Nasal and sinus cancer

The space inside the nose is called the nasal cavity. The paranasal sinuses are spaces in the bones around the nasal cavity. Symptoms of nasal and sinus cancers include:

  • a blocked nose that does not clear
  • pressure or pain behind your nose or in your teeth
  • blood when you blow your nose.

If you have symptoms, it is important to have them checked by your GP. They may refer you to a specialist for tests. These may include a test to examine your nose and throat closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.

The main treatment for nasal and sinus cancers is usually surgery. But you may also be offered radiotherapy or chemotherapy. Your doctor will discuss with you the best treatment for you.

Surgery may affect your speech, how you swallow or your sense of taste and smell. Your hospital team will tell you more about what to expect. There are lots of things that can help you manage side effects during and after treatment.

What are nasal and sinus cancers?

Nasal and sinus cancers are rare cancers of the head and neck that develop inside the nose or paranasal sinuses.


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.

The nasal cavity and paranasal sinuses
The nasal cavity and paranasal sinuses

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Causes and risk factors of nasal and sinus cancers

The exact causes of nasal and sinus cancer are not known. But certain risk factors can increase the chances of developing it.

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.

Smoking tobacco may also increase the risk of nasal and sinus cancer.


Symptoms of nasal and sinus cancers

The most common symptoms of nasal and sinus cancer 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 in your cheek, your upper lip, your upper teeth or the side of your nose
  • headaches
  • stiffness or pain in your jaw
  • loose teeth in your upper jaw
  • speech changes
  • double vision.

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


How nasal and sinus cancer is diagnosed

You usually start by seeing your GP. They will examine your face, eyes, ears and mouth.

They will refer you to a specialist doctor if:

  • they think that your symptoms could be caused by cancer
  • they are not sure what the problem is.

The specialist doctor will ask you about your symptoms and general health.

Nasendoscopy

You may have this test in the outpatient clinic. The doctor passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a light and camera at the end, to help the doctor get a better view of the inside your nose and throat. You might find this a bit uncomfortable, but it only takes about a minute.

Before the test, the doctor may numb your nose and throat with a local anaesthetic spray. Some people prefer to have this done without the anaesthetic spray. If you have this spray, do not eat or drink anything for about an hour afterwards, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way and into your lungs, when you swallow. You could also burn your mouth or throat with hot food or drinks.

Biopsy

To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope. They check the sample for any cancer cells.

A biopsy can be taken in different ways. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.

Sometimes you will have a CT or MRI scan before a biopsy is taken (see below for more information about these tests). This is so your doctor can see exactly where the tumour is and plan the best way to take a biopsy.

It’s hard to imagine how you will cope with the diagnosis of cancer. It has become a familiar word to all of us, but its meaning is highly personal.

Christine


Further tests for nasal and sinus cancers

These 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 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may 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 an 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 is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.

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

MRI scan

An MRI scan 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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging for nasal and sinus cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.

The most commonly used staging systems for nasal and sinus cancer are the TNM and number staging systems.

TNM staging system

TNM stands for tumour, node and metastases.

  • T describes the size of the tumour and whether it has grown into nearby tissues such as, bones, muscles or nerves. It is numbered between 0 and 4 depending on the size and extent of the tumour. T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. A T1 nasal tumour is small and has not spread from the nasal cavity. 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 lymph nodes. N0 means that no lymph nodes are affected. N1, N2 or N3 means that there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to distant organs, such as the lungs or liver.

Number staging system

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading

The grade of a cancer gives the doctors 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 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.


How nasal and sinus cancers are treated

Your treatment will depend on the position, stage and grade of the cancer, as well as 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 facial appearance. Your specialist doctor or nurse will explain the best treatment for you and any side effects that are likely.

The main treatment for nasal and sinus cancers 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 is called chemoradiation.

Any of these treatments may also be given to control symptoms of cancer that has spread to other areas 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 has not spread, the surgeon may be able to remove just the tumour. But sometimes they 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. They plan the operation to avoid changing your facial appearance. They also try to avoid damaging areas of the mouth or face that help you talk, swallow, eat or see.

However, sometimes the surgeon advises removing bigger areas and rebuilding them with tissue, skin or bone taken from somewhere else in the body. They may need to do this to remove all of the tumour. If the surgeon removes part of the roof of the mouth, they fit a special piece of plastic (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. They might do this even if the nodes do not show any signs of cancer. This is to reduce the risk of the cancer coming back.

