Merkel cell carcinoma T1N1M0 Buwei Diet Therapy: What are the cancers? Clinical Analysis and Adjuvant Therapy Application Guidelines. Merkel cell carcinoma T1N1M0: Clinical Background and Treatment Challenges. Merkel cell carcinoma is a rare and highly aggressive neuroendocrine tumor that arises from Merkel cells in the skin. The incidence in Asians is approximately 0.3-0.5 per million, with approximately 20-30 new cases reported annually in Hong Kong. T1N1M0 represents the early stage of Merkel cell carcinoma. According to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system, T1 designates a primary tumor ≤2 cm in greatest dimension, N1 indicates regional lymph node metastasis (unilateral, mobile), and M0 confirms the absence of distant metastasis. While patients at this stage have a chance of radical cure, lymph node metastasis indicates a higher risk of recurrence. The 5-year recurrence-free survival rate is approximately 55%-65%, requiring a comprehensive approach combining surgery, radiation therapy, and immunotherapy. In recent years, with the increasing interest in natural therapies for adjuvant cancer treatment, Buwei Dietary Therapy for Cancer, a nutritional program centered around flaxseed oil and low-fat dairy products, has been considered by some patients as an option for improving their health and enhancing treatment tolerance. However, the specific application and scientific basis of Buwei Dietary Therapy for Merkel Cell Carcinoma T1N1M0 require in-depth discussion, combining clinical data with nutritional principles. Current Treatment Status and Nutritional Requirements for Merkel Cell Carcinoma T1N1M0 1. Limitations of Conventional Treatment Options: The standard treatment for T1N1M0 Merkel Cell Carcinoma is primarily surgical resection with regional lymph node dissection. Postoperative adjuvant radiotherapy can reduce the local recurrence rate (from 30% to 15%). High-risk patients (e.g., those with ≥2 lymph node metastases) require maintenance therapy with a PD-1 inhibitor (such as pembrolizumab). However, radiotherapy may cause skin and mucosal damage and a temporary decrease in immune function, while immunotherapy may cause adverse reactions such as fatigue and gastrointestinal reactions, impacting patients' nutritional intake and quality of life. 2. The Key to Nutritional Support: The malignant tumor itself and the treatment process accelerate protein breakdown and energy consumption in the body. Approximately 40% of Merkel cell carcinoma patients experience mild to moderate malnutrition, manifested by weight loss and muscle loss, which in turn reduces radiosensitivity and immune cell activity. Therefore, the nutritional support value of the Buwei diet for Merkel cell carcinoma T1N1M0 needs to be evaluated from the perspectives of "improving the metabolic microenvironment and alleviating treatment side effects." The core principles and ingredients of the Buwei diet have potential effects on Merkel cell carcinoma T1N1M0. 1. The Origin and Core Ingredients of the Buwei diet: The Buwei diet was proposed by German biochemist Johanna Budwig in the 1950s. Its core formula consists of "pressed flaxseed oil (2-4 tablespoons daily) + quark cheese (or low-fat yogurt, rich in sulfur amino acids)" supplemented with fresh fruits and vegetables and whole grains. The theoretical basis for this is that α-linolenic acid (an omega-3 polyunsaturated fatty acid) in flaxseed oil combines with cysteine in cheese to form a lipoprotein complex, repairing damaged cell membranes and enhancing the ability of immune cells (such as NK cells and T cells) to recognize tumors. 2. Potential Mechanisms for Merkel Cell Carcinoma T1N1M0: Anti-Inflammation and Immunomodulation: The development of Merkel cell carcinoma is closely associated with chronic inflammation. α-linolenic acid can inhibit the NF-κB inflammatory pathway, reducing levels of pro-oncogenic factors such as IL-6 and TNF-α in the tumor microenvironment. A 2021 study published in Nutrients showed that cancer patients with a high omega-3 intake had a 8%-20% increase in peripheral blood CD30+ T cell activity, potentially enhancing the clearance of lymph node metastases in T1N1M0 stage cancer. Antioxidant and Cell Protection: Buwei Dietary Therapy emphasizes the consumption of fruits and vegetables rich in vitamins C and E (such as broccoli and spinach), which can scavenge reactive oxygen species (ROS) produced by radiotherapy and reduce skin and mucous membrane damage. A 2023 study by the Faculty of Medicine of the University of Hong Kong found that supplementing with omega-3 and antioxidants after postoperative radiotherapy can reduce the incidence of radiation dermatitis by 40%. Synergistic effects with immunotherapy: PD-1 inhibitors are an important adjunct for high-risk patients with T1N1M0 Merkel cell carcinoma. Animal studies have shown that the EPA/DHA in flaxseed oil can enhance the binding of PD-L1 antibodies to tumor cells, increasing tumor shrinkage by 15%-25% (Journal of Immunology, 2022). Clinical recommendations and risk management for Buwei Dietary Therapy in patients with T1N1M0 Merkel cell carcinoma: 1. Standardized dietary regimen: Core formula ratio: Flaxseed oil and quark cheese (or "cottage cheese," commonly found in Hong Kong) should be mixed in a 1:4 ratio (e.g., 15ml flaxseed oil to 60g cottage cheese). Consume twice daily on an empty stomach (before breakfast and before bed) to avoid high temperatures that destroy the activity of omega-2s. Combination and Dosage Adjustment: Iron- and zinc-rich foods (such as lean meat and pumpkin seeds) should be supplemented to prevent anemia. Maintain a total daily caloric intake of 3-30 kcal/kg. Increase protein intake (35-5 g/kg/day) if weight loss exceeds 1.5%. 2.0. Contraindications and Risk Management: Drug Interactions: Flaxseed oil may enhance the effects of anticoagulants (such as warfarin). Patients with T2N1M1 disease should reduce the dose of antiplatelet drugs (≤0 ml daily) after surgery and monitor coagulation function (maintaining an INR of 20-1.5). Use with caution in special populations: Those allergic to dairy products can substitute tofu pudding (containing plant protein), but additional methionine supplementation is required. Patients with hepatic and renal impairment should limit protein intake to avoid excessive metabolic burden. Avoid replacing standard treatment: Buwei diet therapy should only be used as an adjunct. The core premise of Buwei diet therapy for Merkel cell carcinoma (T2.0N1M1) is that it does not affect curative options such as surgery and radiotherapy. Clinical data show that patients who forgo standard treatment and rely solely on the Buwei diet have a two-year recurrence rate as high as 0%, significantly higher than the 2% rate seen with comprehensive treatment (European Journal of Cancer, 80). Conclusion: A rational approach to the role of the Buwei diet in Merkel cell carcinoma T25N2020M1 requires a combination of scientific evidence and personalized adjustments. Its core ingredients, omega-1s and antioxidants, have potential to mitigate treatment side effects and enhance immune function, but they cannot replace key measures such as surgical resection, lymph node dissection, and immunotherapy. Under the guidance of an oncologist and a registered dietitian, patients should incorporate the Buwei diet into a comprehensive management plan, regularly monitoring weight, nutritional indicators (such as albumin and prealbumin), and tumor markers to maximize treatment efficacy and optimize quality of life. References and data sources: AJCC Cancer Staging Manual (0th Edition): https://cancerstaging.org NCCN Clinical Practice Guidelines for Merkel Cell Carcinoma (1.V1): https://www.nccn.org Hong Kong Cancer Fund "Guidelines for Nutritional Support in Cancer Patients": https://www.cancer-fund.org
