A look at skull base cancers and their treatment

Written by: Mr Priy Silva
Published: | Updated: 11/10/2019
Edited by: Lisa Heffernan

A skull base cancer is a malignant tumour that can start in the linings of the nose, the ear, eyes, facial skin or the scalp, before spreading to the base of the skull. There can be many different types, most of which are relatively rare. Sometimes, skull base cancers spread from a metastasis which is due to a primary cancer that has developed in the lungs, kidneys or breasts, for example.

 

Mr Priy Silva talks to us a bit more about skull base cancers, the signs and how these cancers are treated.

What does skull base mean?

The skull base is that part of the skull that runs from the eyes to the back of the head. It separates the brain from the eyes, nasal cavity, ears and neck.

 

Important blood vessels such as the carotid arteries (that supply the brain) and nerves like the cranial nerves can be found in the skull base. Cranial nerves are responsible for sensory functions like smell, taste, sensations and hearing. They are also involved in swallowing, balance and making sounds with the voice box.

 

What causes skull base cancers?

The exact cause of many skull base cancers is unknown. Some cancers that start in the mouth and nose might be related to smoking. Other times, the cancer may be caused by exposure to a known hazard like wood dust for those people who cut or work with wood. Skull base cancers are rarely linked to genetics or previous exposure to radiotherapy.

 

What are the symptoms of skull base cancers?

Initial symptoms depend on where the cancer started. Cancer starting in the nose may manifest as a blocked nose for weeks with nasal discharge or blood. Tear ducts may become blocked as the cancer progresses and the patient may experience watery eyes or numbness of the face.

 

Cancer starting in the ear canal can be similar to an ear infection that doesn’t go away. There may be ear discharge, ear pain and even muscle weakness on the side of the face around the affected ear. Skull base cancers can also present as one-sided facial pain that increases in intensity and as numbness of the face. Unfortunately, as skull base cancer can present as an earache or simply a blocked nose, many patients don’t seek urgent medical attention and often don’t report symptoms for months.

 

How do you diagnose skull base cancer?

Skull base cancers are diagnosed using a number of tests, such as scans of the head and neck and a biopsy.

 

Scans include a CT (CAT scan), to look closely at the bone and an MRI to provide information about soft tissues and nerves. Further scans are also carried out to confirm that the cancer hasn’t spread to other parts of the body and usually include; a full-body CT and sometimes a PET scan. The biopsy can confirm the cancer, the type of cancer and where it originated from. After these tests, the type of cancer and course of treatment to follow can be determined by the doctor.

 

How are skull base cancers treated?

Treatment will depend on the type of cancer. The course of treatment should be decided at a skull base MDT meeting, where a group of experts decide on the right course of treatment for the patient.

 

Most skull base tumours are treated with combination multimodality therapy. This therapy is usually surgery, followed by radiotherapy. Some skull base cancers need chemotherapy, while proton therapy is another option.

 

Treatment doesn’t always aim to cure the cancer, as this may not be possible in some cases, however, treatment can slow down the progression of the cancer and reduce its effects. It can also control the cancer so that it doesn’t spread elsewhere.

 

What does skull base surgery involve?

Surgery to remove the tumour is very complex and requires very specialised surgeons. Your doctor will talk you through whether or not you need surgery to remove the cancer and what’s involved.

 

Surgery usually involves a team of surgeons, including an ENT head and neck surgeon, neurosurgeon and occasionally a plastic surgeon. The surgery itself involves removal of the cancer, followed by reconstruction work if needed. To reduce the number of cuts on the face, surgeons usually perform keyhole surgery or endoscopic surgery. The reconstruction work involves taking tissue from another part of the body (back, arm or abdomen) and transferring it to the surgery site. This is called free flap surgery. This is a very complex surgery that needs to be carried out by highly-trained specialists.

 

Discover more about head and neck surgery with Mr Priy Silva.

By Mr Priy Silva
Otolaryngology / ENT

Mr Priy Silva is a consultant ENT / head and neck surgeon in Oxford who, in addition to his general adult and paediatric ENT practice, holds a subspecialty interest in cancers of the head and neck, as well as the anterior and lateral skullbase. He undertakes the full range of cancer procedures involving the head and neck. He routinely works with the neurosurgical and plastic surgical teams undertaking complex head and neck operations.

Graduating from medical school in 1999, he completed his surgical training in Manchester, working with a number of leaders in the field. He undertook a two year period of postgraduate research in head and neck cancer at the renowned Christie Cancer Centre, where he was awarded his MD. He presented this work both nationally and internationally.

Mr Silva undertook two advanced surgical fellowships in head and neck surgery initially for two years in Oxford and a further year in Australia. He was then appointed as a consultant with an NHS practice based at the Oxford University Hospitals NHS trust. He is a core member of both the head and neck and skullbase MDT groups. He is chair of the Head and Neck Cancer Alliance Group for the Thames Valley Cancer Network. Mr Silva is also the governance lead for ENT.

Mr Silva is currently a member of the guidelines development group for mucosal melanomas of the head and neck. He is also involved in the medical school head and neck anatomy teaching programme at the University of Oxford, which is held annually, and is the clinical lead for this. Mr Silva also has an interest in clinical negligence and medicolegal work and is an expert witness for the GMC. 

As a consultant ENT surgeon, he recognises the importance of being able to see the correct appropriately qualified specialist who can help manage the problems which a patient may face. He also understands the minefield which patients may have to negotiate before they get to see the right individual and receive the best treatment.

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