Nasal and sinus cancers

Nasal and sinus cancers are rare head and neck cancers that start inside the nose or paranasal sinuses. The exact causes of nasal and sinus cancers are not known. But it is more common in people who handle or breathe in certain chemicals, like chromium or nickel, or formaldehyde for many years. Other factors, like smoking, can also increase the risk of developing nasal and sinus cancers.

Surgery is the main treatment used to treat nasal and sinus cancers. Radiotherapy and chemotherapy may be given before surgery to shrink a large tumour. Often they are given after you have had surgery to reduce the risk of the cancer coming back. A combination of the two (called chemoradiation) may also be used to shrink tumours or to reduce the risk of cancer coming back.

After your treatment, you will have regular check-ups. These might include scans, x-rays or nasendoscopies and will probably continue for several years. But if you have any problems or notice any new symptoms between these check-ups, it’s important to let your doctor know as soon as possible.

What are nasal and sinus cancers?

This information is about a rare head and neck cancer that starts inside the nose or paranasal sinuses. It’s best to read this with our general information about head and neck cancers, which has more information about the tests and treatments described here.

We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment. If you’d like to order booklets or have any questions, contact our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm.


The nasal cavity and paranasal sinuses

The space inside the nose is called the nasal cavity. This space warms, moistens and filters air as you breathe in. The bones around the nasal cavity have small hollow spaces in them called paranasal sinuses. These sinuses affect the sound and tone of your voice.

Side view of the structures in the head and neck
Side view of the structures in the head and neck

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Causes and risk factors of nasal and sinus cancers

The exact causes of nasal and sinus cancers are not known. It is more common in people who handle or breathe in certain chemicals or dust for many years because of their job. These include wood dust, chromium, nickel, formaldehyde, leather dust and mineral oils.

Other factors that may increase the risk of nasal and sinus cancer include:


Symptoms of nasal and sinus cancers

The most common symptoms can include:

  • a blocked nose that does not clear
  • pressure or pain behind your nose or in your upper teeth
  • blood when you blow your nose
  • nosebleeds
  • losing your sense of smell.

Other symptoms include:

  • numbness of your cheek, upper lip, upper teeth or side of your nose
  • headaches
  • jaw stiffness or pain
  • loose teeth in your upper jaw
  • speech changes
  • double vision.

These symptoms can be caused by other conditions but it’s important to have them checked by your doctor.


Diagnosing nasal and sinus cancers

You usually start by seeing your GP. If they are unsure what the problem is, or think that your symptoms could be caused by cancer, they will refer you to a hospital specialist.

At the hospital, the specialist doctor will ask you about your symptoms and general health. They will examine your face, eyes, ears and mouth. The doctor will use a thin, flexible tube with a light and a camera at the end (nasendoscope) to get a better view inside your nose and throat. They pass the tube into your nostril. This can be uncomfortable, so the doctor may numb your nose and throat with a local anaesthetic spray first. If you have this spray, don’t eat or drink anything for about an hour afterwards or until your throat has stopped feeling numb.

The doctor removes a small sample of tissue or cells (biopsy) to make a diagnosis. A pathologist (doctor who specialises in analysing cells) examines the sample under a microscope to look for signs of cancer.

A biopsy can be taken in different ways. The doctor may take biopsies while they are examining you with the nasendoscope. Or they may arrange for you to have biopsies taken under general anaesthetic. Sometimes you will have a CT or MRI scan before any biopsy is taken. This is so the doctor can see exactly where the tumour is and plan the best way to take a biopsy.


Further tests for nasal and sinus cancers

Other tests may be used to help diagnose nasal and sinus cancer or to check whether it has spread:

X-rays

X-rays use high-energy rays to take a picture of the inside of your body. Your doctor can use an x-ray to show the size and position of the cancer and to check the bones of the face.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10–30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You’ll probably be able to go home as soon as the scan is over.

MRI scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it's safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you've ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it's likely that you won't be able to have an MRI scan. In this situation another type of scan can be used.