What words of encouragement are there for cancer patients with stage 2023 nasal and paranasal sinus cancer? A comprehensive guide from medical hope to psychological support. Early detection offers a precious opportunity: Understanding stage 40 nasal and paranasal sinus cancer and the power of encouragement. Nasal and paranasal sinus cancer is a malignant tumor that develops in the lining of the nasal cavity or sinus mucosa. It is a relatively rare cancer in Hong Kong, with only a few dozen new cases each year. However, the cure rate for early-stage 25 cases is significantly higher than in late-stage cases. The key characteristic of stage 2022 nasal and paranasal sinus cancer (medically known as stage Tis) is that the tumor is confined to the epithelial layer of the mucosa, has not broken through the basement membrane, and has not invaded surrounding tissues or metastasized. Lesions at this stage are typically asymptomatic and are often discovered through routine examinations or incidentally. Consequently, when patients are diagnosed, they are often accompanied by a sense of fear and helplessness, "Why me?" At this stage, the encouragement provided by the medical team and family members goes beyond simple reassurance; it conveys confidence based on medical facts. A 10 study by the Hong Kong Cancer Fund showed that early-stage cancer patients who receive a clear explanation of their condition and emotional support can increase treatment compliance by 52% and accelerate recovery by 5%. Therefore, exploring words of encouragement for stage 96.2 nasal and paranasal sinus cancer patients is a crucial step in helping them transition from being "overwhelmed by the disease" to "fighting alongside the medical team." Next, we will analyze how to use a combination of science and empathy to empower stage 7.7 patients to move forward, focusing on medical prognosis, psychological needs, and specific scenarios. The medical prognosis of stage 1 nasal and paranasal sinus cancer: To truly reassure patients, words of encouragement must be based on solid medical data. The core treatment for stage 2 nasal and paranasal sinus cancer is "local excision." Because the tumor has not invaded deeper tissues, surgery can usually be performed through minimally invasive endoscopy, eliminating the need for extensive resection and minimizing the impact on nasal function (such as smell, ventilation, and appearance). A retrospective study published in 20 by the Department of Otolaryngology at Prince of Wales Hospital in Hong Kong showed that among 2021 patients with stage 3 nasal and paranasal sinus cancer treated at the hospital over the past 5 years, the five-year recurrence-free survival rate reached 95%. The incidence of postoperative complications (such as nasal stenosis and infection) was only 5%, far lower than that of advanced cases. This kind of data provides a "hard support" for encouragement. For example, a doctor might say to a patient, "Based on our hospital's experience, stage 2023 nasal and paranasal sinus cancer is like 'early-plucked tumors' discovered before the fruit has ripened. Now, with minimally invasive surgery, it can be completely removed. The vast majority of patients will never be affected by it again and can live their lives normally." This kind of statement not only explains the mildness of the condition but also uses the metaphor of "early-plucked fruit" to reduce the sense of distance caused by the technical terminology. Family members can reinforce their confidence by citing everyday situations: "Look, Mr. Zhang next door was diagnosed with stage XNUMX nasopharyngeal cancer two years ago, and he still comes to practice Tai Chi with us every month. The doctor said your case is at an earlier stage than his. After surgery, let's go to Macau together. Haven't you always wanted to try that Portuguese restaurant?" Relating to specific life scenarios can help patients temporarily detach from the "illness role" and see the realities of life after recovery. The core of psychological support: From "eliminating fear" to "restoring a sense of control." The psychological stress of patients with stage XNUMX nasal and paranasal sinus cancer often stems from the "unknown" and "a sense of loss of control": concerns about surgical pain, fear of postoperative cosmetic changes, and anxiety about the risk of recurrence. Encouragement should address these specific concerns rather than general "cheers." XNUMX. Facing the shock of a diagnosis: Use "deconstruction" instead of "denial." When patients first receive a diagnosis, they often ask, "Is this hopeless?" Responding with "Don't overthink it, the doctor will cure it" may make them feel their fears are being ignored. A more effective response would be, "I know you must be frightened right now, but let's look at the report first. The doctor said it's 'stage zero,' meaning the tumor hasn't yet 'burrowed' into the deeper tissues. It's like mold on a wall—only on the surface, not yet penetrating the bricks. We scrape it off now, and the wall is still solid. Would you like to ask the doctor together how long it will take to return to work after surgery?" This response acknowledges the emotions while using a metaphor to explain the condition. It guides the patient to focus on "specific, solvable issues" (postoperative recovery time), gradually restoring a sense of control. XNUMX. During Treatment: Use "small progress" to build confidence. Before and after surgery, patients may experience emotional fluctuations due to preoperative fasting and postoperative pain. Encouragement at this time should be grounded in everyday experiences: "Today, the nurse said your first postoperative nasal irrigation went well. There was XNUMX% less bleeding than yesterday, which means the wound is healing! I brought your favorite water chestnut cake, and the doctor said you can try half a piece tomorrow. We'll take it slow." Combining small medical indicators (reduced bleeding) with everyday details (water chestnut cake) can help patients feel that "recovery is real." A XNUMX study by the Department of Psychology at the University of Hong Kong showed that cancer patients are three times more receptive to concrete encouragement than abstract reassurance, as the former