Early Detection, Diagnosis, and Staging of Nasal Cavity and Paranasal Sinus Cancers

Learn about the signs and symptoms of nasal cavity and paranasal sinus cancers. Find out how nasal cavity and paranasal sinus cancers are tested for, diagnosed, and staged.

Can nasal cavity and paranasal sinus cancers be found early?

Small cancers of the nasal cavity (nose) and paranasal sinuses usually do not cause any specific symptoms that help doctors find them at an early stage, when they're small and treatment is more likely to be successful.

Many of the symptoms of nasal cavity and paranasal sinus cancers can also be caused by benign (non-cancerous) conditions like infections.

Because of this, many of these cancers aren't found until they have grown large enough to block the nasal airway or sinuses, or until they've spread to nearby tissues or to distant parts of the body.

Screening for nasal cavity and paranasal sinus cancers

Screening is testing for diseases such as cancer in people without symptoms to try to find them early. However, there's no simple screening test for nasal cavity and paranasal sinus cancers. These cancers are also uncommon. Because of this, neither the American Cancer Society nor any other group recommends routine screening for these cancers.

Signs and symptoms of nasal cavity and paranasal sinus cancers

Some nasal cavity and paranasal sinus cancers might be found early because of symptoms they’re causing. Some possible early signs and symptoms of these cancers include:

• Nasal congestion and stuffiness that doesn’t get better
• Nosebleeds
• Pain above or below the eyes
• Post-nasal drip (nasal drainage in the back of the nose and throat)
• Pus draining from the nose
• Problems with your sense of smell
• Numbness or pain in parts of the face, including the teeth
• A lump or mass on the face, palate (top of the mouth), or inside the nose

Most of these symptoms are much more likely to be caused by less serious problems such as a sinus infection. Still, if you have any of them, and especially if they don’t go away, it’s important to see a health care provider so that the cause can be found and treated, if needed.

Tests for nasal cavity and paranasal sinus cancers

Nasal cavity and paranasal sinus cancers are usually found when a person sees a health care provider because of signs or symptoms they’re having. If cancer is suspected, tests will be done, sometimes by specialists, to confirm the diagnosis.

Medical history and physical exam

You will be asked about your medical history, any problems you've been having, and possible risk factors, such as where you work and what chemicals you work with.

The doctor will examine you to look for signs of nasal cavity or paranasal sinus cancer, as well as other health problems.

During the exam, the doctor will carefully check your head and neck, including your nose and sinuses, for numbness, pain, swelling, and/or firmness in your face and the lymph nodes in your neck. The doctor will look for changes in the symmetry of your eyes and face (both sides should be about the same), vision changes, and other problems.

Exam by a specialist

If your doctor thinks you might have cancer of the nasal cavity or paranasal sinuses or another part of the head or neck, you'll likely be referred to an otolaryngologist, a doctor who specializes in ear, nose, and throat problems, also called an ENT doctor. This doctor will carefully check your nasal passages.

The doctor will look into the front part of your nose with a light or headlight. The doctor might use a tool called a nasal speculum to gently open your nostril for a better view.

The ENT doctor will most likely do a nasal endoscopy, in which a thin, flexible, lighted tube with a camera on the end is put in through your nose to look into deeper areas. This can usually be done in the office with a numbing spray. If anything abnormal is seen, a biopsy might be done to remove a piece of it for testing.

The doctor will most likely check the rest of your head and neck as well, including your mouth, tongue, and throat. This is known as a complete head and neck exam.

Imaging tests

Imaging tests are used to create pictures of the inside of your body. Imaging tests are not used to diagnose nasal cavity or paranasal sinus cancers, but they might be done for a number of reasons both before and after a cancer diagnosis, including:

• To help look for a tumor if one is suspected
• To see if a tumor can be safely biopsied without causing a lot of bleeding
• To learn how far the cancer might have spread (metastasized)
• To see if the cancer can be removed with surgery
• To help determine if treatment is working
• To look for signs that the cancer has come back (recurred) after treatment

Biopsies

The only way to confirm whether a growth is nasal cavity or paranasal sinus cancer is to remove a sample and examine it in the lab. This is called a biopsy.  

If cancer is found, testing of the biopsy samples can also show what kind of cancer it is and how fast it’s likely to grow and spread. This information is needed to help plan the best treatment.

Different types of biopsies can be used to diagnose nasal cavity or paranasal sinus cancer. Doctors look closely at where the tumor is and the blood vessels around it when deciding on the best way to do a biopsy.

Some biopsies can be done in the doctor’s office or clinic, using medicines to numb the area. If the tumor is in a place that is hard to get to or might bleed a lot, the biopsy might need to be done in an operating room.

Lab tests of biopsy samples

Biopsy samples from endoscopy or surgery are sent to a lab, where they are looked at closely. If cancer is found, lab tests  might be done on the biopsy samples to help better classify the cancer and possibly find specific treatment options.

Doctors  might test the cancer cells for certain gene or protein changes. This might affect treatment, especially if the cancer is advanced. For example, cancer cells might be tested for the PD-L1 protein, which  might predict if the cancer is more likely to respond to treatment with certain immunotherapy drugs.

Other pre-treatment tests

Other tests  might be done if you are found to have nasal cavity or paranasal sinus cancer. These tests can show if you are healthy enough for certain treatments like surgery or chemotherapy.