Mayo Clinic's approach

At Mayo Clinic, specialists work together to provide you with expert, individualized care.

Diagnosis at Mayo Clinic

Mayo Clinic offers rapid, coordinated diagnostic testing and assessments that are done by a team of skilled doctors with specialized expertise in nasal and sinus tumors, including esthesioneuroblastoma. Mayo Clinic doctors use the latest testing methods.

Esthesioneuroblastoma diagnosis may involve:

  • Physical examination. A careful history of your signs and symptoms and an examination of your eyes, nose, and head and neck give doctors important information to understand the tumor's extent and aid in diagnosis.
  • Using a tiny, flexible camera to see in your nose. During an endoscopic examination, a thin, flexible tube (endoscope) is inserted in your nose. The tube is attached to a camera that allows doctors to look at the extent of the tumor in the nose, back of the nose (nasopharynx) and in the sinus area of the nasal cavity.
  • Imaging tests. Imaging tests such as an MRI and positron emission tomography (PET) help to determine the location and extent of your esthesioneuroblastoma and help determine whether it has spread.
  • Removing a sample of tissue for testing. A biopsy is a procedure to remove a sample of the tumor tissue for pathologic analysis. A biopsy may be performed by inserting special instruments through your nose to remove a small piece of the cancer. This procedure can often be done in a doctor's office.
  • Pathologic analysis. Accurate testing and analysis of the biopsy sample is necessary to distinguish esthesioneuroblastoma from other tumors that may appear similar. Esthesioneuroblastoma diagnosis is difficult since it is very rare and can appear very similar to other cancers that occur in the head, neck or nasal areas.

    Pathologic analysis also determines the aggressiveness (grade) of the tumor. Mayo Clinic pathologists use the latest advances in molecular pathologic study to accurately diagnose esthesioneuroblastoma.

Treatments at Mayo Clinic

Treatment for esthesioneuroblastoma typically involves surgery and radiation. Chemotherapy is another treatment option that may be used.

Surgery

Mayo Clinic head and neck surgeons and neurosurgeons are leaders in performing esthesioneuroblastoma operations, which can be challenging procedures. Generally, a neurosurgeon and a head and neck surgeon work together as a team to remove esthesioneuroblastoma safely and effectively.

Surgical techniques vary, depending on the tumor's location, and generally include procedures performed by:

  • A neurosurgeon to open the skull to gain access to the tumor. A craniotomy is a procedure to remove a small portion of the skull in order to remove the tumor and separate it from the brain.
  • A head and neck surgeon to remove the nasal portion of the tumor. The head and neck surgeon may make an incision along the side of the nose (lateral rhinotomy) to access the cancer. Or, in many cases, the procedure may be performed using minimally invasive surgery to access the cancer through the nose.

    Endoscopic surgery uses a long, thin tube (endoscope) equipped with a camera inserted through the nose to assess the cancer. Special surgical tools are passed through the endoscope to visualize the area and assist with the removal of the cancer and the surrounding tissue.

Pathologists examine the edges (margins) of tissue removed during surgery (frozen section analysis). This helps surgeons to ensure that as much of the cancer is removed as possible during surgery.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. People with esthesioneuroblastoma often undergo radiation therapy after surgery to kill any microscopic cancer cells that might remain in the head and neck.

Radiation therapy can also be used alone or in combination with chemotherapy if surgery isn't an option due to other health concerns or if the cancer is too advanced to be removed through an operation.

Because esthesioneuroblastoma is located near many critical structures in your head, such as your brain and your eyes, radiation beams must be aimed precisely to focus on cancer cells and spare the healthy tissue nearby. Mayo Clinic offers many advanced forms of radiation treatment planning and delivery, such as proton therapy and intensity-modulated radiation therapy.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. In people with esthesioneuroblastoma, chemotherapy is combined with radiation therapy after surgery to kill any cancer cells that may remain, especially for cancers that are very aggressive or extensive.

July 19, 2016
References
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