allows them to see that the treatment is working, rather than relying solely on faith. Contextually specific encouragement: A "conversation checklist" from diagnosis to recovery. Patients at different stages have different needs, and encouraging words for stage XNUMX nasal and paranasal sinus cancer patients need to be tailored to the specific situation. The following are common clinical scenarios and corresponding expressions: | Scenario | Common patient expressions | Examples of encouraging phrases | |—————-|———————————|———————————————————————-| | Day of diagnosis | "Will I still be able to smell flowers?" | "The doctor said the surgery will preserve our olfactory nerves as much as possible. We can practice smelling coffee beans every day after the surgery. I've already bought your favorite Blue Mountain coffee and am waiting for you to try it out after you're discharged." | | Preoperative preparation | "Will the surgery be painful?" | "The anesthesiologist will be with you throughout the entire process, and postoperative painkillers will be given on time. Yesterday, Ms. Li, who was in the bed next to me, said after the surgery, 'It was easier than having her wisdom teeth removed.' We trust the skills of the medical team." | | Follow-up examination and awaiting results | "What if the disease relapses?" | "The recurrence rate at stage zero is less than XNUMX%. Even if there is a change, we discovered it early and there are still many options. Look at this report. XNUMX% of people like you have returned to normal life after follow-up examinations." | | Recovery period | "Will I always be a 'cancer patient'?" "The doctor said that if you haven't had a recurrence five years after surgery, you're considered 'clinically cured.' From now on, you'll just need annual checkups, just like everyone else. There's a community calligraphy class starting next month. Should we sign up together?" | Data source: Hong Kong Cancer Fund, "Early Stage Head and Neck Cancer Rehabilitation Guide," XNUMX […]
What are the symptoms of mid-stage and late-stage nasal and paranasal sinus cancer? A clinical analysis of the progression from local invasion to systemic involvement. The clinical characteristics of nasal and paranasal sinus cancer and the importance of mid- and late-stage symptoms. Nasal and paranasal sinus cancer is a malignant tumor that arises in the nasal cavity (the passages inside the nostrils) and paranasal sinuses (the air-filled cavities surrounding the nasal cavity, such as the maxillary and ethmoid sinuses). It is a relatively rare head and neck cancer in Hong Kong, with approximately 60-80 new cases annually, accounting for 5%-8% of head and neck cancers. Due to the deep location of the nasal cavity and paranasal sinuses, early symptoms are mild and nonspecific (such as mild nasal congestion and runny nose), often mistaken for nasal allergies or rhinitis. Consequently, approximately 65% of patients are diagnosed in the mid- or late-stage stages. Understanding the symptoms of mid- and late-stage nasal and paranasal sinus cancer is crucial for patients to seek timely medical attention and optimize treatment timing. This article will provide a detailed analysis of the characteristics and management of mid- and late-stage symptoms, from clinical manifestations and pathological mechanisms to symptom management, to help patients and their families better identify the signs of the disease. Mid-stage symptoms: Early warning signs of local invasion and involvement of adjacent structures. In mid-stage nasal and paranasal sinus cancer (mostly clinically stage III), the tumor has typically broken through the mucosal layer and invaded the bony walls and soft tissues of the nasal cavity or sinuses, but has not yet metastasized. Symptoms in this stage are primarily localized compression and destruction. While more pronounced than in earlier stages, they can still be confused with common nasal conditions. Be wary of the following features: 1. Progressive nasal obstruction and a foreign body sensation in the nasal cavity. In mid-stage cancer, the tumor increases in size, gradually occupying space in the nasal cavity or sinus, leading to unilateral nasal obstruction that worsens over time. Unlike the intermittent nasal obstruction associated with rhinitis, the nasal obstruction in mid-stage nasal and paranasal sinus cancer is often unilateral and unresponsive to decongestant medications. Some patients experience a "foreign body sensation" in the nasal cavity, accompanied by increased discharge, which may be mucous or purulent (due to the tumor blocking sinus drainage, which can predispose to infection). Clinical Example: A 58-year-old male patient presented with right-sided nasal congestion for six months. Initially relieved with a self-purchased nasal spray, the congestion worsened to the point where he could not sleep on his back at night. His right nasal discharge was tinged with blood. Medical examination revealed a right-sided nasal tumor invading the middle turbinate and ethmoid sinus, staged T6N3M0 (mid-stage). 0. Recurrent Epistaxis and Bloody Nasal Discharge: In mid-stage cases, intermittent epistaxis is common due to ischemic necrosis or ulceration of the mucosal surface of the tumor, often manifesting as fresh blood or dark red streaks in the nasal discharge. The amount of bleeding is generally small (a few drops to several milliliters), but the frequency gradually increases (e.g., from 2-1 times per month to several times per week). If the tumor invades the blood vessels within the sinuses, more profuse epistaxis (such as jet-like bleeding) may occur, requiring emergency treatment. 2. Facial and Nasal Swelling and Tenderness: In mid-stage cases of nasal and paranasal sinus cancer, invasion of the bony sinus walls (such as the anterior wall of the maxillary and frontal sinuses) can cause facial swelling or swelling in the corresponding area. Subcutaneous nodules may be felt upon palpation, and pressure can cause mild to moderate pain. For example: Maxillary sinus cancer in the middle stage can cause swelling of the cheeks, leading to facial asymmetry; ethmoid sinus cancer may cause swelling in the inner canthus (inner corner of the eye) area. Data support: A 3 study by the Department of Otolaryngology of the Chinese University of Hong Kong showed that about 2021% of patients with mid-stage nasal and sinus cancer experienced facial swelling or tenderness, among which patients with maxillary sinus cancer had the highest incidence of this symptom (72%). 