Skip to main content
SpringerLink
Log in

Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case–control study

  • Original Article
  • Published:
International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Purpose

Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case–control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer.

Methods

Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls.

Results

The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34–58) years.

Conclusions

Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Acheson ED, Cowdell RH et al (1968) Nasal cancer in woodworkers in the furniture industry. Br Med J 2(5605):587–596

    Article  CAS  Google Scholar 

  • Anaya-Saavedra G, Ramirez-Amador V et al (2008) High association of human papillomavirus infection with oral cancer: a case-control study. Arch Med Res 39(2):189–197

    Article  CAS  Google Scholar 

  • Andersen HC, Andersen I et al (1977) Nasal cancers, symptoms and upper airway function in woodworkers. Br J Ind Med 34(3):201–207

    CAS  Google Scholar 

  • Andrea’t Mannetje MS, Kogevinas M et al (1999) Sinonasal cancer, occupation, and tobacco smoking in European women and men. Am J Ind Med 36(1):101–107

    Google Scholar 

  • Bamia C, Trichopoulou A et al (2004) Tobacco smoking in relation to body fat mass and distribution in a general population sample. Int J Obes Relat Metab Disord 28(8):1091–1096

    Article  CAS  Google Scholar 

  • Barnes L (1986) Intestinal-type adenocarcinoma of the nasal cavity and paranasal sinuses. Am J Surg Pathol 10(3):192–202

    Article  CAS  Google Scholar 

  • Batsakis J (1987) Pathology of tumors of the nasal cavity and paranasal sinuses. In: Panje WR, Thawley SE (eds) Comprehensive management of head and neck tumours. WB Saunders, Philadelphia, pp 327–343

    Google Scholar 

  • Bimbi G, Saraceno MS et al (2004) Adenocarcinoma of ethmoid sinus: an occupational disease. Acta Otorhinolaryngol Ital 24(4):199–203

    CAS  Google Scholar 

  • Boening J (2004) Risikoverhalten im Umgang mit Suchtmitteln–Daten und Einblicke in die Behandlung. Gesundheitswesen 66:71–79

    Article  Google Scholar 

  • Bonneterre V, Deschamps E et al (2007) Sino-nasal cancer and exposure to leather dust. Occup Med (Lond) 57(6):438–443

    Article  Google Scholar 

  • Boysen M (1985) Histopathology of the nasal mucosa in furniture workers. Rhinology 23(2):109–113

    CAS  Google Scholar 

  • Bradley KA, McDonell MB et al (1998) The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res 22(8):1842–1849

    CAS  Google Scholar 

  • Bush K, Kivlahan DR et al (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med 158(16):1789–1795

    Article  CAS  Google Scholar 

  • Bussi M, Gervasio CF et al (2002) Study of ethmoidal mucosa in a population at occupational high risk of sinonasal adenocarcinoma. Acta Otolaryngol 122(2):197–201

    Article  CAS  Google Scholar 

  • Caroyer JM, Van Dessel F (1987) Cancer of the upper respiratory tract in woodworkers. Acta Otorhinolaryngol Belg 41(1):5–15

    CAS  Google Scholar 

  • De Silva P, Jayawardana P et al (2008) Concurrent validity of the alcohol use disorders identification test (AUDIT). Alcohol Alcohol 43(1):49–50

    Google Scholar 

  • Demers PA, Kogevinas M et al (1995) Wood dust and sino-nasal cancer: pooled reanalysis of twelve case-control studies. Am J Ind Med 28(2):151–166

    Article  CAS  Google Scholar 

  • Dich J, Zahm SH et al (1997) Pesticides and cancer. Cancer Causes Control 8(3):420–443

    Article  CAS  Google Scholar 

  • Donhuijsen K, Hattenberger S et al (2004) Nasal sinus carcinoma after wood dust exposure. Morphological spectrum of 100 cases. Pathologe 25(1):14–20

    Article  CAS  Google Scholar 

  • Engzell U (1979) Occupational etiology and nasal cancer. An internordic project. Acta Otolaryngol Suppl 360:126–128

    CAS  Google Scholar 

  • Euteneuer S, Sudhoff H et al (2004) Malignomas of the nasal cavity and the paranasal sinuses: clinical characteristics, therapy and prognosis of different tumor types. Laryngorhinootologie 83(1):33–39

    Article  CAS  Google Scholar 

  • Fontana L, Lietin B et al (2008) Occupational exposure to wood dust and nasal sinus cancer. Ann Otolaryngol Chir Cervicofac 125(2):65–71

