Paranasal sinus cancers differ from other squamous cell cancers of the upper aerodigestive tract in their risk factors, such as occupational exposures (ie, adenocarcinoma linked to wood dust exposure), and in the presence of premalignant lesions such as Schneiderian papillomas [98]. Patients most commonly present with nasal obstruction, rhinorrhea, and/or epistaxis. Symptoms can oftentimes be unilateral and can frequently be overlooked because of their overlap with more common benign etiologies [98]. Furthermore, pain is generally absent until there is associated skull base or nerve involvement. For these reasons, sinonasal tumors are commonly large at presentation [55,98]. Additionally, the sinonasal cavity has close proximity to complex skull base anatomy, the orbits, and the pterygopalatine fossae, which facilitates early disease extension. Radiography Chest CXR is not useful in the evaluation of pulmonary metastatic disease in the initial staging of suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis, because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. A heavy smoking history may also be a separate indication for CT chest imaging at initial staging, because tobacco use is a risk factor not only for squamous cell carcinoma of the head and neck but also for primary lung cancer [15,20].
Staging and Post Therapy Assessment of Head and Neck Cancer. Paranasal sinus cancers differ from other squamous cell cancers of the upper aerodigestive tract in their risk factors, such as occupational exposures (ie, adenocarcinoma linked to wood dust exposure), and in the presence of premalignant lesions such as Schneiderian papillomas [98]. Patients most commonly present with nasal obstruction, rhinorrhea, and/or epistaxis. Symptoms can oftentimes be unilateral and can frequently be overlooked because of their overlap with more common benign etiologies [98]. Furthermore, pain is generally absent until there is associated skull base or nerve involvement. For these reasons, sinonasal tumors are commonly large at presentation [55,98]. Additionally, the sinonasal cavity has close proximity to complex skull base anatomy, the orbits, and the pterygopalatine fossae, which facilitates early disease extension. Radiography Chest CXR is not useful in the evaluation of pulmonary metastatic disease in the initial staging of suspected or diagnosed cancer of the paranasal sinuses or nasal cavity. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis, because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. A heavy smoking history may also be a separate indication for CT chest imaging at initial staging, because tobacco use is a risk factor not only for squamous cell carcinoma of the head and neck but also for primary lung cancer [15,20].