Understanding Sinonasal Cancer
- A 65-year-old man, with poorly managed hypertension (high blood pressure), was diagnosed with a sinonasal glomangiopericytoma (GPC), a rare tumor found in the nasal cavity or paranasal sinuses, after suffering from a left nasal obstruction for two years. A recent study suggests that the poorly manage high blood pressure may have led to the diagnosis.
- According to NY Langone Health’s Perlmutter Cancer Center sinonasal cancer “develops in the nasal cavity, which is the space behind the nostrils, and the paranasal sinuses, the air-filled cavities on either side of the nose.”
- Nasal cavity and sinus cancers are rare, and symptoms don’t usually show up at earlier stages of the disease. Sometimes these cancers are discovered during treatment for a sinus infection.
- Being your own advocate can be key to coming to a correct cancer diagnosis and obtaining the best treatment possible while dealing with a diagnosis.
When doctors at Chang Gung Memorial Hospital and Chang Gung University in Guishan, Taiwan, looked into why the man had a nasal obstruction, they determined in an article, recently published in JAMA Otolaryngology–Head & Neck Surgery, that the mans poorly controlled high blood pressure may have contributed to his diagnosis.
Read MoreAdditionally, MedPage explains that “while the cause of GPC remains unknown, hypervascularity associated with factors including hypertension, trauma, pregnancy, and corticosteroid use has been reported.”
Thankfully the doctors were able to surgically remove the mass and cauterized [burn off] the tumor’s feeding vessels. The authors concluded, “Complete surgical resection with adequate margins remains the primary management strategy in patients with GPC.”
According to the National Library of Medicine’s PubMed, a glomangiopericytoma is a rare tumor arising from the periyctes surrounding capillaries and accounts for less than 0.5% of all sinonasal tumors.
“It falls within the category of borderline and low-malignant-potential soft tissue tumors of the nose and paranasal sinuses. It is defined by the World Health Organization as a sinonasal tumor demonstrating a perivascular [area surrounding blood vessels) myoid phenotype.”
As for hypertension, otherwise known as high blood pressure, the World Health Organization (WHO) describes it as “when the pressure in your blood vessels is too high (140/90 mmHg or higher). It is common but can be serious if not treated,” noting, “People with high blood pressure may not feel symptoms. The only way to know is to get your blood pressure checked.”
The Who explains further, “Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.
“Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.”
As for what complications may arise from uncontrolled hypertension, the WHO said it can “cause serious damage to the heart,” potentially leading to chest pain, heart attack, heart failure, irregular heart beat, burst or blocked arteries, as well as kidney damage.
Understanding Sinonasal Cancer
The American Cancer Society describes nasal cavity and paranasal sinus cancers as types of head and neck cancers, and depending on where the cancer develops will determine the type of cancer.
“Nasal cavity cancers start in the opening behind the nose and paranasal sinus cancers start in the air-filled spaces in the skull around or near the nose,” the ACS explains.
According to NY Langone Health’s Perlmutter Cancer Center sinonasal cancer “develops in the nasal cavity, which is the space behind the nostrils, and the paranasal sinuses, the air-filled cavities on either side of the nose.”
The center explains that the majority of sinonasal tumors arise in the maxillary sinuses, found on either side of the nose in the cheekbone area, or in the ethmoid sinuses, which is located between the eyes near the bridge of the nose.
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“Rarely, tumors form in the frontal sinuses, located above the brows and near the center of the forehead, and the sphenoid sinuses, which sit farther back in the head near the optic nerve, which runs from the eyes to the brain,” the center adds.
