There are different nasal cancers, depending on whether the tumor affects the exterior, therefore the skin which covers this appendix, or the interior, therefore the mucous membranes which cover the nasal cavities. The prognosis and patient care are therefore not the same. Explanations with Dr Nadia Benmoussa-Rebibo, surgeon in otorhinolaryngology and head and neck surgery, reconstructive surgery in the head and neck cancer department at Gustave Roussy (Villejuif), the leading cancer center in Europe.
What is nasal cancer?
Definition of a nasal tumor
Nose cancer is one of the head and neck cancers. It refers to all malignant tumors located on the nose or inside the nasal cavity.
Cancer of the skin of the nose or inside the nose
If we consider the location of the tumor, we distinguish two types of nasal cancer: dermatological nasal cancerwhich affects the skin of the nose, and the nasal cavity cancerwhich affects the mucous membrane which covers these cavities.
We can also classify nasal cancers according to the nature of the cells that cause them:
- THE dermatological nasal cancers can arise from the basal cells of the epidermis, it is then basal cell carcinomas of the nose ; they can also derive from squamous cells, thin and flat cells present at the level of the spinous layer of the epidermis, in these cases we speak of squamous cell cancers ; if they come from cutaneous melanocytes, these pigment cells which give color to the skin, they are melanomasspecifies Dr Nadia Benmoussa-Rebibo ;
- The nasal cavity cancer is, for its part, more of the squamous type.
- “Certain nasal cancers can also be derived from central facial lymphomas or mucosal melanomas.indicates the specialist.
How many people suffer from nasal cancer in Europe?
The prevalence of nasal cancers in Europe is poorly known. It is difficult to quantify the number of people who suffer from these malignant tumors since a large proportion of them are classified as skin cancers and are therefore not necessarily counted as nasal cancers. But we can say that skin cancers of the nose are more common than cancers of the nasal cavity.
Who can be affected by nasal cancer?
Like skin cancers, cutaneous type nasal cancers mainly affect people over 60 years old. Nasal cavity cancers, on the other hand, can affect anyone, regardless of age, says Dr. Benmoussa-Rebibo.
What are the causes of nasal cancer?
They are essentially environmental. But again, it all depends on the type of nasal cancer you are considering:
- THE cutaneous nasal cancers are mainly due to ultraviolet (UV) rays via excessive exposure to the sun, or to genetic predispositions favoring the development of skin cancer;
- THE nasal cavity cancers are linked to chronic irritations resulting from the inhalation of toxic products, particularly in the professional context, or even tobacco. Smoking is in fact the primary risk factor for nasal cavity cancer, because inhaling smoke irritates the mucous membranes.
Can nasal cancer be prevented?
Yes, by applying preventive measures resulting from the risk factors for this cancer: avoid smoking and protect yourself from toxic vapors by wearing a suitable protective mask when handling toxic products that you risk inhaling. particularly in the professional context when it is recommended.
What are the signs of nasal cancer?
The signs of nasal cancer depend on whether it is located on the skin of the nostrils and bridge of the nose, or inside the nose.
Symptoms of skin cancer of the nostrils
And skin cancer of the nose manifests itself as a lesion at the level of the nostrils or the tip of the nose. Present for more than a month, this lesion is characterized by its irregular edges, its continued growth and possible bleeding.
Symptoms of cancer inside the nose
Cancer of the nasal cavity is naturally less visible. In addition, it does not cause any pain. Generally, it manifests itself by a wound on the nasal mucosa which does not heal, with infiltrated ulceration, often painless and persistent, by repeated bleeding, a blocked or running nostril or even by a blister which deforms the nose, indicates Dr. Benmoussa-Rebibo. “It is not normal to have something bulging inside the nose and persisting for more than 3 to 4 weeks.”, underlines the surgeon. Non-specific signs, often attributed to a banal nasal obstruction. However, their presence on only one side of the nose should alert you.
Ethmoid cancer, a nose disease that affects the sense of smell
In contrast, the sense of smell is not affected by nasal cancer,”except when the ethmoidal structures, located far behind the nasal cavity and which contain the olfactory bulbs, are affected.. Ethmoid tumors correspond to a particular form of cancer of the upper aero-digestive tract and are recognized as occupational diseases among carpenters and workers exposed to the inhalation of wood dust, nickel or solvents (wood glue, formaldehyde, cutting oil, etc.)
How to diagnose nasal cancer?
The diagnostic process for nasal cancer involves a consultation with your doctor who, based on the clinical examination and questioning of the patient, will refer the latter to an ENT doctor or a dermatologist, depending on the symptoms observed. The specialist doctor will then carry out an endoscopy in order to precisely visualize the nasal mucosa and then a biopsy: carried out under local anesthesia, this somewhat uncomfortable but not very painful examination consists of taking a sample of the suspicious lesion using forceps at purposes of anatomopathological analysis.
If the biopsy confirms the diagnosis of nasal cancer, imaging tests may be prescribed depending on the type of cancer. “For dermatological nasal cancer, an ultrasound of the neck may be prescribed to establish an assessment of extension but this is not systematic.indicates Dr. Benmoussa-Rebibo. On the other hand, an ENT scanner and, sometimes, an MRI of the head will be essential in the diagnosis of nasal cavity cancer in order to characterize the tumor and evaluate its local, lymph node and distant extent..
How to treat nasal cancer?
Decided at a multidisciplinary consultation meeting (RCP), the treatment necessarily involves an assessment of the lesions and an assessment of extension. The further treatment, on the other hand, depends on the type of tumor.
What are the treatments for nasal cancer?
- THE skin tumors seen in cutaneous nasal cancer are usually treated with surgery.
- Surgery is also the treatment of choice for squamous cell carcinomas of the nasal cavity. Most often, the specialist uses endoscopic surgery during the procedure. These tumors can also be treated by brachytherapy if they meet certain criteria (size, location, etc.). Radiotherapy and/or chemotherapy may be offered in addition depending on the stage of the disease to eliminate cancer cells that may be nearby and thus reduce the risk of recurrence.
- If nasal cancer is caused by lymphomathe patient will be cared for in hematology and treated with chemotherapy and radiotherapy – and therefore without surgical treatment.
What is the prognosis for nasal cancer?
The prognosis for nasal skin cancer is often better than that for nasal cavity cancer: less visible because it is located inside the nose, the latter is often diagnosed late and is more likely to spread. In this case, the treatment combines several therapeutic approaches: surgery, cervical lymph node dissection, radiotherapy and/or chemotherapy.
In more severe cases, the tumor may have metastasized to the lungs; Treatment will generally be based solely on chemotherapy.
Nose cancer surgery
It is sometimes necessary to perform a rhinectomy to remove a tumor located in the nasal vestibule. This surgery involves removing the nose, in part (partial rhinectomy) or in whole (total rhinectomy).
“Once removed, the nose is not reconstructed”, indicates Dr Benmoussa-Rebibo; “the surgeon applies a prosthesis (we speak of epithesis) for at least one year to ensure the absence of recurrence. Aesthetically and functionally, it is generally satisfactory. A reconstructive surgery operation called rhinopoiesis can be offered after this period of 1 year, but patients should nevertheless know that it is an operation in several stages which generally requires between 4 and 10 interventions spaced over 6 to 8 months.