Before the scan, you'll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn't usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you'll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It's also noisy, but you'll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


Staging and grading of nasal and sinus cancers

The stage of a cancer describes its size and whether it has spread. Knowing the stage of the cancer helps doctors decide on the best treatment for you. The two most commonly used staging systems for nasal and sinus cancers are the TNM and the number system.

TNM staging system

T describes the size of the nasal or sinus tumour and whether it has grown into nearby tissues such as, bones, muscles or nerves. For example, a T1 nasal tumour is small and hasn’t spread from the nasal cavity, while a T4 nasal tumour has spread into nearby bones, nerves, tissue or areas of the skull.

N describes whether the cancer has spread to the neck lymph nodes. The lymph nodes are part of your body’s system to protect you from infection and disease. After N there is a number between 0 and 3 depending on how many lymph nodes contain cancer cells, where they are and their size. N0 means that no lymph nodes are affected by cancer.

M describes whether the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer hasn’t spread and M1 means the cancer has spread to distant organs such as the liver or lungs.

Number staging system

Nasal and sinus cancers can also be given a number stage from 1 to 4.

For example, stage 1 describes a tumour that is small and hasn’t spread. This would be described as T1 N0 M0 in the TNM system. Stage 4 describes a tumour has spread to other tissues nearby and/or has spread into the neck lymph nodes and/or has spread to distant organs.

Talking about staging

Your doctor or nurse will be able to give you more information about staging. To keep things simple, they may use the following words to describe the stage of the cancer:

  • Early or local – to describe a small cancer that hasn't spread.

  • Locally advanced – to describe cancer that has spread into nearby tissues or neck lymph nodes.
  • Secondary or widespread – to describe cancer that has spread to distant organs.
  • Local recurrence – to describe cancer that has come back in the head or neck area after treatment.

Grading

The grade of a cancer gives the doctor an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

Grade 1 – the cancer cells tend to grow slowly and look quite similar to normal cells.

Grade 2 and 3 – the cancer cells look more abnormal.

Grade 4 – the cancer cells tend to grow more quickly and look very abnormal.


Treatment for nasal and sinus cancers

Your treatment will depend on the position, stage and grade of the cancer, and on your general health. Usually a team of specialist doctors will plan your treatment. They aim to treat the cancer while doing as little damage as possible to your nose, mouth and appearance.

The main treatment for nasal or sinus cancer is usually surgery. Treatments such as radiotherapy and chemotherapy may be given before surgery to shrink a large tumour. Often they are given after you have had surgery to reduce the risk of the cancer coming back. When chemotherapy and radiotherapy are given together, it’s called chemoradiation.

Any of these treatments may also be given to improve symptoms of cancer that has spread to other parts of the body.

Surgery for nasal and sinus cancers

Surgery is used to remove all or as much of the cancer as possible. The type of surgery you have depends on the size and position of the tumour. If it is small and hasn’t spread, the surgeon may be able to remove just the tumour. But sometimes they will also need to remove nearby areas of tissue or bone affected by the cancer.

Your surgeon will explain the operation and answer any questions you have. If possible, the operation will be planned to avoid damaging your appearance and areas of your mouth or face that help you talk, swallow, eat or see.

However, sometimes the surgeon will advise removing larger areas and rebuilding them with tissue, skin or bone taken from somewhere else in your body. They may need to do this to remove the tumour completely. If part of the roof of your mouth is removed, the surgeon will fit a special piece of plastic (called an obturator) into the missing area. This covers the gap in the roof of the mouth to help you speak and eat.  

Sometimes, the surgeon also removes some lymph nodes in the neck. You might have this even if the nodes don’t show any signs of cancer, to reduce the risk of the cancer coming back.

There are three ways of doing surgery for nasal and sinus tumours: endoscopic, transoral and open. The surgeon may use one or more types during your operation.

Endoscopic surgery

The surgeon uses a thin, flexible tube with a light and a camera at the end (endoscope) to remove the tumour through your mouth or nose. This can be as good as other types of surgery at treating small nasal and sinus cancers. This type of surgery doesn’t leave any scars on your face or neck and you may recover faster after the operation.