The types of sinonasal cancers can vary, with squamous cell carcinoma being the most common type, Other types of sinonasal cancers include:
- Adenocarcinoma
- Adenoid Cystic Carcinoma
- Mucosal Melanoma
- Esthesioneuroblastoma
- Lymphoma
RELATED: What You Need to Know About Squamous Cell Carcinoma
Meanwhile, Brigham and Women’s Hospital, notes that a variety of tumors can develop in the nose or sinuses, also including:
- Inverted papillomas
- Transitional cell carcinoma
- Neuroblastoma
- Sarcomas
- Plasmacytoma
- Giant cell tumor
- Metastatic carcinoma
- Sinonasal undifferentiated carcinoma (SNUC)
As for what causes sinonasal cancers, Brigham and Women’s Hospital explains, “There are several identified causes for sinonasal malignancies. Exposure to industrial environmental fumes from nickel refining process, chromium compounds, wood dust, leather tanning can cause certain types of sinonasal cancers. Tobacco smoke also can cause nasal cancers.
“Certain Human Papilloma Viruses (HPV) are associated with various types of benign and malignant tumors of the sinonasal cavity. Prior irradiation for other cancers has also been associated with the development of a sinonasal cancer.”
Pushing For A Correct Diagnosis
When it comes to your health, be a little pushy. You know your body better than anyone else. When you see a doctor for a problem, don’t hesitate to make sure that your question is fully answered and that you are comfortable with the plan moving forward. From a doctor’s perspective, every problem should have a diagnosis, a treatment, a plan for follow-up, and a plan for what happens next if the treatment doesn’t work.
As a patient, if you don’t feel like each of these four things has been accomplished, just ask! Even if it requires multiple visits or seeing additional providers for a second opinion, always be your own advocate.
Advocating for Yourself While Navigating the Medical World
Dr. Zuri Murrell, director of the Cedars-Sinai Colorectal Cancer Center, previously told SurvivorNet that healthcare guidelines are meant to do the right thing for the largest number of people while using the fewest resources.
“The truth is you have to be in tune with your body, and you realize that you are not the statistic,” he said.
Dr. Murrell says not every patient will “fit into” the mold, so it’s important to “educate yourself and be your own health care advocate.”
“Every appointment you leave as a patient, there should be a plan for what the doc is going to do for you, and if that doesn’t work, what the next plan is,” Dr. Murrell said. “And I think that that’s totally fair. And me as a health professional that’s what I do for all of my patients.”
Leading Experts Urge Us to Be Proactive
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care,” National Cancer Institute Chief of Surgery Steven Rosenberg told us in a previous interview, “because finding a doctor who is up to the latest of information is important.”
RELATED: Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation
As we highlight in several areas of SurvivorNet, highly respected doctors sometimes disagree on the right course of treatment, and advances in genetics and immunotherapy are creating new options. Also, in some instances the specific course of treatment is not clear cut. That’s even more reason why understanding the potential approaches to your disease is crucial.
At the National Cancer Institute, there is a patient referral service that will “guide patients to the right group depending on their disease state so that they can gain access to these new experimental treatments,” Rosenberg says.
Cancer Research Legend Urges Patients to Get Multiple Opinions
Furthermore, getting another opinion may also help you avoid doctor biases. For example, some surgeons own radiation treatment centers. “So there may be a conflict of interest if you present to a surgeon that is recommending radiation because there is some ownership of that type of facility,” Dr. Jim Hu, director of robotic surgery at Weill Cornell Medical Center, tells SurvivorNet.
RELATED: Mental Health & Cancer: A Third of Patients Aren’t Getting the Help They Need
Other reasons to get a second opinion include:
- To see a doctor who has more experience treating your type of cancer
- You have a rare type of cancer
- There are several ways to treat your cancer
- You feel like your doctor isn’t listening to you, or isn’t giving you good advice
- You have trouble understanding your doctor
- You don’t like the treatment your doctor is recommending, or you’re worried about its possible side effects
- Your insurance company wants you to get another medical opinion
- Your cancer isn’t improving on your current treatment
Bottom line, being proactive about your health could be a matter of life or death. Learn as much as you can from as many experts as you can, so that you know that you did your best to take control of your health.
Contributing: SurvivorNet Staff
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