Sinonasal and Skull Base Tumors

Nasal Cavity and Sinus Tumors

The nasal cavity and surrounding sinuses assist in maintaining the functionality and structure of the head and neck area.
Most tumors of the sinuses are benign, but may result in troubling symptoms such as nasal obstruction, facial pain, visual difficulties, sleep apnea, snoring and chronic sinus infections. Sinus tumors may be diagnosed through endoscopic examination through the nose, or through imaging techniques such as X-rays, CT scans or MRI scans.

When small benign tumors are present, particularly if they are not interfering with the patient's quality of life, they may only necessitate ongoing observation by the physician. In a small number of cases the mucosa lining of the nose and sinuses
can be susceptible to abnormal cell development, which can lead to the formation of cancerous tumors. Malignant cancers of the nose and sinuses are, however, quite rare. When they do occur, they are most often composed of squamous cells, and do not often metastasize. Nonetheless, any malignant growth in the nose or sinuses must be removed.

Causes of Cancer of the Nose and Sinuses

Nasal cavity and paranasal sinus cancers tend to develop most often in those who smoke, have a family history of cancer, or are frequently exposed to chemicals or other irritants at home or in the workplace. Exposure to the following substances increases the risk for nasal and sinus cancer:

House dust
Sawdust
Chromium
Nickel
Formaldehyde
Cloth fibers

There is also evidence that radiotherapy for retinoblastoma is a serious risk factor for the development of nasal or sinus cancer.

Symptoms of Cancer of the Nose and Sinuses

Some of the symptoms of nose or sinus cancer are the same as those of upper respiratory infections, severe allergies and sinus infections. These symptoms may include:

Nasal congestion
Facial pain
Post-nasal drip
Drainage of thick mucus from the nose
Decreased sense of smell
Visual disturbance
Blockage of one side of the nose
Tooth pain

A worsening of these symptoms, and the presence of one or more of the following symptoms, may indicate a tumor. A tumor may or may not be malignant, but should always be checked for a definitive diagnosis.
More serious symptoms that may indicate nasal or sinus cancer include:

Facial numbness
Numbness or loosening of teeth
Pain or pressure in one of the ears
Constantly watery eyes
Bulging of one eye
Loss of vision
Growth or mass of the face, nose or palate
Trouble opening the mouth
Enlarged lymph nodes in the neck

Diagnosis of Cancer of the Nose and Sinuses

If nasal or paranasal sinus cancer is suspected, contact our office to schedule an appointment with one of the physicians at Coastal Ear, Nose and Throat. The doctor will perform a thorough physical examination of the head, neck, nose, throat and sinuses, and will note areas of numbness or pain on the face or in the neck, feel for swollen lymph nodes, check for visual changes, and assess the symmetry of the face.
Part of this examination will likely include the use of a nasal endoscope, a thin, flexible tube with a lighted tip, which enables the doctor to see the upper nasal cavity and sinuses. If a malignancy is suspected, various visualization tests, including X-rays, CT scans or MRI scans, may be administered. A biopsy of any suspicious tissue growth may be taken for laboratory analysis.

Treatment of Cancer of the Nose and Sinuses

Treatment for cancer of the nose or sinuses usually involves surgery to remove the tumor and surrounding tissue. It may be performed in conjunction with chemotherapy or radiation therapy to ensure complete eradication of the cancer. The location of a tumor is essential in determining whether or not surgery is possible. Other treatments for malignancies of the nose and sinuses may include radiation therapy and chemotherapy.

Nasopharyngeal Tumors

A nasopharyngeal tumor is a growth that forms in the nasopharynx or the uppermost portion of the throat that is found behind the nasal cavity. The nasopharynx serves as a passageway for air from the nose to the throat and eventually to the lungs. A tumor in the nasopharynx may be either benign or malignant. Nasopharyngeal tumors that are malignant, or cancerous, may spread to surrounding tissue and other parts of the body.

Symptoms of Nasopharyngeal Tumors

The symptoms of a nasopharyngeal tumor may include:

Pain
Persistent sore throat
Earache
Nosebleeds
Hoarse voice

Causes of Nasopharyngeal Tumors

While the exact cause of nasopharyngeal tumors is unknown, certain people may be at an increased risk of developing this condition, including those who:

Smoke
Chew tobacco
Consume large amounts of alcohol
Have a personal or family history of head and neck cancer
Have had exposure to certain chemicals in the workplace
Lack fruits and vegetables in their diet

Diagnosis of Nasopharyngeal Tumors

To diagnose a nasopharyngeal tumor, a doctor will take a detailed medical history and perform a physical examination. A fiber optic nasopharyngoscopy may be performed to evaluate the nasopharynx and carefully observe any abnormal growths within the tissue. During the procedure, a thin, fiber optic tube with a camera on the end is inserted into the nose to provide real-time images of the area. A biopsy may be performed, and small samples of tissue can be removed from the area during the nasopharyngoscopy.

Additional imaging tests may be helpful in obtaining a better view of the mass and may include:

MRI
X-ray
CT scan

Treatment of Nasopharyngeal Tumors

If no cancer is found, the benign tumor will likely be removed endoscopically. The tumor may be an angiofibroma, hemangioma or salivary gland tumor. Removing the tumor is recommended even when it is benign because many of these masses can grow to large sizes, causing obstructions and damaging surrounding structures. If cancer is present, it will typically be treated with a combination of chemotherapy or radiation therapy. However, surgery may also be necessary, particularly if the tumor is recurrent.