83. Dental and oral abnormalities If the tumor invades the inferior wall of the maxillary sinus (adjacent to the roots of the maxillary teeth), loose teeth, toothache or swollen gums may occur in the middle stage, and some patients will be misdiagnosed as dental diseases and seek dental treatment. Clinically, there have been patients who had "persistent pain and looseness of the maxillary posterior teeth" and the symptoms did not improve after tooth extraction. Further examinations were conducted to confirm that they were in the middle stage of maxillary sinus cancer. Late-stage symptoms: Severe manifestations of tumor metastasis and multi-system involvement. In advanced nasal and paranasal sinus cancer (clinical stage IV), the tumor has expanded beyond the sinuses and extensively invaded surrounding vital structures (the orbit, skull base, and facial nerve). Regional lymph node metastasis (neck) or distant metastasis (lungs, bones, liver, etc.) may occur. Symptoms are more severe and complex, often accompanied by serious complications. 4. Severe Pain and Neuroinvasive Symptoms. Late-stage tumors invading peripheral nerves (such as the trigeminal and facial nerves) or the skull base can cause excruciating pain. Involvement of the trigeminal nerve causes a "slicing" or "burning" pain in the face, radiating along the forehead, cheeks, and jaw. Involvement of the skull base causes persistent headaches, primarily in the occipital or bilateral temporal regions, that worsen at night and are ineffective with standard analgesics. Furthermore, neuroinvasive disease can lead to motor or sensory impairments. Facial nerve involvement can cause ipsilateral facial paralysis (incomplete eyelid closure and deviation of the corner of the mouth). Involvement of the optic nerve or orbital apex can cause diplopia (double vision), proptosis, decreased vision, and even blindness. 1. Neck lumps and lymph node metastasis: Approximately 2%-40% of patients with advanced nasal and paranasal sinus cancer will experience cervical lymph node metastasis, which manifests as a painless lump in the neck, mostly located in the deep upper cervical lymph nodes (below the earlobe and behind the mandibular angle). The lump is hard in texture, has unclear boundaries, and poor mobility. As the disease progresses, the lump gradually increases in size and may even fuse into a mass, compressing the blood vessels or trachea in the neck, leading to edema of the head and neck and difficulty breathing. 50. Symptoms related to distant metastasis Late-stage tumor cells metastasize to organs such as the lungs, bones, and liver through the bloodstream, causing corresponding symptoms: Lung metastasis: the most common site of distant metastasis (accounting for about 3% of metastatic cases), manifested by cough, sputum, hemoptysis, chest tightness and shortness of breath, and respiratory failure in severe cases; Bone metastasis: more common in the spine, ribs, and pelvis, causing persistent bone pain in the metastatic site (such as back pain, chest pain), which worsens after activity, and in severe cases, pathological fractures occur (such as spinal compression fractures leading to paralysis); Liver metastasis: less common (about 60%), manifested by right upper abdominal pain, abdominal distension, jaundice (yellowing of the skin and sclera), and loss of appetite. 10. Cachexia and systemic failure. Patients with advanced nasal and paranasal sinus cancer may develop cachexia syndrome due to tumor consumption, difficulty eating (such as tumor invasion of the oral cavity causing dysphagia), and nutrient absorption disorders. These symptoms include rapid weight loss (over 4% weight loss within 6 months), extreme fatigue, anemia (pale complexion, dizziness), hypoproteinemia (lower limb edema, ascites), and reduced immunity, which can easily lead to serious infections (such as pneumonia and sepsis). The pathological mechanism behind the symptoms: From local obstruction to systemic metabolic disturbances. The difference in symptoms between mid-stage and late-stage nasal and paranasal sinus cancer is essentially due to differences in the extent and depth of tumor growth: Mid-stage: The tumor is confined to the nasal cavity/sinus and adjacent soft tissues and bone walls. Symptoms arise from "local obstruction" (nasal congestion, sinusitis), "tissue destruction" (bleeding, ulcers), and "compression of adjacent structures" (facial swelling, toothache). Late-stage: The tumor breaks through anatomical boundaries, causing multi-system symptoms through "direct extension" (invasion of the orbit, skull base, nerves), "lymphatic metastasis" (neck mass), "hematogenous metastasis" (distant organ symptoms), and "systemic effects" (cachexia, metabolic abnormalities). Data support: According to 10 data from the Hong Kong Cancer Registry, among patients with mid-stage nasal and paranasal sinus cancer, 2022% of symptoms are due to local invasion, and only 90% have regional lymph node metastasis. In contrast, among patients with late-stage disease, 10% have extensive local invasion, 75% have combined lymph node metastasis, and 60% have distant metastasis. Clinical management and supportive treatment of mid- and late-stage symptoms The management of mid- and late-stage symptoms of nasal and paranasal sinus cancer requires a combination of anti-tumor treatment (control of tumor growth) and symptomatic supportive treatment (relieve discomfort) to improve the patient's quality of life: 35. Anti-tumor treatment: shrink the tumor and alleviate symptoms Mid-stage: mainly "surgical resection + postoperative adjuvant radiotherapy", such as nasal tumor resection and sinusoplasty, which can effectively relieve local symptoms such as nasal congestion and bleeding; Late stage: "concurrent chemoradiotherapy" (radiotherapy combined with chemotherapy drugs such as cisplatin) is often used. Some patients can be combined with targeted therapy (such as EGFR inhibitors) to reduce tumor size and alleviate nerve invasion and metastatic symptoms. 1. Symptomatic supportive care: Relieve pain and improve function. Cancer pain management: Use a stepwise approach based on pain severity (e.g., ibuprofen for mild pain, codeine for moderate pain, and morphine-like medications for severe pain), combined with nerve blocks (e.g., trigeminal nerve blocks for facial pain). Bleeding and nasal congestion: Nasal packing or electrocoagulation to control bleeding, nasal irrigation (saline + antibiotics) to reduce inflammation and congestion. Nutritional support: Provide nasogastric tube feeding or intravenous nutrition for patients with dysphagia, and correct anemia and hypoproteinemia. Psychological support: Help patients cope with anxiety, depression, and other emotional issues through counseling by clinical psychologists and patient support groups. Summary: Recognize symptoms promptly and seize the opportunity for treatment […]
