Nasal Cancer - Symptoms, Causes, Pictures and Treatment

Nasal cancer, or nasopharyngeal cancer, is a head and neck cancer that starts in the nasal cavity or paranasal sinus. It is a rare type of cancer in most parts of the world and in India, except for the hill states of Northeast India. 

Depending on where the cancer begins, the disease can have different names. 

If the cancer begins in the opening behind the nose, it is called nasal cavity cancer. The nasal cavity, which is right behind the nose, runs along the roof of the mouth and joins the upper part of the throat. 

1. Maxillary: present in the cheekbones on both sides of the nose.
2. Frontal: present in the lower forehead above the nose.
3. Sphenoid: present behind the nose, in the center of the skull.
4. Ethmoid: present beside the upper nose, between the eyes.

Besides the physical location of the type of nasal cancer, nasal cancers can also vary depending on the affected cells. These include:

1. Squamous Cell Carcinoma: A most common type of nasal cancer (accounts for about 70% of nasal cancers) that starts in the thin, flat cells that line the nasal cavity and upper part of the throat.
2. Adenocarcinoma: This type of cancer (about 10% to 20% of nasal cancer cases) starts in the glandular cells that produce mucus in the nasal cavity and sinuses.
3. Lymphoma: Cancer (about 5% of nasal cancers) of the immune system cells that can occur in the nasal cavity and surrounding lymph nodes.
4. Melanomas: Cancer that is rare (about 3%) but very aggressive and starts in the sinus lining cells that give skin its natural colour. 
5. Esthesioneuroblastoma: This rare type of cancer starts in the nerve cells that are responsible for a person's sense of smell.

Stages of Nasal Cancer

Nasal cancer is staged based on the size and extent of the tumour and whether it has metastasised (spread) to nearby lymph nodes or other body parts.

The stages of nasal cancer are typically categorised using the TNM staging system, which stands for Tumor, Node, and Metastasis. The following are the stages of nasal cancer:

1. Stage 0: This is also known as carcinoma in situ, where cancer cells are only found in the surface layer of cells lining the nasal cavity or sinuses. This stage is usually highly curable with surgery.
2. Stage I: At this stage, the tumour has grown larger but is confined to the nasal cavity or sinuses and has not spread to lymph nodes or other body parts.
3. Stage II: The tumour has grown in size and affects more areas of the nasal passages. However, cancer has not spread to lymph nodes or other body parts. 
4. Stage III: The tumour has grown outside the nasal passages. The cancer has spread to nearby tissues and lymph nodes and may have started to affect structures such as the eye or skull base.
5. Stage IV: The most advanced stage of nasal cancer, where cancer has spread beyond the nasal cavity or sinuses to other body parts, such as the brain or lungs.

The nasal cancer symptoms can be vague and similar to other conditions, such as infections or nasal polyps, making the condition difficult to diagnose. However, some of the common early symptoms of paranasal sinus and nasal cavity cancer include:

1. Persistent nasal congestion or blockage
2. Nosebleeds or discharge from the nose
3. Pain around the eyes
4. Mucus draining into the back of the patient’s nose and throat
5. A decreased sense of smell

Symptoms of nasal cancer at a later stage of the disease may include:

1. Pain or numbness in some parts of the face
2. Presence of a lump in the nose
3. Swelling or lumps in the neck
4. Changes in vision or hearing
5. Constant watery eyes
6. Pain or pressure in one ear
7. Headache
8. Trouble opening the mouth
9. Loose teeth or dentures that do not fit properly
10. Swollen glands in the neck

Nasal and sinus cancer develops when a genetic mutation turns normal, healthy cells into abnormal ones. Healthy cells in the human body grow at a fixed rate and die at a set time.

However, abnormal cells grow and multiply uncontrollably and do not die. This abnormal accumulation of cells causes the formation of a tumour.  

When these abnormal cells become cancerous, they may even separate from the initial tumour and spread to other body parts. 

Nasal Cancer Risk Factors

Several risk factors may increase an individual’s likelihood of developing nasal cancer. Having these risk factors does not necessarily mean a person will develop nasal cancer, and many people with nasal cancer have no identifiable risk factors. These risk factors may include:

1. Exposure to Certain Chemicals: Long-term exposure to certain chemicals such as wood dust, leather dust, nickel dust, chromium, formaldehyde, and other chemicals used in certain industries may increase the risk of developing nasal cancer.
2. Viral Infections: Certain viral infections like human papillomavirus (HPV) can increase the risk of nasal cancer.
3. Tobacco and Alcohol Use: Long-term tobacco and alcohol use can increase the risk of developing nasal cancer, especially squamous cell carcinoma.
4. Age and Gender: Nasal cancer is more common in men and tends to occur in people over the age of 40.
5. Genetics: In some cases, genetic mutations can increase the risk of developing nasal cancer.

There is no surefire way to prevent nasal cancer. But there are certain steps that can reduce their risk of developing the disease. Some of these steps include:

1. Limiting Exposure to Chemicals: People who work in an industry should take steps to minimise their exposure to chemicals. This may include wearing protective equipment like masks and gloves.
2. Quitting Smoking: If someone is a smoker, quitting can reduce their risk of developing nasal cancer and other types of cancer.
3. Limiting Alcohol Consumption: Long-term alcohol use can increase the risk of nasal cancer, so limiting alcohol consumption can help reduce the risk.
4. Protecting Yourself from Viral Infections: Getting vaccinated for viral infections like HPV can reduce the risk of nasal cancer.
5. Seeing a Doctor for Regular Check-Ups: Regular check-ups with a doctor can help detect potential health problems, including nasal cancer, early on when they are most treatable.

If nasal cancer is suspected, a doctor will refer the patient to an otolaryngologist, a healthcare professional specialising in Ear, Nose, and Throat (ENT) diseases. An otolaryngologist will typically begin by asking the patient about their symptoms and taking down their medical history. 

The doctor will physically examine the nose and surrounding areas to look for swelling, numbness, or firmness.

If the exam suggests the possibility of paranasal sinus or nasal cavity cancer, the doctor may recommend further tests, including:

1. Imaging Tests: Imaging tests like CT scans, MRI scans, PET scans, head and neck X-rays, or ultrasounds can help determine the tumour’s size and location. Imaging tests are performed for several reasons before and after a diagnosis, such as:
   1. Looking for a suspected cancer
   2. Checking if the tumour can be safely biopsied without causing much bleeding
   3. Checking the spread of cancer
   4. Seeing if cancer can be removed with surgery
   5. Helping determine if the treatment is working
   6. Looking for signs of cancer recurrence
2. Biopsy: A biopsy involves removing a small tissue sample from the tumour and examining it under a microscope to know if it is cancerous. 
   1. The results of the biopsy help guide treatment. 
   2. The biopsy type(fine-needle aspiration, incisional, and excisional) depends on the cancer’s location and the amount of tissue sample required for testing. 
3. Nasal Endoscopy: An endoscopy involves using a thin, flexible tube to inspect the inside of the nose and surrounding areas.
   
   The tube has a camera attached at the end to help the doctor look inside the nasal cavity. 
4. Laryngoscopy: In this procedure, the doctor checks the larynx (voice box) with a laryngoscope (a thin tube with a light, lens, and video camera) to look for abnormalities inside the throat and voice box. 
5. Other Pre-treatment tests: People diagnosed with nasal cancer may need certain other tests to see if they are healthy for treatments like surgery or chemotherapy. These tests include:
   1. Blood Tests: A complete blood count helps determine whether the patient’s blood has normal numbers of different types of blood cells.
      
      A blood chemistry test is used to assess the working of the liver and kidneys. 
   2. Electrocardiogram and Pulmonary Function Tests: If the patient needs to undergo surgery, the doctor may recommend an electrocardiogram to check the heart’s functioning.
      
