Nasal and sinus cancer is a rare cancer that affects the nasal cavity (the space behind your nose) and the sinuses (small air-filled cavities inside your nose, cheekbones and forehead).
Nasal and sinus cancer is different from cancer of the area where the nose and throat connect. This is called nasopharyngeal cancer. Cancer can start in the lining of the space behind the nose (nasal cavity) or the nearby air cavities (paranasal sinuses) and sometimes spread to lymph nodes and other parts of the body.
Your nostrils open into the space behind the nose (nasal cavity). The nasal cavity is a space above the roof of your mouth. It curves down to connect with your mouth at the back of your throat.
The nasal cavity warms and moistens the air we breathe and helps to filter out small particles and harmful bacteria. It also has small receptors that catch the molecules responsible for smell in the air. The area where the nose and throat meet is called the nasopharynx. If you have cancer here, it’s called nasopharyngeal cancer. It is different from nasal and paranasal sinus cancer.
The nasal cavity is close to your eyes, the nerves that leave at the bottom part of the brain (cranial nerves) and your mouth. Cancer in this area can sometimes spread causing pressure and pain in these structures. This could affect your vision and ability to open your mouth. Cancer in the nasal cavity can also affect your sense of smell.
Paranasal means around or near your nose. Sinuses are spaces or small tunnels. Paranasal sinuses are small, air filled spaces within the bones of your face. They are above and behind your nose and behind your cheekbones. They give your voice its clarity and tone and lighten the weight of your skull. There are several pairs of sinuses and cancer can develop in any of them. You have:
- maxillary sinuses behind your cheeks, below your eyes and on either side of your nose
- frontal sinuses at the very top of your nose in your forehead close to the eyebrows
- ethmoid sinuses between the upper nose and the eyes
- sphenoid sinuses behind the ethmoid sinuses, above the nasopharynx and between the back of your eyes
These sinuses fill with mucus and become blocked during infections like a cold. This causes the pressure and pain you feel around your nose and eyes when you have a cold (sinus pain).
Lymph nodes in your neck
Like other parts of the body, the head and neck contains lymph nodes (also called lymph glands). These small, bean shaped glands are part of the lymphatic system. Lymph nodes are often the first place cancer cells spread to when they break away from a tumour. There are major groups of lymph nodes in the neck. Nasal and paranasal sinus cancers can spread to these nodes. You may need an operation to remove lymph nodes. This will usually be on the same side of your neck as the cancer. More rarely, a surgeon may suggest removing nodes from both sides of your neck. These operations are called neck dissections. You may hear your surgeon call this type of surgery a radical neck dissection. A specialist in human tissues (a pathologist) examines the lymph nodes to see if they have cancer cells. It helps them to find out how advanced the cancer is. This is also called the stage of the cancer and helps doctors decide on the most suitable treatment for you. Nasal and paranasal sinus cancer rarely spreads to other parts of the body such as the lungs, bones or liver.
Symptoms of nasal and sinus cancer
The most common symptoms of nasal and sinus cancer are:
- a blocked nose that does not go away and usually only affects 1 side
- a decreased sense of smell
- mucus running from your nose – this can be bloody
- mucus draining into the back of your nose and throat
These symptoms can be similar to more common and less serious conditions, such as a cold or sinusitis. At a later stage, symptoms can include:
- pain or numbness in the face, particularly in the upper cheek, that does not go away
- swollen glands in the neck
- partial loss of vision or double vision
- a bulging eye
- a watering eye that does not go away
- pain or pressure in 1 ear
- a persistent lump or growth on your face, nose or roof of your mouth
When to see a GP
See a GP if you notice any unusual or persistent symptoms. It’s very unlikely they’ll be caused by nasal or sinus cancer, but it’s worth getting them checked out. If a GP thinks you might need some tests to find out what’s causing your symptoms, you’ll usually be referred to an ear, nose and throat (ENT) consultant at a hospital.
Diagnosing nasal and sinus cancer
Tests you may have to help diagnose nasal and sinus cancer include:
- a nasal endoscopy (nasoendoscopy) – where a long, thin, flexible tube with a camera and light at the end is inserted into your nose to examine the area; this can be uncomfortable, so before the procedure you’ll be asked whether you’d like anaesthetic sprayed on the back of your throat
- a biopsy – where a small sample of tissue is removed and examined; this may be done during an endoscopy
- a fine needle aspiration – where fluid and cells are taken from a lymph node using a needle to see if the cancer has spread
If you’re diagnosed with nasal and sinus cancer, you may have a CT scan, MRI scan, PET scan or ultrasound scan to help stage and grade the cancer.
Risk groups for nasal and sinus cancer
Several factors are known to increase the risk of developing nasal and sinus cancer. These include:
- prolonged exposure to certain substances through your work – including wood dust, leather dust, cloth fibres, nickel, chromium and formaldehyde
- smoking – the more you smoke, the higher your risk of developing several types of cancer, including nasal and sinus cancer
- human papillomavirus (HPV) – a group of viruses that affect the skin and moist membranes, such as the mouth and throat
Treatments for nasal and sinus cancer
The treatment recommended for you will depend on several factors, including the stage at which the cancer was diagnosed, how far it’s spread, and your general level of health. Treatment may include:
- surgery to remove a tumour – this can be performed through open surgery or as keyhole surgery through the nose (endoscopic microsurgery)
- radiotherapy – where high-energy radiation is used to kill the cancerous cells, shrink a tumour before surgery, or destroy small pieces of a tumour that may be left after surgery
- chemotherapy – where medicine is used to help shrink or slow down the growth of a tumour, or reduce the risk of the cancer returning after surgery
If you smoke, it’s important that you give up. Smoking increases your risk of cancer returning and may cause you to have more side effects from treatment. Your treatment will be organised by a head and neck cancer multidisciplinary team (MDT), who’ll discuss the treatment options with you. A combination of treatments will often be recommended.
Outlook for nasal and sinus cancer
There are many different types of cancer that can affect the nasal cavity and sinuses. The outlook varies, depending on the specific type of nasal and sinus cancer you have, its exact location, how far it’s spread before being diagnosed and treated, and your overall level of health and fitness.