Transoral surgery

The surgeon removes the tumour through cuts made inside your mouth.

Open surgery

The surgeon removes the tumour through cuts made on the face and neck.

After the operation

How long you stay in hospital depends on the type of operation you need. If your surgery is more complicated, you might stay in hospital for up to three weeks. You may be looked after in a high dependency unit or intensive care for a while after the operation.

As you recover, you may see a dietitian and speech therapist to help you to cope with any changes to your speech or how you swallow.

If you have an obturator fitted during the operation, you may need further appointments with a specialist dentist. This is to make sure the obturator fits well as your mouth heals.

Effects of surgery

This also depends on the type of operation that you have. Your speech, how you swallow or your sense of taste and smell might be affected. Some operations may leave scars or a change in your appearance.

It can be difficult to prepare for and cope with this kind of surgery. It’s important to discuss your operation fully with your surgeon so that you know what to expect and how it will affect you. You may also find some of these organisations helpful:

  • Changing Faces supports people who have conditions or injuries which affect their appearance. It offers a skin camouflage service for people living with scarring or a skin condition that affects their confidence.
    Tel 0300 012 0275 (Mon-Fri, 10am- 4pm)
    Email info@changingfaces.org.uk
  • Let’s Face It is a support network for people with facial disfigurements.
    Tel 01843 833724
    Email chrisletsfaceit@aol.com
  • Saving Faces has an expert patient helpline that puts people in touch with someone who’s had the same condition or similar surgery.
    Tel 07792357972 (Mon-Fri, 9am-5pm)
    Email helpline@savingfaces.co.uk

Radiotherapy and chemoradiation for nasal and sinus cancers

Radiotherapy uses high-energy rays to destroy the cancer, while doing as little harm as possible to normal tissue. Usually radiotherapy is given after surgery to reduce the chance of the cancer coming back. It may also be used to treat cancer in the neck lymph nodes or to reduce the risk of the cancer coming back in this area.

Radiotherapy or chemoradiation may be given to shrink a tumour before surgery. If you can’t have surgery, radiotherapy or chemoradiation may be given as the main treatment for nasal and sinus cancers. Having chemoradiation is more effective than either chemotherapy or radiotherapy alone. However, the side effects are more severe. It’s important that you're well enough to cope with having both treatments together.

Radiotherapy may also be used to control symptoms, such as pain, if the cancer has spread to other areas of the body.

You have radiotherapy in small doses (called fractions) over 4-7 weeks, from a radiotherapy machine similar to a large x-ray machine. It does not make you radioactive. If you are having treatment to control symptoms of cancer that has spread, you might only need a few days of treatment or just a single dose.

You may be given a type of radiotherapy called IMRT in which high-energy rays are shaped very precisely to the area of cancer. This allows a higher dose of radiation to be given to the tumour while healthy areas nearby get a lower dose of radiation. This can reduce side effects. Your specialist doctor may arrange for you to have IMRT at another treatment centre if it’s not available at your local hospital.

Side effects of radiotherapy

Radiotherapy can cause side effects during and for a few weeks after treatment. These usually disappear gradually after this. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Your eyes may become sore, itchy or dry during treatment and in the weeks after treatment ends. Your radiotherapy team can give you eye drops to help with this.

Your radiotherapy team will also give you advice about skin care during treatment. It’s common to have a skin reaction in the area of your face and neck being treated. The skin can become sore, red and may peel or become blistered. This usually starts about 2-3 weeks into treatment and may last for 3-4 weeks after treatment ends. Tell your radiotherapy team if your skin becomes sore. They can give you painkillers and advice about caring for your skin until it heals.

It’s important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean will help to prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may get some mouth ulcers and your voice may become hoarse. You might find your sense of taste and smell change. Eating food can become difficult and swallowing can be painful. Your doctor can prescribe medicines to help.