The Nasopharyngeal Tumor Removal Procedure

Endoscopy is also commonly used to remove a malignant nasopharyngeal tumor. It involves the use of an endoscope, which is a thin, flexible tube with a light and camera at the end to provide the surgeon with a detailed view of the treatment site. The surgeon typically operates through the nose to approach the skull base and remove the nasopharyngeal tumor.

Will Nasopharyngeal Tumor Removal Require Incisions?

No incisions are necessary for an endoscopic nasopharyngeal tumor removal procedure. The endoscope and small surgical tools are inserted directly through the nostrils. This route provides greater access to areas of the nasopharynx than external incisions on the face or within the mouth.

What Happens If My Nasopharyngeal Tumor is Cancerous?

The surgeon uses the tools to completely remove all of the tumor tissue found in the nasopharynx while viewing the procedure on a monitor. If the tumor is cancerous, it may be necessary to remove some of the tissue surrounding it as well.

After the Nasopharyngeal Tumor Removal

After the nasopharyngeal tumor is removed, follow-up appointments with a doctor are recommended, since some types of nasopharyngeal tumors may eventually recur and require treatment.

Skull Base and Pituitary Tumors

Pituitary tumors are abnormal growths in the pituitary gland, a small gland at the base of the brain. The pituitary gland is extremely important because it both releases its own hormones and controls hormones released by other endocrine glands, such as the thyroid and adrenal glands, and is thus responsible for regulating multiple systems in the body. For this reason, pituitary tumors can have serious medical consequences.
Pituitary tumors are common, occurring in as much as 20 percent of the population. Most are benign adenomas and many never result in symptoms of any kind. The causes of pituitary tumors are unknown except for those that result from a genetic disorder known as multiple endocrine neoplasia type 1 (MEN1).

Symptoms of Pituitary Tumors

Because pituitary tumors may cause too much or too little hormone secretion, a variety of different symptoms may result. When a tumor of the pituitary damages hormone-producing cells of the gland, the result will be hypopituitarism. When a tumor results in excessive hormone secretion, any of the following symptoms may occur:

Hyperthyroidism (overactive thyroid gland)
Cushing's syndrome (over production of ACTH or steroid production)
Acromegaly or gigantism (over production of grown hormone)
Nipple discharge (from prolactin over production)

Pituitary adenomas are categorized by size as either macroadenomas or microadenomas. Macroadenomas cause pressure which may result in the following symptoms:

Nausea or vomiting
Nasal drainage
Difficulties with sense of smell
Double vision, diminished visual field, drooping eyelids
Lethargy

Although rare, in some cases, these symptoms of pressure may appear suddenly and be severe.

Diagnosis of Pituitary Tumors

In order to diagnose a pituitary tumor, a comprehensive physical examination and several diagnostic tests are necessary, including an MRI scan of the head and tests to assess the patient's field of vision. Hormone levels, which may be measured in the blood or urine, must also be tested. These include levels of cortisol, insulin, prolactin, testosterone, estradiol, and thyroid hormones.

Treatment of Pituitary Tumors

Since most pituitary tumors are not malignant, there is usually no danger of metastasis. Nonetheless, as a pituitary tumor grows, the pressure on significant blood vessels and nerves can cause serious, and sometimes dangerous, complications. Treatment of a pituitary tumor most often involves surgical excision, especially if the tumor is pressing on the optic nerve.
Most pituitary tumors can be removed through the nose and sinuses, but some require transcranial surgery. For patients who are not candidates for surgery, radiation therapy may be used to shrink the tumor. Radiation therapy may also be used in conjunction with surgery to make sure the entire tumor has been removed. For certain types of pituitary tumors, medications are also administered.

Risks of Pituitary Tumors

The risks of untreated pituitary tumors and the risks of their surgical removal are similar. Because of the gland's proximity to the optic nerve, there is a danger or blindness as a result of pressure on the nerve by the tumor or damage to the nerve during surgery. Because the pituitary gland releases and controls so many hormones, unaddressed tumor growth or surgery may cause permanent hormone imbalance. Hormone replacements may have to be taken and monitored for the remainder of the patient's life.

Orbital Tumors

Tumors are abnormal growths of tissue that can be either benign (non-cancerous) or malignant (cancerous). Tumors situated on the orbit, or eye socket, should be evaluated and treated as soon as possible. A cancerous tumor requires immediate medical attention.

Symptoms of an Orbital Tumor

A tumor can cause pain or damage to the eye, and include symptoms such as:

Blocked tear ducts
A partial loss of vision
Double or blurry vision
A swollen appearance
Difficulty in closing the eye completely
Floaters
A change in the position or movement of the eye in the socket
A change in the size of the pupil
A change in the color of the iris

Diagnosis of an Orbital Tumor

After a thorough medical examination of the eyes, a series of diagnostic tests will be conducted to confirm the diagnosis of an orbital tumor. Some of these tests may include:

Dilation of the eye
Slit lamp examination
CT scan
MRI
Ultrasound
X-ray
Gonioscopy

If an orbital tumor is found, a surgical biopsy, known as an orbitotomy, may be performed to determine if the tumor is benign or malignant.

Treatment of an Orbital Tumor

Depending upon the type of tumor, its size, and location, there are numerous treatment options available. In some cases, surgery will be recommended to fully remove the tumor. In other cases, it may be best treated with: