Occupational cancer: diagnosis of paranasal sinus carcinoma.
Occupational safety and health symposia 1979. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 80-139, 1980 Jun; :45-52
Diagnosis of paranasal sinus cancer (PSC) and anatomy of the sinuses were discussed. Facial symptoms (cheek swelling and pain) occurred in 76 percent of cases and represented initial complaints in 44 percent. Nasal symptoms were present in 73 percent of cases and were first signs of disease in 36 percent. Diagnosis of PSC should include taking a careful history, performing a thorough physical examination and taking plain film radiographs of sinuses in five views. Visual telescopic examination could be done with the minimum of equipment under local anesthesia. Any suspicious area can be biopsied under direct vision. Hypocycloidal and computerized tomography provide detailed images of bony walls and soft tissue compartments. Gallium-67 isotope scanning of 25 patients showed that 18 had carcinoma that was confirmed by a subsequent biopsy. Labeled bleomycin has an affinity for malignant epidermoid cells, but had not been systematically tested. Differentiation between chronic sinusitis and maxillary cancer was achieved by ultrasound scanning (US) in more than 2000 patients. US could distinguish between maxillary solid tumors and fluid secretions within sinuses. The primary care level was the point of failure in 47 percent of cases. Most patients, 72 percent, presented for special diagnostic evaluation required only a simple biopsy to confirm the diagnosis of cancer. The author states that these patients with gross disease could have been diagnosed at an earlier stage if specialized diagnostic techniques had been used soon after the onset of symptoms or when the disease was in a more occult form. The primary task for the medical community, should be dissemination of certain technical skills and knowledge. Such efforts should be complemented by improved patient education, easier access to the primary health care, improved communications between health facilities, and better data collection. The author concludes that earlier diagnosis of paranasal sinus cancer is a practical goal that should provide improved patient survival.
NIOSH-Contract; Contract-210-79-0009; Medical-care; Medical-examinations; Neoplasms; Medical-services; Nasal-cancer; Diagnostic-tests; Medical-equipment; Medical-screening; Histopathology; Respiratory-neoplasms
DHHS (NIOSH) Publication No. 80-139
Occupational safety and health symposia 1979