    Article  CAS  Google Scholar 

  • Franquemont DW, Fechner RE et al (1991) Histologic classification of sinonasal intestinal-type adenocarcinoma. Am J Surg Pathol 15(4):368–375

    Article  CAS  Google Scholar 

  • Giang KB, Allebeck P et al (2008) Alcohol use and alcohol consumption-related problems in rural Vietnam: an epidemiological survey using AUDIT. Subst Use Misuse 43(3–4):481–495

    Article  Google Scholar 

  • Hadfield EH, Macbeth RG (1971) Adenocarcinoma of ethmoids in furniture workers. Ann Otol Rhinol Laryngol 80(5):699–703

    CAS  Google Scholar 

  • Hardell L, Johansson B et al (1982) Epidemiological study of nasal and nasopharyngeal cancer and their relation to phenoxy acid or chlorophenol exposure. Am J Ind Med 3(3):247–257

    Article  CAS  Google Scholar 

  • Hayes RB, Kardaun JW et al (1987) Tobacco use and sinonasal cancer: a case-control study. Br J Cancer 56(6):843–846

    CAS  Google Scholar 

  • Hernberg S, Westerholm P et al (1983) Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden. Scand J Work Environ Health 9(4):315–326

    CAS  Google Scholar 

  • Hitter A, Soriano E et al (2007) Outcome of surgical and adjuvant radiotherapy treatment of T3–T4 squamous cell carcinoma of the floor of the mouth: evaluation of oncological control and treatment related morbidity. Rev Laryngol Otol Rhinol (Bord) 128(3):155–162

    CAS  Google Scholar 

  • Johnson N (2001) Tobacco use and oral cancer: a global perspective. J Dent Educ 65(4):328–339

    CAS  Google Scholar 

  • Kauppinen T, Vincent R et al (2006) Occupational exposure to inhalable wood dust in the member states of the European Union. Ann Occup Hyg 50(6):549–561

    Article  CAS  Google Scholar 

  • Kleinsasser O, Schroeder HG (1988) Adenocarcinomas of the inner nose after exposure to wood dust. Morphological findings and relationships between histopathology and clinical behavior in 79 cases. Arch Otorhinolaryngol 245(1):1–15

    Article  CAS  Google Scholar 

  • Klintenberg C, Olofsson J et al (1984) Adenocarcinoma of the ethmoid sinuses. A review of 28 cases with special reference to wood dust exposure. Cancer 54(3):482–488

    Article  CAS  Google Scholar 

  • Leclerc A, Martinez Cortes M et al (1994) Sinonasal cancer and wood dust exposure: results from a case-control study. Am J Epidemiol 140(4):340–349

    CAS  Google Scholar 

  • Levy LS, Martin PA et al (1986) Investigation of the potential carcinogenicity of a range of chromium containing materials on rat lung. Br J Ind Med 43(4):243–256

    CAS  Google Scholar 

  • Lietin B, Mom T et al (2006) Adenocarcinomas of the ethmoid sinus: retrospective analysis of prognostic factors. Ann Otolaryngol Chir Cervicofac 123(5):211–220

    Article  CAS  Google Scholar 

  • Llewellyn CD, Linklater K et al (2003) Squamous cell carcinoma of the oral cavity in patients aged 45 years and under: a descriptive analysis of 116 cases diagnosed in the South East of England from 1990 to 1997. Oral Oncol 39(2):106–114

    Article  CAS  Google Scholar 

  • Luce D, Leclerc A et al (2002) Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies. Cancer Causes Control 13(2):147–157

    Article  Google Scholar 

  • Mignogna MD, Fedele S et al (2004) The World Cancer Report and the burden of oral cancer. Eur J Cancer Prev 13(2):139–142

    Article  CAS  Google Scholar 

  • Miller PM, Day TA et al (2006) Clinical implications of continued alcohol consumption after diagnosis of upper aerodigestive tract cancer. Alcohol Alcohol 41(2):140–142

    Google Scholar 

  • Molarius A, Seidell JC et al (1997) Smoking and relative body weight: an international perspective from the WHO MONICA project. J Epidemiol Community Health 51(3):252–260

    Article  CAS  Google Scholar 

  • Moreno-Lopez LA, Esparza-Gomez GC et al (2000) Risk of oral cancer associated with tobacco smoking, alcohol consumption and oral hygiene: a case-control study in Madrid, Spain. Oral Oncol 36(2):170–174