There are 3 ways of doing surgery for nasal and sinus tumours. The surgeon may use one or more of the following types of surgery 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 the mouth or nose. This can be as good as other types of surgery at treating small nasal and sinus cancers. This type of surgery does not leave any scars on the face or neck, and you may recover faster after the operation.
  • Transoral surgery – The surgeon removes the tumour through cuts or an opening they make inside the mouth.
  • Open surgery – The surgeon removes the tumour through cuts or an opening they make on the face or neck.

After the operation

How long you stay in hospital depends on the type of operation you have. If your surgery is more complicated, you might stay in hospital for up to 3 weeks. You may be looked after in a high-dependency unit or intensive care for a while after the operation. Your specialist doctor can tell you more about the type of operation and how long you may need to stay in hospital.

As you recover, you may see a dietitian and speech and language therapist (SLT) to help you 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.

We have more information about what to expect before and after surgery.

Effects of surgery

Depending on the type of operation you have, it might:

  • affect your speech
  • affect your sense of taste and smell
  • affect how you swallow
  • leave scars or change your appearance.

It can be difficult to prepare for and cope with this kind of surgery. It is important to discuss your operation fully with your surgeon, so you know what to expect and how it will affect you. Your surgeon can also tell you what support is available.

You may also find some of these organisations helpful:

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

A man is pressing his finger on his throat in a doctor's office.

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos


Radiotherapy and chemoradiation for nasal and sinus cancer

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Usually radiotherapy is given after surgery to reduce the chance of the cancer coming back. This may start about 6 weeks after surgery. It may also be used to treat cancer in the neck or 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. Or if you cannot have surgery, you may have radiotherapy or chemoradiation as the main treatment for nasal and sinus cancers. Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with the side effects of 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.

Planning your radiotherapy treatment

To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.

You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.

Having radiotherapy

Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.

The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually get better slowly after treatment finishes, but many people continue to have a dry mouth.

Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. 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.

Sore eyes

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.

Sore or sensitive skin

The skin over your face and neck will slowly redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.

When you wash your face and neck, it is very important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished your treatment. They can also tell you when and how to use sun-protection cream after your treatment.

We have more information about skin care when you have radiotherapy to the head and neck area.

Sore mouth

It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean will help prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may get mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.

We have more information about coping with a sore mouth.

Dry mouth

Radiotherapy to the head and neck may reduce the amount of saliva (spit) you make. It can make your mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to get tooth decay. So it is really important to care for your teeth during and after treatment.

It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.

We have more information about coping with a dry mouth.

Thick saliva (mucus)

Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.

Rinsing your mouth regularly can help with this. Your specialist head and neck team can give you advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.

Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.

Sore and blocked nose (nasal congestion) and ears

You may have:

  • a sore or blocked nose
  • nosebleeds
  • a fluid build-up in the middle ear, which might affect your hearing.

Talk to your specialist about what might help. It usually gets better once your treatment has finished.

Difficulty eating

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 or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can buy some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.

Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.

Headaches

Some people have headaches during radiotherapy and for a few weeks afterwards. Let your doctor or nurse know, as they may be able to prescribe medicines to help.

Hair loss

You may lose your hair in the area that is being treated with radiotherapy. The hair often starts to grow back a few weeks after the treatment finishes. Sometimes hair loss is permanent.

Tiredness

This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.

Late effects of radiotherapy

Most side effects get better after treatment ends. But some people will have late effects, such as loss of sight in one eye. Your doctor, specialist nurse or radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.

Our general information about head and neck cancers has more information about:

  • radiotherapy
  • coping with side effects
  • late effects
  • mouth care
  • how to cope with eating problems.

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for nasal and sinus cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Chemotherapy may be given:

  • with radiotherapy (called chemoradiation)
  • alone, before either chemoradiation or surgery
  • to treat cancer that has spread or has come back after earlier treatment.

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

Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.

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.

Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes 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 other side effects, such as:

  • feeling tired
  • a sore mouth
  • feeling sick (nausea) or being sick (vomiting)
  • diarrhoea
  • hair loss.

Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.

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

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Clinical trials for nasal and sinus cancer

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

Research into treatments for nasal and sinus cancer is ongoing. But because nasal and sinus 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 you fully understand the trial and what it means to take part. You can decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.


Follow-up after treatment

After your treatment finishes, you will have regular check-ups and tests. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.


Your feelings

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.

It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.

Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.

You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.

If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.

There are national support groups that you may find helpful:

  • Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
  • Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).

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