The loss of two close family members diagnosed with cancer meant David Prabhu was all too familiar with the insidious disease, so when he started suffering nose bleeds, mucus buildup and difficulty breathing, and sought medical attention, he never anticipated he would be diagnosed with the dreaded “C” word.
At diagnosis at age 49, in August 2021, Prabhu had a Stage 1 cancerous tumor growing in his sinus cavity. Owing to the fast-spreading cancer, based on the location, it was recommended he have the tumor removed as soon as possible.
“I was very shocked at the diagnosis, especially when I saw the size of the tumor and the fact that I never had any pain or tenderness in my sinus cavity,” said Prabhu.
According to Johns Hopkins Medicine, a paranasal sinus tumor is a cancer that has grown inside the sinuses – the open spaces behind a person’s nose. The tumor can begin in the cells of the membranes, bones or nerves that line the area. They say a person may not know or even suspect that a tumor is growing until it spreads.
“I was always tired at work, but I pushed through,” Prabhu recalled. “That was in addition to the nose bleeds, mucus buildup and difficulty breathing.”
Johns Hopkins Medicine says the sooner a person gets a diagnosis and starts treatment, the better their chances of beating the cancer are likely to be.
Prabhu had surgery in September 2021 to remove the tumor.
He underwent a battery of tests two weeks before his surgery date, and was then off approximately three weeks post-surgery.
He had to do a full body PET scan to make sure all the cancer was removed and that there was no spread.
“The results were then reviewed to determine if I needed chemotherapy or radiation treatments, which I thankfully didn’t have to do,” he said.
According to Johns Hopkins Medicine, the most common approach to treating a paranasal sinus tumor is a combination of surgery and radiation therapy. The goal of surgery is to remove as much of the tumor as possible. If the cancer has spread to lymph nodes, they will be removed as well. Surgery will be planned to preserve as much of the patient’s face and function as possible. And that surgery can be complex and may involve a variety of specialists, such as doctors who specialize in the ear, nose and throat (ENT doctors or otorhinolaryngologists), neurosurgeons, and maxillofacial surgeons.
Radiation therapy they say may be given before surgery to attempt to shrink the tumor. Or it may be given after surgery to destroy any remaining cancer cells.
Chemotherapy is determined on a case-by-case basis.
A patient may be given a combination of chemotherapy medicines or a combination of chemotherapy and radiation, called chemoradiation.
Paranasal sinus tumors and their treatment may lead to complications that can include scarring from surgery; long-term changes in vision, breathing, speech, chewing, or swallowing, caused by the tumor or surgery; nerve damage that can affect sensation in the face and movement in the face, shoulder, or arms; side effects from radiation therapy such as pain, nausea, trouble eating, mouth sores, loss of teeth, and changes in taste; and cancer spreading to other parts of the body (metastasis).
Johns Hopkins Medicine says people who are treated for paranasal sinus tumors should continue to meet regularly with their doctor. If the cancer returns, they say it is most likely to happen in the first few years after treatment.
Prabhu remains under observation/testing as the first year is when paranasal sinus tumors have a high chance of reoccurring.
“Subsequent scans have shown everything is clear,” he said.
Prabhu was diagnosed at Stage 1, which meant the tumor was contained in the sinuses and had not spread.
“Early detection is the key. If you are experiencing any type of bleeding that is not normal, then you should be checked out immediately before it gets too far. Even prior to my diagnosis, I always would give encouragement to fighters and survivors and hope everyone else would do the same.”
At Stage II, the tumor has spread into other parts of the sinuses. Stage III means the tumor has spread into the bone of the sinuses or the eye socket and may have spread to a lymph node. Stage IV means the tumor has spread deeper into the eye socket, into the brain, or into other parts of the skull and neck, and possibly to more distant parts of the body and may have a larger presence in the lymph nodes.
Not all paranasal sinus tumors have known causes. Johns Hopkins has cited possible causes which include exposure to industrial chemicals, being infected with the human papillomavirus (HPV), exposure to wood, leather, flour, textile, nickel, or chromium dust, exposure to radium and smoking cigarettes.
Early symptoms of paranasal sinus tumors are similar to symptoms of colds or infections, so they’re often missed – blockage of sinuses or congesting that never goes away; changes in the voice or breathing, reduced sense of smell, headaches, numbness or pain in the face, ears or teeth; teeth that become loose; pus draining from the nose or post-nasal drip; frequent nosebleeds; growth on the face or palate; eyes that continuously water; bulging eyes; loss of or change in vision; and trouble opening the mouth.
In diagnosing paranasal sinus tumors, a doctor will typically take a person’s health history and do a physical exam which includes looking at a person’s eyes, ears, nose, mouth, face, neck and throat.
According to Johns Hopkins Medicine, any details a person can provide about any pain they are having can help with the diagnosis, including details such as whether the pain is sharp, burning, dull, or achy, where it’s located, and when it occurs.
They say a doctor may order an endoscopy of the sinuses – a procedure in which a thin tube with a tiny light and a video camera on the end is inserted into the sinuses. Looking inside the sinuses will help the medical professional to figure out the location and size of the tumor.
The doctor may also order blood tests; imaging tests of the skull such as x-rays, CT scans, or MRI of the sinuses; imaging tests of the chest; and a biopsy where a small tissue sample from the tumor is removed and checked in a lab for signs of cancer.
Prabhu said his grandmother succumbed to breast cancer in 1984. In 2018, his mom passed.
“So, I have always been a strong supporter of the cause and the awareness of this dreadful disease.”
He has participated for seven years in the CIBC FirstCaribbean’s Walk for the Cure. Monies from the fundraising walk and associated events are used primarily to assist with the purchase and maintenance of equipment used in the diagnosis and treatment of cancer patients. They are also used to provide assistance, care and counseling to patients and their families as well as to raise awareness and stress the importance of early detection, through education campaigns across the region.