracking and Control Process

• Tracking and Control Process

Regular follow-up after treatment is completed is critical for both detecting possible recurrence early and monitoring treatment-related late side effects. Endoscopic examination is an important part of the follow-up process.

Things to Consider About Relapse Symptoms

Things to Consider About Relapse Symptoms

Nasal congestion or resumption of bleeding discharge

A new swelling, pain, or numbness in the face

Vision changes

Unexplained weight loss or persistent pain

12. Pre-Surgery Checklist

• Pre-Surgery Checklist

Completing the following steps while preparing for the day of surgery will help the process proceed more safely and orderly.

Medical Preparation

☐ All blood tests, ECG and imaging results were completed and shared with the physician

☐ Anesthesia consultation was made

☐ All medications used (especially blood thinners) were reviewed with the physician ☐ Eye examination and dental evaluation completed if necessary

Lifestyle and General Preparation

☐ If possible, smoking and alcohol use were stopped before surgery ☐ The fasting (hungry and thirsty) instructions given by the physician were followed ☐ If a prosthesis (obturator) is required, preliminary measurements and planning were made ☐ Return home and companion planning was made after the surgery

☐ Items to be brought to the operating room have been prepared (ID, health reports, comfortable clothing) Do not hesitate to ask any questions you may have to your doctor or nurse at the final pre-operative check-up.

13. Post-Surgery Checklist

• Post-Surgery Checklist

Clarifying the following issues before and after discharge facilitates the recovery process and enables early detection of possible problems.

Maintenance and Follow-up

Maintenance and Follow-up

☐ Wound care and dressing change frequency were explained ☐ Learned how to care for and remove prosthesis (if any) ☐ The pain management plan and the medications to be used have become clear

☐ Feeding and swallowing evaluation was performed

Rehabilitation and Communication

☐ If necessary, a first appointment with a speech/swallowing therapist was scheduled ☐ The date of the first control examination (including endoscopic) is determined ☐ It is known when and to whom to contact in case of emergency (alarm symptoms) ☐ Psychosocial support resources and support groups were contacted

☐ Necessary materials for home care were provided This checklist is intended as a general guide; Individualized discharge instructions should always be followed first.

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