Prognosis and survival for nasal cavity and paranasal sinus cancer
People with cancer in the nasal cavity or paranasal sinuses may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for nasal cavity and paranasal sinus cancer.
Stage is the most important prognostic factor for cancers of the nasal cavity and paranasal sinuses. The earlier a tumour in the nasal cavity or paranasal sinuses is found, the more favourable the prognosis. Unfortunately, many tumours in the nasal cavity or paranasal sinuses are found at a later stage.
Tumours that have grown into the brain or the outer membrane of the brain (called the dura mater) have a poor prognosis.
The stage of nasal cavity and paranasal sinus cancer is based on if it has spread to lymph nodes and the size of the lymph nodes that contain cancer. The more lymph nodes that contain cancer and the larger these lymph nodes are, the poorer the prognosis.
Type of tumour
Low-grade esthesioneuroblastomas, adenocarcinomas and chondrosarcomas (a type of bone cancer) tend to have the best prognosis.
Squamous cell carcinomas (SCCs) tend to have a better prognosis if the cancer started in the ethmoid sinus rather than the nasal cavity or other paranasal sinuses.
Melanoma and sinonasal undifferentiated carcinomas (SNUC) have a poor prognosis.
Younger people tend to have a better prognosis than older people.
Women may have a more favourable prognosis than men.
People who have higher performance status scores may survive longer and cope with the effects of treatment better than those who have lower scores.
Location of the tumour
A tumour that started in the nasal cavity or paranasal sinuses and has grown into the nasopharynx and base of the skull is harder to completely remove with surgery. For this reason, cancer that has grown into these structures is linked to a poorer outcome.
Doctors also use Ohngren’s line as a way to predict prognosis. Ohngren’s line is an imaginary line drawn from the inner corner of the eye to the angle of the jaw bone (just below the ear lobe) on the same side of the head. Tumours below this line tend to have a better prognosis than those above.
Cancer cells in the surgical margins
During surgery, the surgeon removes the tumour along with a margin of healthy-looking tissue around it. This tissue is called the surgical margin. If there are cancer cells in the surgical margin, it is called a positive surgical margin. Surgical margins that don’t have cancer cells are called negative surgical margins and have a better prognosis than positive surgical margins.
Smoking and drinking alcohol
People who don’t smoke and drink alcohol tend to have a better prognosis than those who smoke and drink alcohol.
The measure of how well a person is able to perform ordinary tasks and carry out daily activities.
Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.