Squamous Cell Carcinoma

The signs and symptoms of squamous cell carcinoma are dependent on the size of the tumor and what other areas it involves.  Typically nasal obstruction, decreased sense of smell, and nose bleeds, with or without facial pain are initial presenting symptoms.  More advanced tumors that involve the eye can present with visual changes, usually beginning with double vision (diplopia) or protrusion of the eye ball (proptosis), and in extreme cases, loss of vision.  Rarely tumors can extend from the nose to involve the skin of the nose or cheek.

Patients with concerning symptoms are first evaluated by an Otolaryngologist who specializes in sinus disease or head and neck cancer.  At the initial clinic visit, an exam using a small endoscopic camera is used to visualize the nasal cavity.  If a lesion is easily visualized, it generally can be biopsied in clinic to provide a diagnosis.  Patients then undergo an MRI scan focused on the skull base to determine the size and extent of tumor.  This imaging study also helps plan for surgical intervention.  Patients who will need image-guidance during their surgery may additional undergo a CT scan to better visualize the bony anatomy.  Imaging also includes evaluation of the neck to check for spread to the lymph nodes, and may include a PET scan if there is concern for spread to other areas of the body.

Careful multidisciplinary evaluation of each cancer is necessary to determine the best course of treatment.  In general, tumors are treated with surgical removal of all tumor followed by radiation therapy.  Patients who have high suspicion or evidence of cancer spread to the lymph nodes in the neck undergo removal of these lymph nodes.  Chemotherapy may be added to radiation therapy if the extent of tumor does not allows for a removal of a safe margin of tissue around the cancer.  In cases where there is significant involvement of the brain or both eyes, the first course of treatment is generally chemotherapy with or followed by radiation therapy.