    Article  CAS  Google Scholar 

  • Muir CS, Nectoux J (1980) Descriptive epidemiology of malignant neoplasms of nose, nasal cavities, middle ear and accessory sinuses. Clin Otolaryngol Allied Sci 5(3):195–211

    Article  CAS  Google Scholar 

  • Nylander LA, Dement JM (1993) Carcinogenic effects of wood dust: review and discussion. Am J Ind Med 24(5):619–647

    Article  CAS  Google Scholar 

  • Orvidas LJ, Lewis JE et al (2005) Adenocarcinoma of the nose and paranasal sinuses: a retrospective study of diagnosis, histologic characteristics, and outcomes in 24 patients. Head Neck 27(5):370–375

    Article  Google Scholar 

  • Pesch B, Pierl CB et al (2008) Occupational risks for adenocarcinoma of the nasal cavity and paranasal sinuses in the German wood industry. Occup Environ Med 65(3):191–196

    Article  CAS  Google Scholar 

  • Reis SR, do Espirito Santo AR et al (2006) Cytologic alterations in the oral mucosa after chronic exposure to ethanol. Braz Oral Res 20(2):97–102

    Article  Google Scholar 

  • Riechelmann H (2002) Occupational exposure and cancer of the oral cavity and pharynx. Laryngorhinootologie 81(8):573–579

    Article  CAS  Google Scholar 

  • Robert Koch Institute and the Association of population-based Cancer Registries in Germany (2008) Cancer in Germany 2003–2004. Incidence and Trends

  • Roux FX, Pages JC et al (1997) Malignant ethmoid-sphenoidal tumors. 130 cases. Retrospective study. Neurochirurgie 43(2):100–110

    CAS  Google Scholar 

  • Saber AT, Nielsen LR et al (1998) K-ras mutations in sinonasal adenocarcinomas in patients occupationally exposed to wood or leather dust. Cancer Lett 126(1):59–65

    Article  CAS  Google Scholar 

  • Saunders JB, Aasland OG et al (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction 88(6):791–804

    Article  CAS  Google Scholar 

  • Schildt EB, Eriksson M et al (1998) Oral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study. Int J Cancer 77(3):341–346

    Article  CAS  Google Scholar 

  • Snyers A, Janssens GO et al (2009) Malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and morbidity with emphasis on hypothalamic-pituitary deficiency. Int J Radiat Oncol Biol Phys 73(5):1343–1351

    Google Scholar 

  • Takahashi Y, Kondo K et al (2005) Microscopic analysis of the chromium content in the chromium-induced malignant and premalignant bronchial lesions of the rat. Environ Res 99(2):267–272

    Article  CAS  Google Scholar 

  • Van den Oever R (1996) Occupational exposure to dust and sinonasal cancer. An analysis of 386 cases reported to the N.C.C.S.F. Cancer Registry Acta Otorhinolaryngol Belg 50(1):19–24

    Google Scholar 

  • Wolf J, Fengel D et al (1998) The role of combination effects on the etiology of malignant nasal tumours in the wood-working industry. Acta Otolaryngol (Stockh) Suppl 535:3–16

    Google Scholar 

  • Zheng TZ, Boyle P et al (1990) Tobacco smoking, alcohol consumption, and risk of oral cancer: a case-control study in Beijing, People’s Republic of China. Cancer Causes Control 1(2):173–179

    Article  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Julia von Ochsenstein, Tatjana Einwag and Konstantinos Mantsopoulos.

Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander University of Erlangen-Nuremberg, Waldstraße 1, 91054, Erlangen, Germany

    Susanne Ingrid Mayr, Kamber Hafizovic, Frank Waldfahrer & Heinrich Iro

  2. Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University of Erlangen-Nuremberg, Schillerstr. 25, 91054, Erlangen, Germany

    Birgitta Kütting

Authors
  1. Susanne Ingrid Mayr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kamber Hafizovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank Waldfahrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heinrich Iro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Birgitta Kütting
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susanne Ingrid Mayr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mayr, S.I., Hafizovic, K., Waldfahrer, F. et al. Characterization of initial clinical symptoms and risk factors for sinonasal adenocarcinomas: results of a case–control study. Int Arch Occup Environ Health 83, 631–638 (2010). https://doi.org/10.1007/s00420-009-0479-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00420-009-0479-5

Keywords

Search

Navigation