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Name of Patient:

Age/Sex: 52 years old Male


Date of Admission: Aug 28, 2016

PERSONAL INFORMATION:
This is the case of
Religion.

, 52 years old, married, a Roman Catholic in

He was admitted last Aug 28, 2016 with the chief complaint of tumor bleed.
Diagnosis:
Round Cell Carcinoma Nasal Cavity
History of Present Illness:
Patient known to OSPITAL OF MAKATI service as a case of Round cell
Carcinoma nasal cavity last seen June 2016, previously referred to OSPITAL
OF MAKATI for radiation and chemotherapy. Patient was unable to do advised
oncologic treatment.
INTERIM:
Growth of previously known mass which now invades soft and hard
palate. Fungating mass now protrudes through maxillary alveolar ridge with
intermittent episodes of tumor bleeding.
-Few hours prior (+) profuse tumor bleeding in the palatal area.
-No DOB
-No Stridor
-No aspiration
-Patient could tolerate small diet
Physical Examination:
HEENT- amber colored intacting AU (+) Fungating mass obstructing bilateral
nasal cavity fungating mass protruding from soft palate, hard palate, with
gross deformity/destruction of maxillary alveolar dentition.
Family Medical History:
(+) Cancer Breast cancer sister
Personal and Social history

Patient is a smoker with estimated 30 packs per year and an


occasional drinker.

Carcinoma of the nasal and sinus


Nasal and sinus cancers are rare head and neck cancers that start
inside the nose or paranasal sinuses.

Causes and risk factors of nasal and sinus cancers


The exact causes of nasal and sinus cancers are not known. It is more
common in people who handle or breathe in certain chemicals or dust for
many years because of their job. These include wood dust, chromium, nickel,
formaldehyde, leather dust and mineral oils.
Other factors that may increase the risk of nasal and sinus cancer include:

smoking tobacco

an infection called the human papilloma virus (HPV).


Symptoms of nasal and sinus cancers
The most common symptoms can include:

a blocked nose that does not clear

pressure or pain behind your nose or in your upper teeth

blood when you blow your nose

nosebleeds

losing your sense of smell.


Diagnosing nasal and sinus cancers
At the hospital, the specialist doctor will ask you about your symptoms and
general health. They will examine your face, eyes, ears and mouth. The
doctor will use a thin, flexible tube with a light and a camera at the end
(nasendoscope) to get a better view inside your nose and throat. They pass
the tube into your nostril. This can be uncomfortable, so the doctor may
numb your nose and throat with a local anaesthetic spray first. If you have

this spray, dont eat or drink anything for about an hour afterwards or until
your throat has stopped feeling numb.
The doctor removes a small sample of tissue or cells (biopsy) to make a
diagnosis. A pathologist (doctor who specialises in analysing cells) examines
the sample under a microscope to look for signs of cancer.
A biopsy can be taken in different ways. The doctor may take biopsies while
they are examining you with the nasendoscope. Or they may arrange for you
to have biopsies taken under general anaesthetic. Sometimes you will have a
CT or MRI scan before any biopsy is taken. This is so the doctor can see
exactly where the tumour is and plan the best way to take a biopsy.
Further tests for nasal and sinus cancers:
Other tests may be used to help diagnose nasal and sinus cancer or to check
whether it has spread:
X-rays
X-rays use high-energy rays to take a picture of the inside of your body. Your
doctor can use an x-ray to show the size and position of the cancer and to
check the bones of the face.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a three-dimensional picture
of the inside of the body. The scan takes 1030 minutes and is painless. It
uses a small amount of radiation, which is very unlikely to harm you and will
not harm anyone you come into contact with. You will be asked not to eat or
drink for at least four hours before the scan.
MRI scan
This test uses magnetism to build up a detailed picture of areas of your body.
The scanner is a powerful magnet so you may be asked to complete and sign
a checklist to make sure it's safe for you. The checklist asks about any metal
implants you may have, such as a pacemaker, surgical clips, bone pins, etc.
You should also tell your doctor if you've ever worked with metal or in the
metal industry as very tiny fragments of metal can sometimes lodge in the
body. If you do have any metal in your body it's likely that you won't be able
to have an MRI scan. In this situation another type of scan can be used.
Before the scan, you'll be asked to remove any metal belongings including
jewellery. Some people are given an injection of dye into a vein in the arm,