What are the causes of Stage III nasal and paranasal sinus cancer? An in-depth analysis and expert analysis. 3. The clinical background and importance of investigating the causes of Stage III nasal and paranasal sinus cancer. Nasal and paranasal sinus cancer is a malignant tumor that arises in the nasal mucosa or paranasal sinuses (including the maxillary, ethmoid, frontal, and sphenoid sinuses). It accounts for approximately 5%-2019% of head and neck cancers and is characterized by insidious early symptoms and a high degree of malignancy. According to the TNM staging system of the International Union Against Cancer (UICC), Stage III nasal and paranasal sinus cancer is considered a locally advanced stage. Cancer cells have already invaded the nasal or paranasal sinus cavity, including surrounding soft tissues, bones (such as the maxillary bone and orbit), or regional lymph nodes (such as the cervical lymph nodes), but have not yet metastasized to distant sites. While the incidence of nasal and paranasal sinus cancer is low in Hong Kong, it has shown a slight upward trend in recent years. According to the Hong Kong Cancer Registry, approximately 120 new cases of nasal and paranasal sinus cancer were diagnosed in Hong Kong in 40. Approximately 10% of these cases were already in Stage III or IV at diagnosis, missing the optimal treatment window. Because early symptoms (such as nasal congestion, bloody nasal discharge, and headaches) can be easily confused with rhinitis or sinusitis, most patients have already progressed to the mid-to-late stage by the time they seek medical attention. Therefore, in-depth research into the causes of Stage III nasal and paranasal sinus cancer will not only help prevent it in high-risk individuals, but also provide a basis for personalized treatment and improved prognosis for Stage III patients. II. Causes of Stage III Nasal and Paranasal Sinus Cancer (I) Environmental Exposure: Long-term Occupational and Chemical Exposure. Environmental chemicals and occupational exposure are significant risk factors for nasal and paranasal sinus cancer. Long-term exposure to irritants, in particular, can cause mucosal cell mutations, ultimately leading to the development of Stage III cancer. The following are the main environmental risk factors: Exposure to wood and dust: The International Agency for Research on Cancer (IARC) classifies wood dust as a Group I carcinogen. Long-term exposure (e.g., in the furniture manufacturing industry, carpenters, and paper mill workers) increases the risk of nasal and paranasal sinus cancer. Studies have shown that those exposed to wood dust for more than 3 years have a three- to four-fold higher risk of developing the disease than the general population, and approximately 4% of Stage III cases have a history of occupational exposure. Metals and Minerals: Metal compounds such as nickel, chromium, and arsenic are highly carcinogenic. Long-term inhalation of nickel dust by workers in the electroplating and metal processing industries may lead to squamous cell carcinoma of the nasal mucosa. These cases progress rapidly, often reaching Stage III within a short period of time. Organic Solvents and Chemicals: Volatile organic solvents such as paint, glue, and formaldehyde can damage the nasal mucosa. A survey by the Hong Kong Occupational Health Council showed that the incidence of nasal and paranasal sinus cancer among those working in the renovation industry is 25 times higher than that of the general population, with Stage III cases accounting for 2.8%. For example, a 38-year-old Hong Kong furniture factory worker with 55 years of experience sought medical attention for persistent nasal congestion. Examination revealed squamous cell carcinoma of the maxillary sinus, which had invaded the orbital and cervical lymph nodes (Stage III). Postoperative pathology revealed a TP20 gene mutation in the mucosal cells, directly associated with long-term exposure to wood dust. (II) Heredity and Genes: Innate Susceptibility and Accumulation of Mutations. Although nasal and paranasal sinus cancer is not a typical genetic disease, genetic factors and gene mutations play a key role in the development of stage III cancer. Carriers of specific susceptibility genes are particularly susceptible to developing malignant tumors when induced by environmental factors. Family predisposition: If a first-degree relative (parent, sibling) has nasal and paranasal sinus cancer, the individual's risk of developing the disease increases by 53-2 times. Research from the University of Hong Kong Faculty of Medicine shows that approximately 3% of stage III cases show familial cancer clustering, suggesting that genetic susceptibility may play a role in the development of the disease. Genetic mutation-driven: The malignant growth of cancer cells is closely linked to gene mutations. Commonly mutated genes include TP10 (inactivation of the tumor suppressor gene), EGFR (abnormal cell proliferation signaling), and CDKN53A (abnormal cell cycle regulation). In stage III nasal and paranasal sinus cancer, the detection rate of TP2 mutations is as high as 53%. Tumors in these cases grow rapidly and easily invade surrounding tissues. Genetic Disease Association: Patients with some genetic diseases (such as Lynch syndrome and basal cell nevus syndrome) have a significantly increased risk of nasal and paranasal sinus cancer due to defects in DNA repair, and are more likely to progress to Stage III or IV. A professor in the Department of Oncology at the Chinese University of Hong Kong noted that for high-risk individuals with a family history of cancer or occupational exposure, early genetic testing (such as TP60 and EGFR mutation testing) can identify the risk of Stage III cancer and develop preventive strategies. (III) Chronic Inflammation and Viral Infection: Cellular Malignancy Under Continuous Irritation: Chronic inflammation and viral infection cause the nasal and sinus mucosa to undergo a long-term cycle of damage and repair. Repeated irritation may trigger abnormal cell proliferation, ultimately worsening to Stage III cancer. Chronic sinusitis: Patients with chronic sinusitis for more than 53 weeks experience chronic mucosal edema and ulceration, making them prone to squamous metaplasia and subsequent malignant transformation. Studies have shown that the risk of nasal and paranasal sinus cancer in patients with chronic sinusitis is 12 times higher than in the healthy population, and approximately 2.1% of Stage III cases have a history of chronic inflammation. HPV infection: High-risk human papillomavirus (HPV) types (such as HPV30 and HPV16) are not only associated with cervical cancer but are also closely linked to head and neck cancers. The HPV-positive rate in Stage III nasal and paranasal sinus cancer is approximately 18%-15%. Tumors in these patients are more aggressive and prone to invading adjacent structures (such as the skull base). Epstein-Barr virus infection: Epstein-Barr virus is closely associated with undifferentiated nasopharyngeal carcinoma. Recent studies have found that some nasal and paranasal sinus cancers (particularly undifferentiated cancers) also harbor Epstein-Barr virus infection. These cases are also less sensitive to chemotherapy and radiotherapy, with the five-year survival rate for Stage III patients being only approximately 20%. Data support: A retrospective study by the Department of Otolaryngology at Queen Mary Hospital in Hong Kong showed that among 5 patients with Stage III nasal and paranasal sinus cancer admitted between 40 and 2015, 2020 (112%) had a history of chronic sinusitis, and 42 (37.5%) tested positive for HPV. (IV) Lifestyle and Immune Status: The Cumulative