      People may also need to undergo lung tests. 
   3. Hearing Tests: Chemotherapy drugs for treating nasal cancer can affect hearing.
      
      The doctor may check the hearing of the patient using an audiogram before starting treatment. 
   4. Dental Exam: Radiation during treatment can increase the risk of infection, cavities, and breakdown of the jawbone.
      
      The dentist may pull some teeth before radiation which might interfere with the treatment.

How to Prepare for Doctor Consultation?

Preparing for a doctor consultation for nasal cancer can help the patient get the most out of their appointment and ensure that their concerns are addressed. The following tips can help prepare for a doctor consultation:

1. Write down the symptoms: Before the appointment, patients should list any symptoms they are experiencing, when they started, and how often they occur.
   
   Symptoms should be as specific as possible and include any changes they have noticed in their sense of smell, vision, or hearing.
2. Make a list of medications and supplements: Patients must bring a list of all their medications and supplements, including the dosage and frequency.
3. Write down their medical history: It would help to list any medical conditions they have been diagnosed with, surgeries they have had, and any allergies they have.
4. Write down questions: Patients should write down any questions about nasal cancer, including the diagnostic process, treatment options, and potential side effects.
5. Bring a trusted friend or family member: Having a trusted friend or family member with them can help provide support and take notes during the appointment.

What to Expect from the Doctor?

During a nasal cancer consultation appointment, the doctor will likely ask the patient several questions to understand their symptoms and medical history. Some of the questions include:

1. What symptoms are you experiencing? When did they start, and how severe are they?
2. Have you been exposed to chemicals or substances that may increase your risk of nasal cancer?
3. Do you smoke or use tobacco products? If yes, how much and for how long?
4. Do you consume alcohol? If yes, how much and how often?
5. Do you have any other medical conditions, and are you taking any medications or supplements?
6. Have you had any medical procedures or surgeries related to your nose or sinuses?
7. Have you noticed changes in your sense of smell, vision, or hearing?
8. Have you ever been diagnosed with cancer in the past?
9. Are there any family members who have been diagnosed with cancer?
10. Did your symptoms affect your quality of life?

The doctor may also ask follow-up questions based on the answers to these initial questions.

Patients must be honest and thorough in their responses to help the doctor better understand the patient’s situation and provide appropriate treatment recommendations.

What Questions to Ask the Doctor?

Patients with suspected or diagnosed nasal cancer should also prepare questions to ask their doctors during consultation appointments.

Here are some questions patients may consider asking:

1. What are the potential causes of my nasal cancer?
2. What treatment options are available for my nasal cancer, and which do you recommend?
3. What are the potential side effects of nasal cancer treatment options, and how can they be managed?
4. How long will treatment take, and what can I expect during and after treatment?
5. Will I need to be referred to any other specialists for treatment, such as a radiation oncologist or a head and neck surgeon?
6. What is the prognosis for my nasal cancer, and what are my chances of survival?
7. What changes should I make to my lifestyle to aid my treatment and recovery?
8. How can I reduce the risk of cancer recurrence?
9. How frequently will I need follow-up appointments, and what tests or imaging will be performed during these appointments?
10. Are any clinical trials or experimental treatments available for my type of nasal cancer?
11. What resources, such as support groups or counselling services, are available to support me and my family during this time?

The treatment plan for nasal cancer is determined by a team of specialists, like a surgeon, radiation oncologist, medical oncologist, and other healthcare professionals.

The treatment goal is to remove the cancer, preserve as much function as possible, and improve the patient’s quality of life.

The treatment method is determined based on various factors, including:

1. The Location and Spread of the Tumour: The precise location and spread of the tumour in the nasal cavity or paranasal sinuses can impact treatment decisions.
   
   The proximity to critical structures like the eyes, brain, or skull base can influence the choice of surgical techniques or the need for radiation therapy.
2. The Size of the Tumour: The size of the tumour in nasal cancer helps determine the extent of surgical intervention needed.
   
