Nasal Cavity and Paranasal Sinus Cancer
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Created by:
ryangcarlson on March 2, 2012
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Description:
Ch 6 and 12 (Esthesioblastoma) of Hansen
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25 terms
Terms | Definitions |
|---|---|
 What is Ohngren's line | runs from the medial canthus to the angle of the mandible -tumours superior/posterior to Ohngren's line have a poorer prognosis (i.e. suprastructure) |
| What are the histologies for nasal cavity/paranasal sinuses | Most common = SCC Adenoid cystic (and other minor SGT histology) esthesioneuroblastoma plasmacytoma lymphoma melanoma sarcoma |
| What is the lymphatic drainage for the maxillary antrum | submandibular parotid jugulodiagastric retropharyngeal jugular nodes |
| What is the proportion of cancers that arise within each sinus | Maxillary - 55-70% Nasal cavity - 23% ethmoid - 20% Rare in frontal or sphenoid |
| WHat are the risk factors | male (2x as common) Occupational exposures - nickel workers (SCC) - carpenters and sawmill workers (adenocarcinoma) - workers in factories that produce chromium, mustard gas, isopropyl alcohol, radium Smoking EtOH Thorotrast (maxillary sinus) |
| What are the boundaries of the nasal vestibule | Lateral - alae Medial - septum and columella Inferior - floor of nasal cavity |
| What are the boundaries of the nasal cavity | starts at limen nasi and ends at choana Inferior - hard palate Superior - base of skull |
| What are the two regions of the nasal cavity | Olfactory - upper third of nsal cavity and supplied by olfactory nerve Respiratory - rest of the nasal cavity that contains the orifaces connecting to the sinuses |
| What are the orifices that drain the sinuses | Superior meatus - posterior ethmoid Middle meatus - anterior and middle ethmoid, frontal, maxillary sinuses Inferior meatus - nasolacrimal duct Sphenoethmoid recess - sphenoid sinus |
| What are the boundaries of the maxillary sinus | Medial border - nasal cavity Superior - orbit Anterolateral - fascial bone Posteromedial - infratemporal fossa Inferior - maxilla |
| What are the boundaries of the ethmoid sinus | Medial - nasal cavity Lateral - lamina papyracea Superior - cribifrom plate Inferior - nasal cavity and sphenoid sinus |
| What is required on workup | Hx and PE Nasal endoscopy CT +/- MRI Biopsy CXR Routine bloodwork, coag profile, pituitary function hormones (IGF-1, free thyroxin, cortisol, prolactin to get baseline) NOTE - LN and DM are uncommon |
| Benign nasal tumours | Benign: - Inflammatory polyps, - giant cell reparative granulomas, - benign odontogenic tumors, - necrotizing sialometaplasia - inverted papilloma |
| Treatment recommendations for Nasal Cavity and ethmoid sinus tumours | T1-2N0: resection +/- postop RT (+/close margins or PNI) T3-4N0: resectable then postop RT - Unresectable/inoperable: definitive RT or CRT N+: resection + neck dissection followed by post-op RT/CRT vs definitive CRT |
| Treatment recommendations fro maxillary sinus tumours | T1-2N0: resection followed by postop RT for close/+margin, PNI, adenoid cystic - note if positive margins attempt at re-resection T3-4N0: resection followed by postop RT - unresectable then Definitive RT or CRT N+: resection and node dissection - postop RT/CRT vs definitive CRT |
| What are planning volumes are used | GTV - clinical +/- radiologic gross disease CTV1 - 1 cm margin around primary or nodes CTV2 - CTV1 +1-1.5 cm and any disturbed sinuses at time of surgery CTV3 - Nodal voulmes, nerve tract and base of skull margin PTVs - add 0.5 cm |
| What doses are given to each PTV | PTV1 - 70 Gy PTV2 - 63 Gy PTV3 - 56 Gy |
| What dose is given for postop RT | = 66 Gy |
| What cells give rise to esthesioneuroblastomas (ENB) | olfactory receptors of the nasal mucosa or cribiform plate |
| What is the histology of ENB | small round blue cell |
| What is the staging for ENB | Kadish staging system: A: disease confied to nasal cavity (~90% LC) B: disease confined to nasal cavity and paranasal sinuses C: extends beyond cavity and sinus (ie orbit, skull base, intracranial, cervical LN, distant mets) |
| What is the local control per stage (ENB) | A: 70% B: 50-65% C: 30-50% |
| What is the DSS by stage for ENB | A: 95% B: 70% C: 40% all - OS ~60-65% w MS of 88 months |
| What treatment is recommended for ENB | surgery OR RT alone to 65-70Gy OR surgery with preopRT (50Gy) or postopRT (60Gy) |
| Outcomes for maxillary sinus tumours | 5 yr OS: I- 55% II - 45% III - 40% IV - 25% |
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