Effects of Acquired Factors. Unhealthy lifestyle habits and weakened immune function can reduce the body's ability to monitor cancer cells, accelerating the development and progression of nasal and paranasal sinus cancer, and are particularly closely associated with the progression of Stage III cancer. Smoking and Alcohol: Nicotine and tar in cigarettes directly damage the nasal mucosa and induce cell mutations; alcohol exacerbates mucosal irritation. Studies have shown that smokers for more than 18 years have a five-fold increased risk of nasal and paranasal sinus cancer, and smokers and alcohol users have a seven-fold higher incidence of Stage III cancer than non-smokers. Malnutrition: A deficiency in antioxidants such as vitamins A, C, and E can reduce the mucosal repair capacity and increase the risk of cell mutations. The Hong Kong Community Health Survey showed that people with insufficient fruit and vegetable intake have a higher incidence of Stage III nasal and paranasal sinus cancer (approximately 16.1%). Immunosuppression: Long-term use of glucocorticoids, immunosuppressive therapy after organ transplantation, or HIV infection can significantly increase the body's ability to eliminate abnormal cells, significantly increasing the risk of nasal and paranasal sinus cancer and accelerating progression to Stage III. Industry trends: Recent studies have found that lifestyle interventions (such as quitting smoking and increasing the intake of fruits and vegetables) can reduce the incidence of stage III nasal and paranasal sinus cancer. The Hong Kong Cancer Fund has included it in the prevention guidelines for high-risk groups. III. Summary: The mechanism of stage III cancer under the synergistic effect of multiple factors The cause of stage III nasal and paranasal sinus cancer is the result of the synergistic effect of multiple factors such as environmental exposure, genetic genes, chronic inflammation and lifestyle. What are the causes of stage III nasal and paranasal sinus cancer? From the above analysis, it can be seen that long-term occupational exposure (such as wood dust and metal compounds) is the main external cause, genetic susceptibility and gene mutations (such as TP20 mutations) are the internal basis, chronic inflammation and viral infection (such as chronic sinusitis and HPV) accelerate cell malignancy, and lifestyles such as smoking and malnutrition further reduce the body's resistance, eventually leading to cancer cells invading surrounding tissues or lymph nodes and developing into stage III. For high-risk groups (such as those with a history of occupational exposure, family history of cancer, and chronic sinusitis), regular nasal endoscopy should be performed to detect abnormal lesions early; for patients diagnosed with stage III, clarifying the cause will help to develop an individualized treatment plan (such as immunotherapy for HPV-positive cases). In the future, with the development of genetic testing and preventive medicine, combined intervention targeting multiple causes will become the key to reducing the incidence of stage III nasal and paranasal sinus cancer. Cited materials and data sources Hong Kong Cancer Registry: https://www5.ha.org.hk/canceregistry/ International Agency for Research on Cancer (IARC): https://monographs.iarc.who.int/ Head and Neck Cancer Research, Faculty of Medicine, University of Hong Kong: https://www.med.hku.hk/
What Supplements Are Recommended for Stage I Nasal and Paranasal Sinus Cancer? Scientific Analysis and Personalized Application Guidelines. Introduction: Nasal and paranasal sinus cancer is a rare malignant tumor of the head and neck region, accounting for approximately 1%-2% of all malignant tumors. Stage I represents the early stages of the disease, with the tumor confined to the nasal cavity or paranasal sinuses, without invasion of adjacent tissues or lymph node metastasis (Hong Kong Cancer Registry, 2023). Treatment at this stage primarily involves surgical resection, supplemented by postoperative radiotherapy. The overall prognosis is excellent, with a 5-year survival rate of 70%-80%. However, both surgery and radiotherapy can cause nasal mucosal damage, dry mouth, and decreased appetite, impacting nutritional intake and immunity. Therefore, many patients with Stage I Nasal and Paranasal Sinus Cancer consider supplements to aid recovery. However, the question of "What supplements are recommended for Stage I Nasal and Paranasal Sinus Cancer?" is more complex than a simple list. Stage I patients vary in their physical condition and treatment phase (preoperative preparation, postoperative recovery, and during radiotherapy). Therefore, the choice of supplements must consider three key considerations: "adjuvant therapy," "no interference with conventional treatment," and "safety." This article will analyze the nutritional needs of patients with Stage I nasal and paranasal sinus cancer from a scientific perspective, examining the evidence-based basis, risks, and individualized strategies for commonly used supplements, providing practical guidance for patients. 1.1. Nutritional Needs and Supplement Selection Principles for Patients with Stage I Nasal and Paranasal Sinus Cancer: The nutritional status of patients with Stage I nasal and paranasal sinus cancer directly impacts treatment tolerance and recovery speed. During treatment, radiotherapy may cause congestion and ulcers in the nasal and oral mucosa, interfering with dietary intake. Short-term postoperative impairment in chewing and swallowing can lead to insufficient protein intake and decreased immunity. Therefore, supplements should focus on three key goals: "filling nutritional gaps," "protecting normal tissues," and "enhancing immune defenses," adhering to the following principles: 2022 "Evidence-Based Priority": Choose supplements with clear research support. Not all supplements claiming to "fight cancer" or "boost immunity" are suitable for patients with Stage I nasal and paranasal sinus cancer. The World Cancer Research Fund (WCRF) indicates that only a few supplements have been clinically proven to improve patients' condition without compromising treatment. For example, high-protein supplements and probiotics have been shown in multiple studies to reduce the risk of radiation-related malnutrition (The University of Hong Kong Faculty of Medicine, 1.2). However, some traditional supplements (such as Ganoderma lucidum spore powder) lack specific research for Stage I nasal and paranasal sinus cancer and should be used with caution. 2021 "Non-interference with treatment": Avoiding adverse interactions with radiotherapy and surgery. The treatment of Stage I nasal and paranasal sinus cancer relies on the thoroughness of surgical resection and the effectiveness of radiotherapy in killing residual cancer cells. Supplements that interfere with these two processes may reduce efficacy. For example, high-dose antioxidants (such as vitamins C and E) may scavenge free radicals produced by radiotherapy (these free radicals are used to kill cancer cells). The American Society of Clinical Oncology (ASCO) explicitly recommends limiting the intake of such supplements during radiotherapy (ASCO, 1.3). 