which doesn't usually cause discomfort. This is called a contrast medium and
can help the images from the scan to show up more clearly. During the test
you'll lie very still on a couch inside a long cylinder (tube) for about 30
minutes. It's painless but can be slightly uncomfortable, and some people
feel a bit claustrophobic. It's also noisy, but you'll be given earplugs or
headphones. You can hear, and speak to, the person operating the scanner.
Staging and grading of nasal and sinus cancers
The stage of a cancer describes its size and whether it has spread. Knowing
the stage of the cancer helps doctors decide on the best treatment for you.
The two most commonly used staging systems for nasal and sinus cancers
are the TNM and the number system.
TNM staging system
T describes the size of the nasal or sinus tumour and whether it has grown
into nearby tissues such as, bones, muscles or nerves. For example,
a T1 nasal tumour is small and hasnt spread from the nasal cavity, while
a T4nasal tumour has spread into nearby bones, nerves, tissue or areas of
the skull.
N describes whether the cancer has spread to the neck lymph nodes. The
lymph nodes are part of your bodys system to protect you from infection
and disease. After N there is a number between 0 and 3 depending on how
many lymph nodes contain cancer cells, where they are and their
size. N0 means that no lymph nodes are affected by cancer.
M describes whether the cancer has spread to another part of the body. This
is called metastatic cancer. M0means the cancer hasnt spread
and M1 means the cancer has spread to distant organs such as the liver or
lungs.
Number staging system
Nasal and sinus cancers can also be given a number stage from 1 to 4.
For example, stage 1 describes a tumour that is small and hasnt spread.
This would be described as T1 N0 M0 in the TNM system. Stage 4 describes
a tumour has spread to other tissues nearby and/or has spread into the neck
lymph nodes and/or has spread to distant organs.

Talking about staging


Your doctor or nurse will be able to give you more information about staging.
To keep things simple, they may use the following words to describe the
stage of the cancer:

Early or local to describe a small cancer that hasn't spread.

Locally advanced to describe cancer that has spread into nearby


tissues or neck lymph nodes.

Secondary or widespread to describe cancer that has spread to


distant organs.

Local recurrence to describe cancer that has come back in the


head or neck area after treatment.
Grading
The grade of a cancer gives the doctor an idea of how quickly it may
develop. Doctors will look at a sample of the cancer cells under a microscope
to find the grade of the cancer.
Grade 1 the cancer cells tend to grow slowly and look quite similar to
normal cells.
Grade 2 and 3 the cancer cells look more abnormal.
Grade 4 the cancer cells tend to grow more quickly and look very
abnormal.

Treatment for nasal and sinus cancers


Your treatment will depend on the position, stage and grade of the cancer,
and on your general health. Usually a team of specialist doctors will plan
your treatment. They aim to treat the cancer while doing as little damage as
possible to your nose, mouth and appearance.
The main treatment for nasal or sinus cancer is usually surgery. Treatments
such as radiotherapy and chemotherapy may be given before surgery to
shrink a large tumour. Often they are given after you have had surgery to

reduce the risk of the cancer coming back. When chemotherapy and
radiotherapy are given together, its called chemoradiation.
Any of these treatments may also be given to improve symptoms of cancer
that has spread to other parts of the body.
Surgery for nasal and sinus cancers
Surgery is used to remove all or as much of the cancer as possible. The type
of surgery you have depends on the size and position of the tumour. If it is
small and hasnt spread, the surgeon may be able to remove just the tumour.
But sometimes they will also need to remove nearby areas of tissue or bone
affected by the cancer.
Your surgeon will explain the operation and answer any questions you have.
If possible, the operation will be planned to avoid damaging your appearance
and areas of your mouth or face that help you talk, swallow, eat or see.
However, sometimes the surgeon will advise removing larger areas and
rebuilding them with tissue, skin or bone taken from somewhere else in your
body. They may need to do this to remove the tumour completely. If part of
the roof of your mouth is removed, the surgeon will fit a special piece of
plastic (called an obturator) into the missing area. This covers the gap in the
roof of the mouth to help you speak and eat.
Sometimes, the surgeon also removes some lymph nodes in the neck. You
might have this even if the nodes dont show any signs of cancer, to reduce
the risk of the cancer coming back.
There are three ways of doing surgery for nasal and sinus tumours:
endoscopic, transoral and open. The surgeon may use one or more types
during your operation.
Endoscopic surgery
The surgeon uses a thin, flexible tube with a light and a camera at the end
(endoscope) to remove the tumour through your mouth or nose. This can be
as good as other types of surgery at treating small nasal and sinus cancers.
This type of surgery doesnt leave any scars on your face or neck and you
may recover faster after the operation.
Transoral surgery
The surgeon removes the tumour through cuts made inside your mouth.
Open surgery
The surgeon removes the tumour through cuts made on the face and neck.

After the operation


How long you stay in hospital depends on the type of operation you need. If
your surgery is more complicated, you might stay in hospital for up to three
weeks. You may be looked after in a high dependency unit or intensive care
for a while after the operation.
As you recover, you may see a dietitian and speech therapist to help you to
cope with any changes to your speech or how you swallow.
If you have an obturator fitted during the operation, you may need further
appointments with a specialist dentist. This is to make sure the obturator fits
well as your mouth heals.
Effects of surgery
This also depends on the type of operation that you have. Your speech, how
you swallow or your sense of taste and smell might be affected. Some
operations may leave scars or a change in your appearance.
It can be difficult to prepare for and cope with this kind of surgery. Its
important to discuss your operation fully with your surgeon so that you know
what to expect and how it will affect you.

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