Types of Sinonasal Adenocarcinomas
The American Cancer Society says doctors only diagnose 2,000 sinonasal cancers each year in the United States. These rare tumors represent just 3% of all head and neck tumors.
Cancer scientists Alyson Littman and Thomas Vaughn wrote in Cancer Epidemiology and Prevention that sinonasal cancers often act as “sentinel health events,” signaling a strong association with occupational chemical exposure including wood dust, as well as dusts found in the furniture, shoe, leather and nickel refining industries. Cigarette smoke, chromium, mineral oils and formaldehyde exposure are also potential risk factors.
A study published Feb. 1, 2016 in Head and Neck Pathology titled “Sinonasal Adenocarcinoma: Update on Classification, Immunophenotype and Molecular Features (Leivo)” details various tumor classification differences, and differential diagnostic considerations.
The Leivo study says salivary type sinonasal adenocarcinomas develop from the glands and cells lining the nasal cavity and paranasal sinuses. They make up 5 – 10% of sinonasal adenocarcinomas. Adenoid cystic carcinoma (AdCC) is the most common salivary-type adenocarcinoma and the second most common sinonasal malignancy overall after squamous cell carcinoma. AdCC represents 10-18% of all sinonasal malignancies and usually occurs in the maxillary sinuses or the nasal cavity. Long term prognoses for AdCC is poor due to local spread.
Non-Salivary, Intestinal-Type Adenocarcinoma
Intestinal-type adenocarcinoma (ITAC) is the second most common sinonasal adenocarcinoma behind AdCC. ITAC’s growth patterns resemble intestinal carcinomas and adenomas, hence the name. The tumors most often occur in the ethmoid sinuses and less often in the nasal cavities and maxillary antrum. ITACs are aggressive and can spread to adjacent structures.
ITAC typically appears in males in their 50s and 60s.
The Leivo study states scientists identified a “remarkable association” between ITAC diagnoses and long-term wood dust exposure.
“In woodworking industries, workers with occupational exposure to hardwood dusts may show incidences 1000 times those of the general population,” the Leivo researchers said. “Interestingly, the highest incidences are seen in woodworkers in the furniture industry where hardwoods, particularly beech and oak, are used.”
The researchers said occupational dust exposure in the shoe and leather industries, as well as chromium and nickel, have also been implicated as causes of ITAC.
The Leivo researchers consider ITAC a “high-grade malignancy.” A study of 213 ITAC patients showed 50% developing recurrences, 8% developing lymph node metastases and 13% developing distant metastases. The Leivo study states that 60% of ITAC patients die from the disease.
Non-Salivary, Nonintestinal-type Adenocarcinoma
Non-salivary, nonintestinal-type adenocarcinomas show different features than intestinal-type or salivary-type adenocarcinomas. Researchers divide these into two types: high-grade and low-grade.
High-grade nonintestinal-type carcinomas are rare and typically occur in males approximately 60 years old. They display various morphologic patterns, making correct diagnosis difficult. The Leivo researchers note that high-grade nonintestinal-type adenocarcinoma prognosis is poor.
Low-grade nonintestinal-type adenocarcinomas are uncommon, representing 13% of all sinonasal adenocarcinomas. They occur mostly in the ethmoid sinus, nasal cavity and maxillary sinuses.
These cancers typically occur in patients in their 30s to 50s and is also known as terminal tubulus adenocarcinoma, sinonasal tubulopapillary low-grade adenocarcinoma, sinonasal low-grade adenocarcinoma, and sinonasal seromucinous adenocarcinoma.
These cancers exhibit varied morphologies, with a complex growth pattern and local invasive growth supporting a malignancy diagnosis. Differentiating low-grade nonintestinal-type adenocarcinomas from ITACs is highly important for treatment purposes. Death from low-grade nonintestinal-type adenocarcinomas is rare as prognoses are much more favorable than other sinonasal adenocarcinomas. Treatments include complete surgical removal, as well as optional radiotherapy.
If you believe your recent cancer diagnosis might be related to an occupational chemical exposure, please contact the trial attorneys of Allen Stewart, P.C. The firm has decades of combined experience in helping those who have developed cancer due to toxic exposure.