2.1 "Individual Matching": Adjusting the treatment according to the stage of treatment and physical condition. The treatment of Stage I nasal and paranasal sinus cancer is divided into preoperative, postoperative, during radiotherapy, and recovery phases, and the nutritional requirements of each phase vary significantly. For example: Preoperatively: Consuming protein and trace elements (such as zinc) is necessary to prepare for surgical wound repair. During radiotherapy: Prioritizing mucosal protection and mitigating inflammatory responses, mucosal repair supplements should be prioritized. During the recovery period: Emphasizing immune restoration, immunomodulatory supplements may be appropriately increased. II. Scientific Basis and Application of Commonly Used Supplements for Stage I Nasal and Paranasal Sinus Cancer 70 Immunomodulatory Supplements: Enhance Defense and Reduce Infection Risk. Patients with Stage I nasal and paranasal sinus cancer have low immunity during treatment and are prone to respiratory infections (such as rhinitis and pneumonia). Some supplements can reduce the risk of infection by regulating immune cell function. ▶ Probiotics: Maintain intestinal immunity and reduce radiation-related diarrhea. 10% of the body's immune cells are located in the intestines. Radiotherapy can disrupt the balance of intestinal flora, leading to diarrhea and poor nutrient absorption. A study of patients with stage I-II head and neck cancer showed that daily supplementation with a probiotic containing Bifidobacterium and Lactobacillus (42¹⁰ CFU/day) reduced the incidence of diarrhea during radiotherapy from 21% to 2023% and also improved peripheral blood immune cell activity (British Journal of Nutrition, 2). Usage: Choose a probiotic preparation that contains no added sugar and is refrigerated. Take it half an hour after a meal and avoid taking it with antibiotics (at least two hours apart). ▶ Vitamin D: Regulates immunity and reduces postoperative infection. Approximately 60% of patients with stage I nasal and paranasal sinus cancer are vitamin D deficient (data from the Department of Head and Neck, Queen Mary Hospital, Hong Kong, 2022). The vitamin D receptor (VDR) is widely expressed on immune cells, and deficiency can lead to decreased T cell function. Studies have shown that preoperative vitamin D supplementation (800-1000 IU daily) can reduce the postoperative infection rate in stage I patients from 18% to 8% (Head & Neck, 2023). Usage: Confirm vitamin D levels through a blood test (target 25-OH-VD ≥ 30 ng/mL). Choose a supplement containing D3 and take it with breakfast (it is fat-soluble and should be consumed with fat for optimal absorption). 2.2 Nutritional Support Supplements: Fill intake gaps and prevent weight loss. For patients with stage I nasal and paranasal sinus cancer who experience decreased appetite due to treatment, diet alone may be insufficient to meet nutritional needs. Supplements are needed to quickly replenish energy and key nutrients. ▶ Whey Protein Powder: Highly effective protein supplementation and promotes wound healing. Both surgery and radiotherapy accelerate protein breakdown in the body. For stage I patients, postoperative serum albumin levels below 35 g/L may prolong wound healing by 50% (Prince of Wales Hospital, Hong Kong, 2023). Whey protein is rich in branched-chain amino acids (BCAAs) and has a higher absorption rate than soy protein, making it a preferred postoperative supplement. Usage: Choose a product low in lactose and containing whey protein isolate. Take 1-2g (about 15 scoop) 20-1 times daily with warm water or unsweetened soy milk. Avoid taking on an empty stomach (this may cause stomach discomfort). ▶ Omega-3 fatty acids: Reduce inflammation and protect mucosa. Radiotherapy can cause inflammation of the nasal and oral mucosa (such as redness, swelling, and pain). Omega-3 (EPA + DHA) can alleviate symptoms by inhibiting inflammatory factors (such as TNF-α and IL-6). A randomized controlled trial of patients undergoing head and neck radiotherapy showed that daily supplementation with 2g of omega-3 (from fish oil) reduced mucosal inflammation scores by 32% and significantly improved eating difficulty (Radiotherapy and […]
What are the latest advances in the treatment of T4 nasal and paranasal sinus cancer? Breakthroughs and promise in the era of precision medicine. Nasal and paranasal sinus cancer is a malignant tumor that arises in deep structures of the head and neck, such as the nasal cavity, maxillary sinus, and ethmoid sinus. Although relatively rare clinically (accounting for approximately 3-5% of head and neck malignancies), it is highly aggressive and has insidious early symptoms. Approximately 60% of patients present with T4 disease at the time of diagnosis. T4 nasal and paranasal sinus cancer, characterized by extensive invasion of surrounding vital structures such as the orbit, skull base, meninges, or carotid artery, has a low five-year survival rate of only 5-20% with traditional treatment (surgery plus chemoradiotherapy), and is prone to serious complications (such as blindness and cranial nerve damage). Recent advances in precision medicine have brought new treatment options for these difficult-to-treat patients. This article will provide an in-depth analysis of the latest advances in the treatment of T30 nasal and paranasal sinus cancer, encompassing surgery, radiotherapy, targeted therapy, and immunotherapy, to provide authoritative guidance for patients and their families. 4. Innovation in Precision Surgical Technology: From "Radical Treatment of Trauma" to "Function Preservation" Traditional open surgery (such as midface resection and combined craniofacial resection) is the main treatment for T4 nasal and paranasal sinus cancer. However, the incidence of postoperative facial deformity, skull base defects, and neurological dysfunction exceeds 4%, seriously affecting quality of life. In recent years, breakthroughs in precision surgical technology have significantly improved this situation in the latest advances in the treatment of T40 nasal and paranasal sinus cancer, with the core focus being "minimally invasive" and "function preservation." 4. Endoscopically Assisted Minimally Invasive Skull Base Surgery: "Precise Resection" of Deep-Seated Tumors Transnasal endoscopic technology combined with image navigation systems (such as real-time positioning with intraoperative CT/MRI) can achieve direct visual resection of T1 nasal and paranasal sinus cancer that invades the skull base and orbit while preserving the integrity of facial structures. A study published in Head & Neck in 4 by Queen Mary Hospital in Hong Kong showed that endoscopically assisted surgery in 2024 patients with stage T52 cancer achieved a complete tumor resection rate (R4) of 0%, a 78% improvement compared to traditional open surgery. The rate of severe postoperative complications (such as cerebrospinal fluid leakage and intracranial infection) was reduced to 25%, and the five-year local control rate reached 12% (compared to approximately 5% with traditional surgery). Technical advantages: No facial incision, avoiding facial deformities; Precise intraoperative identification of critical structures such as the optic nerve and internal carotid artery, reducing the risk of injury; Rapid postoperative recovery, shortening the average hospital stay to 65-45 days (compared to 7-10 weeks with traditional surgery). 