Sinonasal tumor

Disease Description (Causes and Symptoms)

• Definition: A collective term for tumors arising in the nasal cavity and paranasal sinuses (the hollow spaces beside the nose). They include benign tumors (e.g., inverted papilloma, angiofibroma, hemangioma, osteoma, etc.) and malignant tumors (mainly squamous cell carcinoma). Malignant tumors account for a small proportion of all malignancies in the body, but their prognosis is often poor because they are frequently detected at a late stage.
• Causes and pathophysiology:
  • The cause of most benign tumors is unknown. Inverted papilloma has been reported to be associated with HPV (mainly types 6 and 11).
  • Occupational exposure (leather, nickel, chromium, formaldehyde, wood dust, radiation, etc.) is known to be a risk factor for malignant tumors. The relationship with smoking and alcohol consumption is unclear.
  • Tumors usually arise on one side and, depending on their location, may cause local invasion (the orbit, oral cavity, skull base, etc.) or metastasis.
• Main symptoms:
  • Persistent or progressively worsening unilateral nasal obstruction (the most common symptom)
  • Recurrent unilateral epistaxis (nosebleeds), crusting, decreased or lost sense of smell
  • Orbital symptoms: proptosis, diplopia, decreased vision, conjunctival edema, etc.
  • Oral and dental symptoms: unstable dentures, loose teeth, maxillary sinus fistula after tooth extraction
  • Facial asymmetry, pain, sensory disturbance
  • Symptoms of cranial nerve palsy when the skull base is involved

Treatment Methods

• Diagnostic-based principles: The treatment plan is determined according to the histologic type of the tumor (benign/malignant), primary site, extent of invasion, and presence or absence of metastasis.
• Surgery:
  • Benign tumors: The principle is complete excision with an adequate margin; endoscopic excision is performed when an endoscopic approach is feasible.
  • Highly vascular lesions (e.g., angiofibroma): Preoperative embolization may be performed to reduce the risk of bleeding.
  • Mucocele and similar conditions: Function-preserving treatment through endoscopic opening (to maintain drainage).
  • Malignant tumors: If possible, en bloc total excision with an adequate margin or radical removal. Depending on the tumor location, endoscopic surgery or an open approach (such as midface resection) is selected.
• Radiation and chemotherapy:
  • For malignant tumors, radiotherapy is performed before or after surgery, or when surgery is not possible. Chemotherapy (adjuvant or concurrent therapy) may be combined when necessary, depending on the clinical situation, such as platinum-based therapy.
• Reconstruction and preservation of function:
  • After extensive resection, reconstruction (such as flap reconstruction) is considered for orbital, oral, or skull-base defects.
• Lifestyle and self-care:
  • Manage wounds and drainage after surgery and promote mucosal recovery through nasal irrigation with saline
  • If bleeding is frequent, learn bleeding-control methods and instructions on when to visit a medical facility for acute bleeding
  • If occupational exposure is a risk factor, improve or avoid the work environment
• Precautions and complications:
  • Because early symptoms are nonspecific, delayed diagnosis is common — persistent unilateral symptoms require prompt evaluation
  • Possible complications include postoperative bleeding, infection, decreased sense of smell, facial sensory disturbance, vision changes, and cerebrospinal fluid leakage related to skull-base defects
  • Malignant tumors may recur or metastasize, so long-term follow-up is necessary

Checklist Before an Outpatient Visit (Including Sample Questions)

• Items to prepare (things to bring):
  • List of medications currently being taken (including blood-thinning medications), photos of the pills, or medication bags
  • Copies or CDs of previous medical records and tests (CT/MRI, endoscopic images, biopsy results)
  • A record of when symptoms began and how they have changed (nasal obstruction, frequency and amount of bleeding, vision/facial changes, etc.)
  • Occupational history (whether there has been exposure to hazardous substances), smoking and alcohol history
  • Records of allergies, previous surgeries, and anesthesia history
  • Photos related to symptoms (proptosis, facial asymmetry, etc.)
• Information to tell the doctor in advance during the visit:
  • Whether you are taking anticoagulants (e.g., warfarin, aspirin, DOACs)
  • Any recent history of heavy bleeding or recurrent epistaxis
  • Possibility of pregnancy or whether you are pregnant
• Examples of questions that patients may prepare for the outpatient visit (notes before the appointment):
  • "Please provide specific information about when the symptoms began and the frequency/amount of bleeding."
  • "Please check whether there has been any occupational exposure (wood dust, metals, chemicals, etc.) before coming."

General Examples of Questions to Ask the Doctor

• "What tests are needed to determine with certainty whether this lesion is benign or malignant?"
• "What are the recommended treatment options and their expected benefits and risks (side effects)?"
• "What is the likelihood of recurrence after treatment, and how will follow-up examinations be conducted?"
• "During surgery, what functional effects could there be on daily life, the sense of smell and vision, and appearance (facial asymmetry)?"

Examples of Disease-Specific Questions

• "What are the results of my tumor biopsy, and what treatment is recommended based on them (extent of surgery, radiation, and chemotherapy)?"
• "The tumor appears to have invaded the orbit or skull base. Please explain whether complete surgical removal is possible and what complications are expected if it is removed (such as vision damage or cerebrospinal fluid leakage)."