Cancer of the nose: Facts about nasal cavity and paranasal sinus cancer

Nose and sinus cancers occur when cancerous cells form in the nasal cavity or paranasal sinuses. These types of cancers are extremely rare. In fact, less than 5% of all head and neck tumors occur in the nasal cavity and sinuses.

While squamous cell carcinoma is the most common, there are many other types of cancers of the nose and sinuses. Some of them include:

• adenocarcinoma
• adenoid cystic carcinoma
• olfactory neuroblastoma
• sinonasal undifferentiated carcinoma (SNUC)
• NUT carcinoma

To learn more about nose and sinus cancers, we spoke with head and neck surgeon Ehab Hanna, M.D.

What are the symptoms of nose and sinus cancers?

Early symptoms often mimic those of more common conditions, such as sinus infections and allergies. As a result, these cancers are often misdiagnosed.

Early nose cancer symptoms include:

• nasal congestion
• runny nose
• headache
• disturbance of sense of smell
• facial pain or pressure

Hanna says there are two important things to consider if:

• your symptoms are on either the left or the right side of your head or face, and
• your symptoms don’t respond to decongestants, nasal sprays or antihistamines, and they last longer than two to three weeks.

“If all these factors are true, you need to visit an ear, nose and throat (ENT) doctor to be properly examined,” he says.

Symptoms that could indicate more advanced cancer include:

• sudden and/or repeated nosebleeds that are severe
• swelling or deformity in the cheek, nasal area or around the eye
• double vision
• blurred vision
• bulging eye on one side
• unexplained loss of sense of smell
• tearing of the eye on one side (tears running down your cheek)
• loosening of the teeth
• bulges on the roof of the mouth or upper jaw

If you experience any of these symptoms, you should see an ENT doctor for imaging as well as a biopsy, if needed.

How are nose cancers typically diagnosed?

You’ll have a full examination of your head and neck, and your doctor will pay particular attention to your nose, mouth and eyes. Your doctor may perform a nasal endoscopy, a non-invasive procedure in which an endoscope is placed up the nose to inspect the nasal passage.

If there is any suspicion of a tumor or lump inside the nose, then you’ll have a CT scan or MRI to look into the internal structures. If imaging confirms the presence of a mass, you’ll have a biopsy where a pathologist will examine the cell’s tissue and ultimately determine whether you have cancer.

Why is it so important to get an accurate diagnosis for nose and sinus cancers?

Reaching the correct diagnosis is critically important to choosing the right treatment. But because nose and sinus cancers are so rare, the average pathologist may only see a handful of cases in their lifetime, which increases the risk of misdiagnosis. Our pathologists at MD Anderson have seen all types of nose and sinus cancer many times.

In a study of 400 sinus cancer patients who came to MD Anderson with a diagnosis already, 25% were given a different diagnosis after MD Anderson pathologists examined their biopsy slides. For certain cancers, like SNUC, that rate was as high as 67%.

The study also revealed that patients who did not have their diagnosis revised had higher curability and survival rates.

“In other words, getting the diagnosis right from the beginning saves lives,” says Hanna.

What are the risk factors for nose and sinus cancers?

People who are exposed to occupational hazards, such as those who work in the mining industries for nickel and chromium, are at a much higher risk for developing adenocarcinoma of the sinuses. Some strains of the human papillomavirus (HPV) may be associated with sinus cancer. While smoking cigarettes is more closely associated with throat, lung and oral cancers, it can also increase a person’s chances of developing sinus cancer as well. Some nose and sinus cancers are caused by a mutation in a person’s genetic DNA structure that causes cancer.

“’Genetic’ in this sense doesn’t mean hereditary like they got it from their parent,” Hanna clarifies.

What are treatment options for nose and sinus cancers?

There are three common methods for treating nose and sinus cancers: surgery, radiation therapy and chemotherapy.

The sequence of these treatments is important, Hanna says.

While some nose and sinus cancers are treated primarily with surgery, followed by radiation and sometimes chemotherapy or immunotherapy, other cancers are treated by starting with chemotherapy to shrink the tumor.

MD Anderson's head and neck specialists also found that with some high-grade nose and sinus cancers, such as SNUC, advanced squamous cell carcinoma and neuroendocrine carcinoma, it’s best to start treatment with chemotherapy and see how the cancer responds. Then, your care team can determine the best next steps for treatment.

“For example, if we give a patient two rounds of chemotherapy over five or six weeks, and the tumor shrinks by more than 50%, that tells us the tumor is best treated with radiation therapy, not surgery,” explains Hanna. “If the tumor shrinks by 10% or 15% or not at all, then perhaps it’s best treated with surgery, not radiation, or surgery followed by radiation.”

Some patients can undergo minimally invasive surgery to speed up recovery time and reduce side effects.

“We have pioneered minimally invasive surgery for these types of cancer,” he says. “We use an endoscope and do no cutting on the outside. This avoids facial incisions or deformities and includes a more rapid recovery, shorter hospital stays and fewer side effects.”

The two structures closest to the sinuses that can be damaged during radiation are the eye and the brain. MD Anderson treats sinus cancers with proton therapy, which allows for more efficient targeting of the tumor.

“The goal is to eradicate the cancer and protect the eye and brain,” says Hanna. “Proton therapy, together with minimally invasive surgery, has revolutionized the ability to protect and preserve these precious structures.”

What new research is being done to advance nose and sinus cancer treatment?

We just finished a clinical trial that looked at the treatment approach of starting with chemotherapy to shrink the tumor with two goals: organ preservation (eyes and brain) and optimizing subsequent treatment. The follow-up clinical trial, which is ongoing now, is using chemotherapy plus immunotherapy, rather than chemotherapy alone, to shrink the tumor. We have the same goals: organ preservation and optimizing subsequent therapy.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.