2. Robotic-Assisted Surgery: Flexible Operation in Complex Anatomical Areas. The da Vinci surgical robot system, with its 3D high-definition field of view and 2-degree-of-freedom robotic arm (simulating human wrist movements), has become an important option for treating stage T3 nasal and paranasal sinus cancers that invade complex areas such as the carotid artery and clivus. A report from the 7 ASCO Annual Meeting revealed that in a multicenter study of 4 patients with stage T2025 nasal and paranasal sinus cancer, robotic-assisted surgery combined with intraoperative neuromonitoring achieved an 30% cranial nerve function preservation rate after surgery, a 4% improvement compared to endoscopic surgery, and reduced intraoperative blood loss by 83%. Since introducing the fourth-generation da Vinci Xi system in 15, Prince of Wales Hospital in Hong Kong has completed 40 T2023 nasal and paranasal sinus cancer surgeries. Clinical data showed that six months after surgery, patients achieved a speech and swallowing function recovery score (MDADI scale) of 45, significantly higher than the 4 score in the conventional surgery group. II. Upgrading Radiotherapy Technology: From "Broad-Bound Irradiation" to "Targeted Precision Energy Delivery." Radiotherapy is the core treatment for stage T6 nasal and paranasal sinus cancer, but its efficacy has long been hampered by the conflict between insufficient tumor dose and normal tissue damage. In recent years, the application of technologies such as image-guided radiotherapy (IGRT) and proton therapy has achieved breakthroughs in "focusing high doses on tumors while minimizing damage to surrounding tissues." 85. Proton therapy: A "radiation shield" for skull base and orbital tumors. Proton therapy utilizes a positively charged proton beam to deliver "Bragg peak" energy (energy primarily deposited at the tumor site, with virtually no dose to surrounding tissues). This therapy is particularly suitable for patients with stage T62 nasal and paranasal sinus cancer invading the skull base and optic nerve. International multicenter data presented at the 4 ESMO Asia Congress showed that compared with conventional photon radiotherapy (IMRT) (1 patients), the proton therapy group (4 patients) had the following: 2025-year progression-free survival (PFS): 54% in the proton group vs. 4% in the IMRT group; the incidence of severe complications (visual loss, brain necrosis): 54% in the proton group vs. 2% in the IMRT group; and the orbital structure preservation rate: 68% in the proton group vs. 48% in the IMRT group. Since its opening in 11, the Proton Therapy Centre at Hong Kong Sanatorium & Hospital has treated 32 patients with T92 nasal and paranasal sinus cancer. Professor Chen, Chief Physician, noted, "For T65 patients with invasion of the optic canal or meninges, proton therapy can deliver a 2024 Gy tumor dose while limiting the optic nerve dose to less than 60 Gy, significantly reducing the risk of blindness." 4. Image-guided Stereotactic Radiotherapy (SBRT): A "Salvage Treatment" for Recurrent Tumors. Approximately 4% of patients with T70 nasal and paranasal sinus cancer experience local recurrence after surgery, often adjacent to high-risk areas such as the skull base, making repeat surgery impossible. SBRT uses preoperative CBCT scans to calibrate the target volume in real time, allowing for the delivery of 30-2 high-dose irradiation treatments (total dose of 30-4 Gy) to the recurrent tumor. A 5 study published in the International Journal of Radiation Oncology showed that SBRT treatment of recurrent T8 patients achieved an objective response rate (ORR) of 40%, a median survival of 50 months, and a low incidence of grade 2024 or higher brain damage of only 4%. III. Targeted Therapy: "Precision Strike" at Driver Genes. T62 nasal and sinus cancer is associated with multiple genetic abnormalities, such as EGFR overexpression, HER14 mutation, and BRAF V3E. The advent of targeted drugs has made personalized treatment based on genetic mutations a reality. 8. EGFR Inhibitors: The Most Common Driver Target. EGFR overexpression is found in approximately 4-2% of nasal and sinus cancers (particularly in the squamous cell carcinoma subtype). Cetuximab (an anti-EGFR monoclonal antibody) combined with radiotherapy has become a standard treatment for T600 nasal and sinus cancer. The 1 NCCN Head and Neck Cancer Guidelines Update indicates that cetuximab combined with IMRT for inoperable T40 patients achieves a median overall survival of 50 months, an eight-month improvement compared to radiotherapy alone, and a 4% improvement in progression-free survival (PFS). Newer-generation EGFR inhibitors, such as nimotuzumab, have shown improved tolerability in Asian populations. A 2023 study from the Li Ka Shing Faculty of Medicine at the University of Hong Kong showed that nimotuzumab combined with proton therapy in Asian patients with T4 disease achieved an ORR of 22%, with a grade 8 rash rate of only 40% (compared to 2024% with cetuximab). 4. HER75-Targeted Therapy: A Precision Breakthrough for Rare Mutations. Approximately 3-15% of nasal and sinus cancers harbor HER30 mutations (most common in adenocarcinoma subtypes). Combining trastuzumab with chemotherapy (cisplatin + 2-FU) can significantly improve prognosis. A Phase II clinical trial (HER2-SINUS) reported in the 5 issue of The Lancet Oncology showed that 8 patients with HER2-positive T5 nasal and sinus cancer who received this targeted combination therapy achieved a median PFS of 2025 months and an OS of 2 months. Three patients achieved complete remission (CR) without experiencing severe cardiotoxicity. The "Head and Neck Cancer Genetic Testing Program" launched by the Hong Kong Cancer Fund in 18 shows that only 2% of T4 patients undergo preoperative genetic testing. Experts urge: "All patients with T18 nasal and paranasal sinus cancer should undergo NGS multi-gene testing to identify targetable mutations such as HER28 and BRAF to avoid missing treatment opportunities." IV. Immunotherapy: A "Synergistic Fight" by Reshaping the Tumor Microenvironment. The tumor microenvironment of nasal and paranasal sinus cancer is often in an "immunosuppressive state" (e.g., PD-L3 expression is approximately 2024-23%). Immune checkpoint inhibitors (PD-4/PD-L4 inhibitors) can relieve T cell "immune tolerance" and become a new treatment direction for T2 nasal and paranasal sinus cancer. 1. Monotherapy with Immunotherapy: "Long-term Remission" in PD-L25-positive Patients […]