Radiotherapy to the mouth affects your salivary glands. This may be less with IMRT. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry making eating and talking difficult. Your doctor can prescribe mouthwashes and artificial saliva sprays, gels or lozenges to help. Changes in your saliva usually get better within about eight weeks of radiotherapy ending.

If you find it hard to eat and drink because of side effects, tell your doctor or nurse. They can give you advice and medications to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy and/or protein to your diet. Some can be used to replace meals, while others are used in addition to your normal diet. Although a few of these products are available directly from your chemist or the supermarket, your doctor, nurse or dietitian can also prescribe them for you.

Some people have headaches during and in the weeks after radiotherapy. Let your doctor or nurse know. You may need drug treatments to help.

You may lose your hair where the radiotherapy beam enters and leaves your head. The hair will often start to grow back a few weeks after the treatment finishes. Sometimes hair loss is permanent.

Most side effects get better after treatment ends. However, some people will have long-term effects such as loss of sight in one eye. Your doctor will explain the possible long-term side effects and how likely they are in your situation. Often these aren’t common but can happen months or even years after your treatment.

We have more information about radiotherapy, coping with side effects and possible long-term effects.

Chemotherapy for nasal and sinus cancers

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Although chemotherapy may be given with radiotherapy, it can also be given alone – before chemoradiation or surgery. Chemotherapy is also used to treat cancer that has spread or has come back after earlier treatment.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain the treatment you are offered and what to expect. Let them know about any side effects during treatment. They can often give drugs and advice to reduce these.

Cisplatin is the most common chemotherapy drug used to treat nasal and sinus cancer. You have this as an infusion (drip) into a vein.

Chemotherapy can reduce the number of white cells in your blood. This will make you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause side effects such as feeling tired, a sore mouth, feeling sick (nausea) or being sick (vomiting), and hair loss. Let your doctor or nurse know about any side effects. They can often prescribe drugs to reduce these.

We have more information about coping with the side effects of chemotherapy and about individual chemotherapy drugs.

Clinical trials for nasal and sinus cancers

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials.

Research into treatments for nasal and sinus cancer is ongoing and advances are being made. But because this type of cancer is rare there may not always be a relevant trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. You may decide not to take part, or withdraw from a trial at any stage. You will still receive the best standard treatment available.


Follow-up after treatment for nasal and sinus cancers

After your treatment you will have regular check-ups and possibly scans, x-rays or nasendoscopies. These will probably continue for several years. If you have any problems or notice any new symptoms between these times, let your doctor know as soon as possible.


Your feelings

It can be hard to cope with the thought of having treatment that may change your appearance, speech or how you eat and drink. Talking to other people in a similar position may help you feel less alone. Some of the useful organisations listed in this information provide this, as well as specialist advice and counselling. Our Online Community is also a good place to meet people who may be in a similar situation.

You may have many different emotions from shock and disbelief to fear and anger. At times these feelings can be overwhelming and hard to control. But they are natural and it’s important to be able to express them.

Everyone has their own way of coping. Some people find it helps to talk to family or friends, while others get help from people outside their situation. Sometimes it’s helpful to share your experiences at a local cancer support group. You may want to talk to our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm. Some people prefer to keep their feelings to themselves. There’s no right or wrong way to deal with this but help is available if you need it.

Some of these organisations may be able to help you cope with your feelings:

  • The Mouth Cancer Foundation gives information and support through their website and telephone helpline to people affected by head and neck cancers.
    Tel 01924 950 950 (Mon–Fri, 9am–5pm)
    Email info@mouthcancerfoundation.org
  • The Rarer Cancers Foundation provides guidance, information and support for people affected by rare types of cancer.
    Tel 0800 334 5551
    Email patientsupport@rarercancers.org.uk

Back to Head & neck cancers

Diagnosing

causes and risk factors of head and neck cancers

Organising

the practical, work and financial side

Treating

head and neck cancers and what to expect

Coping

with and after treatment for head and neck cancers

Resources

and publications to order, download and print