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Invited Commentary
September 08, 2016

Can Chronic Sinusitis Cause Cancer?

Author Affiliations
  • 1Department of Head and Neck Surgery, University of California–Los Angeles
JAMA Otolaryngol Head Neck Surg. Published online September 8, 2016. doi:10.1001/jamaoto.2016.2649

Can the inflammation associated with chronic rhinosinusitis (CRS) contribute to the development of head and neck cancer, especially nasal cavity or paranasal sinus cancer? Or is any association between CRS due to reverse causation because nasal and sinus cancer can present initially with sinusitis symptoms?

Inflammatory insults in other areas of the body have a well-established etiologic link with malignancy. For example, gastroesophageal reflux disease may lead to Barrett metaplasia and esophageal cancer, and ulcerative colitis has been associated with colon cancer. The infiltration of immune cells into tissues may lead to the production of small molecules, such as cytokines, chemokines, and growth factors, which promote carcinogenesis and allow tumor cells to evade host immune response.1 High levels of proinflammatory cytokines are known to play a role in the development of head and neck squamous cell carcinoma,2 but a possible pathway between inflammation associated with CRS and the development and progression of cancer is still being elucidated. For example, interleukin 6 (IL-6) is known to be an important proinflammatory cytokine expressed during CRS.3 Recent studies have showed that Epstein-Barr virus (EBV)-infected nasopharyngeal epithelial cells often acquire an enhanced response to IL-6–induced signal transduction and transcription activation to promote their growth and invasive properties.4 Therefore, a cytokine receptor–mediated mechanism may be involved in the relation between inflammation and nasopharyngeal cancer (NPC).5 Moreover, oxidative stress increases during CRS, and genes involved in nitric oxide and reactive oxygen species regulation are altered, which may lead to DNA damage and decrease in the local immune response, which also favor tumorigenesis.6

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