A few small bumps in your nose might not sound very concerning to you. Nasal polyps are pretty common, especially for people who have allergies, asthma or sinus conditions.
But sometimes those bumps aren’t nasal polyps at all. For Tammy Spantiko of Elgin, Illinois, a mother of two and pet parent of three golden retrievers, they turned out to be more serious.
“When the polyps first presented in my nose, they were only on the left side,” Spantiko says. “I saw an ENT. She thought they were benign little tags, and she said she treats them commonly for allergies. But these were persistent.”
Medication wasn’t working on the stubborn polyps. So Spantiko’s ear, nose and throat physician tried removing them with surgery and sent the tissue for testing.
The results showed that the polyps weren’t routine at all. They were squamous cell carcinoma, a type of cancer.
That diagnosis started Spantiko on a path that led to radiation, recurrence and finally remission when she got treatment from Pete Papagiannopoulos, MD, an otolaryngologist and head and neck surgeon who specializes in sinus and endoscopic skull base surgery at Rush, and a team of experts.
The clues of cancer
Nose and sinus cancers can be very serious. At first, symptoms can be mild.
“My whole left side was stuffed up, and I had drainage coming out my nose,” Spantiko says. “I thought it was a cold, and it wasn't going away with medicine.”
But over time, symptoms can worsen. Cancers in the nose can cause severe nosebleeds, vision problems, facial swelling and deformities, loss of sense of smell and loosening teeth, among other issues.
The problem with Spantiko’s first treatment was that it started as medication and surgery for routine polyps — not squamous cell carcinoma.
But there were clues that the polyps might be cancer. The first hint was that they only appeared on one side of Spantiko’s nose.
“Suspicion for cancer of the paranasal sinuses should be higher in somebody who has polyps on just one side of the nose and not on the other," Papagiannopoulos says. “Polyp disease, which is what they thought Tammy had, is typically on both sides.”
The other clue was that Spantiko did not respond to medication. Symptoms of polyp disease can often be managed with antihistamines, nasal sprays and other drugs.
So Spantiko's first surgery wasn’t the most appropriate procedure for her condition.
Then, when squamous cell carcinoma was discovered, Spantiko needed further radiation treatment. But within two years, the cancer came back.
That’s when her doctor referred her to Papagiannopoulos.
The right surgery — and remission
When Spantiko first came to Papagiannopoulos, he wasn’t the only physician she saw.
“I consulted with him, and he had a whole team of people that did MRIs, the physical exam and biopsies,” she says. “And he and his team determined that I get surgery.”
“For anybody that comes in with cancer to my office, it’s not just me making decisions by myself,” Papagiannopoulos says. “We always present each case at our weekly tumor board. It’s a meeting of doctors that includes surgeons like myself, chemotherapy physicians, oncology physicians and radiation oncologists, among other specialists.”
Together, the board reviewed Spantiko’s test results and formed a plan. They decided that the most appropriate treatment would be a procedure called endoscopic resection.
This surgery was different from Spantiko’s initial treatment in a few important ways.
“What’s different about it is that we’re opening the sinus cavity much more widely with cameras and drills,” Papagiannopoulos says. “Then the key thing is to find where the cancer is growing from.”
Papagiannopoulos says one way to imagine how cancer in the nose grows is to picture a tree. The tissue you first see is like the leaves of the tree. But a surgeon needs to look further and follow the branches of cancer to the trunk and the roots.
"In her case, the roots were growing from an area behind the maxillary sinus. It’s a deep space where there are nerves and arteries,” Papagiannopoulos says. “So we had to open that space, called the pterygopalatine fossa, and remove the roots of the tumor.”
After the surgery, tests and biopsies came back negative for cancer. The surgery was a complete success.
“We were very lucky in her case that the tumor was one that allowed us to clear it without needing anything further,” Papagiannopoulos says. “It has saved her from needing more treatment like chemotherapy or radiation thus far.”
That was a relief for Spantiko, who was dreading the thought of going through radiation treatment again.
“I was tremendously apprehensive about having radiation a second time," she says. “It just wasn't easy for me because I am claustrophobic, and I had a mask on my face each time that I did the radiation. So that was definitely a fear of mine."
A clear nose without cancer
Now that Spantiko is in remission, she only needs to come back to see Papagiannopoulos every few months for imaging and monitoring. Eventually, she’ll only need to come in once a year or so.
And now that her nose is clear, she feels like life is back to normal.
"I’m definitely tasting food better,” she says. “I don't have tear drainage or nose drainage anymore. I feel so happy and thankful for my family. And I'm able to work out and get out there with my dogs and really enjoy life.”
She is also grateful to Papagiannopoulos for his care.
“He was very professional, friendly and amiable, and I just felt comfortable around him," she says. “He was very caring and really, really talented. I can't thank him enough for everything he did.”
And for anyone who has unusual symptoms, like polyps on one side of their nose, Papagiannopoulos has some advice.
“When it comes to sinus lesions, there are general ENTs, but within the field of ENT there are specialists like me who focus on rhinology and skull base surgery,” he says. “If there’s ever something that isn’t quite normal or isn’t explained well, getting a second opinion from a specialist is always a good idea.”
If you’re having unusual nasal symptoms or would like a second opinion on your diagnosis, call Rush at (888) 352-7874. A care coordinator will help you set up an appointment with a specialist. You can also learn more on our Otorhinolaryngology, Head and Neck Surgery (ENT) Services page.
