If there are symptoms that give reason to suspect that a person has nasal cavity or paranasal sinus cancer, the doctor will take a complete medical history and perform a physical exam. Additional tests will be done to find out if the disease is really present and to determine its stage (how far the cancer has spread).

Symptoms of nasal and paranasal sinus cancers

• nasal congestion and stuffiness that doesn't get better or even worsens
• pain above or below the eyes
• blockage of one side of the nose
• post-nasal drip (nasal drainage in the back of the nose and throat)
• nosebleeds
• pus draining from the nose
• decreased sense of smell
• numbness or pain in parts of the face
• loosening or numbness of the teeth
• growth or mass of the face, nose, or palate
• watery eyes that persists over time
• bulging of one eye
• visual loss
• pain or pressure in one of the ears
• trouble opening the mouth
• lymph nodes in the neck getting larger

Many of these symptoms are most often caused by benign conditions such as allergies or infections. When the symptoms are caused by cancer, they don't get better over time. People with these symptoms should see a doctor. If a cancer is present, early detection greatly improves the chance that treatment will be successful.

Medical history and physical exam

When your doctor "takes a history," he or she will ask you a series of questions about your symptoms and risk factors. A physical exam will provide other information about signs of nasal cavity and paranasal sinus cancer and other health problems.

During your physical exam, your doctor will pay special attention to the areas of the nose and sinuses that are causing symptoms. He or she will also pay attention to areas of numbness or pain, swelling and firmness in areas of the face or lymph nodes in the neck, changes in the symmetry of the eyes and face, visual changes, and any other associated problem that you may be experiencing. Your doctor may also examine the nasal cavity with a headlight or even look inside your nose with a special instrument called a nasal endoscope (a thin tube designed to allow the doctor to see into cavities of the body).

If your doctors suspects cancer of the nasal cavity or paranasal sinuses, you will be referred to a specialist in ear, nose, and throat (ENT) diseases called an otolaryngologist.

Imaging tests

X-rays of the sinuses

These x-ray images may tell if the sinuses are not filled by air as they should be. This would suggest that something is wrong, although it may not be a tumor. Most of the time, an abnormal sinus x-ray means there is an infection. If treatment for infection doesn't work, then other more specialized x-ray tests may be done. Sinus x-rays are not done often any more, as many doctors prefer to order a computed tomography (CT) scan instead.

Chest x-ray

This test may be done to determine whether nasal cavity or paranasal sinus cancer has spread to the lungs, which is the most common site of spread other than lymph nodes.

Computed tomography scan

The computed tomography (CT) scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then processes these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied. This test is very useful in identifying cancers of the nasal cavity and paranasal sinuses.

Often after the first set of pictures is taken, you will receive an injection of a "dye" or radiocontrast agent into an intravenous (IV) line. This dye helps better outline structures in your body. A second set of pictures is then taken. The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medication can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.

CT scans take longer than regular x-rays, and you need to lie quietly on a table while they are being done. But just like other computerized devices, they are getting faster, and your stay might be pleasantly short. Also, you might feel a bit confined by the machine you lie within when the pictures are being taken.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected just as with CT scans. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. Because they are better than CT in distinguishing fluid from tumor, sometimes they can tell a benign tumor from a malignant one.

MRI scans take longer than CT scans, often up to an hour. Also, you are placed inside a tube, which is confining and can upset people with claustrophobia or fear of enclosed spaces. The machine gives off a thumping noise, and some facilities provide headphones with music to block out the noise. However the benefits of the test outweigh any discomfort.

Both tests are helpful in identifying cancers of the nasal cavities and paranasal sinuses and their characteristics. While the CT scan can tell if the cancer is growing into bone, the MRI is better at evaluating the kind and size of the cancer. Both can tell if it has spread to lymph nodes in the neck.

Biopsy

A biopsy is the removal of a sample of tissue to examine under a microscope in order to see if a growth is cancer. If it is a cancer, the biopsy can tell what type of cancer it is and how aggressive it is. This is important to plan the most effective treatment. Often, biopsies are done in the doctor's office or clinic. If the tumor is in an area that is hard to reach, the biopsy will be done in the operating room. Several types of biopsies are used to diagnose nasal cavity or paranasal sinus cancer.

Fine needle biopsy

In this type of biopsy, the doctor places a thin, hollow needle directly into a tumor or lymph node to take out cells and a few drops of fluid. The doctor may repeat this procedure 2 or 3 times during the same appointment to take samples from several areas of the nodule. The cells can then be viewed under a microscope to see if they look cancerous or benign. This type of biopsy is often used in patients with enlarged lymph nodes in the neck. In these patients, fine needle biopsy can be useful in deciding whether the lymph node swelling is from the spread of cancer from somewhere else (such as the sinus), a lymphoma (cancer that begins in lymph nodes), or reactive hyperplasia (lymph node swelling in response to an infection). If someone who has already been diagnosed with nasal cavity or paranasal sinus cancer has enlarged neck lymph nodes, a fine needle biopsy can help determine whether the lymph node swelling is due to the spread of cancer.

Incisional biopsy

In this type of biopsy, the surgeon cuts out a small piece of the tumor. The surgeon may remove small biopsy specimens by using special instruments placed into the nose.

Excisional biopsy

In this type of biopsy, the entire tumor is removed and then sent to the laboratory for analysis.

Endoscopic biopsy

This type of biopsy is done through an endoscope (a thin, flexible lighted tube).

Open biopsy

In some cases, it may necessary to cut through the skin next to the nose and through the underlying bones to reach tumors inside the sinuses. These operations are discussed in greater detail in the section on treatment of nasal cavity or paranasal sinus cancers.

Anesthesia is used for a biopsy, but the type of anesthesia that is used depends on which biopsy method is used. Local anesthesia (numbing medication) is often used for an incisional biopsy or needle biopsy. Local anesthesia can be injected into the skin and nearby tissues or even applied directly onto the inside of the nose to make the area numb for the biopsy. General anesthesia may be required for endoscopic biopsies and is necessary for procedures that cut through the sinus bones.