   Larger tumours may require more extensive surgery or additional treatments like radiation therapy to achieve complete removal of cancer.
3. The Type of Cancer: The specific type of nasal cancer play a crucial role in determining the treatment approach.
   
   Different types of nasal cancer may respond differently to certain treatments. 
4. Patient's Age and General Health: The patient's age and overall health are taken into consideration to assess their ability to tolerate certain treatments and the impact on their quality of life.
5. Diagnosis of Cancer (First Time or Recurred): Treatment approaches differ based on cancers that have just been diagnosed and the ones that have recurred after treatment. 

Based on the diagnosis and other factors, the doctor would recommend one or a combination of the following treatment methods.

1. Surgery: Surgery is often the first-line treatment for nasal cancer. It aims to remove the tumour and any affected surrounding tissues or lymph nodes.
   
   Sometimes, the entire nasal cavity or sinuses may need to be removed. Surgical options include:
   1. Open Surgery: The surgeon makes an incision near the nose or in the mouth to access the patient’s nasal cavity.
      
      They remove the tumour and other affected areas, such as nearby bone. 
   2. Minimally Invasive Surgery: In certain cases, the surgeon may access cancer using nasal endoscopy and special tools inserted through the nose.
      
      These tools have a tiny camera attached at the end, allowing the surgeon to perform the surgery. 
2. Radiation Therapy: Radiation therapy uses high-energy beams, like X-rays and protons, to kill cancer cells.
   
   It may be used after surgery or as the primary treatment for smaller tumours. 
3. Chemotherapy: Chemotherapy uses drugs like cisplatin, fluorouracil, and methotrexate to kill cancer cells.
   
   It may be combined with radiation therapy or surgery to shrink the tumour before or after treatment.  
4. Immunotherapy: Immunotherapy is a newer treatment that uses drugs to activate the body’s immune system to fight cancer.
   
   It may be combined with other advanced or recurrent nasal cancer treatments.
5. Palliative Care: It focuses on enhancing the well-being of individuals with advanced nasal cancer.
   
   It may include treatments such as pain management, nutrition support, and emotional and spiritual support.

Please Note: The treatment choice for nasal cancer depends on the cancer stage, location, and other factors like the patient’s age, overall health, and the doctor’s opinion. 

Survival Rate of Nasal Cancer

The five-year survival rates compare the likelihood of a person with nasal cancer surviving five years after diagnosis to the general population.

For instance, if a disease has a five-year survival rate of 90%, it means that the patients with that disease, on average, are about 90% as likely as people without the disease to live for at least five years after diagnosis.  

The survival rate for nasal cancer is as follows:

Nasal cancer and its treatments can come with various risks and potential complications. The following are the risks associated with nasal cancer:

1. Blockage of Nasal Passages: Nasal cancer can cause blockages in the nasal passages, making breathing difficult through the nose.
2. Loss of Sense of Smell: Nasal cancer can cause a loss of sense of smell, also known as anosmia.
3. Hearing Loss and Vision Problems: Nasal cancer can affect hearing and vision if it grows into the ear, the eye, or the optic nerve. 
4. Changes in Appearance and Function: Surgery or radiation therapy may result in changes to the appearance of the face or nose, as well as changes to breathing, smelling, swallowing, and speaking.
5. Side Effects of Treatment: Surgery, radiation therapy, chemotherapy, and other treatments can cause side effects such as pain, swelling, fatigue, nausea, trouble eating, change in taste, mouth sores, hair loss, and skin irritation.
6. Damage to Nearby Tissues and Organs: Surgery and radiation therapy can damage nearby tissues and organs, such as the eyes, brain, and skull base.
7. Psychological Impact: A diagnosis of nasal cancer and its treatments can cause emotional stress, anxiety, and depression.

Risks If Not Treated in Time

Not treating nasal cancer in time can lead to several risks and complications. Some of the risks associated with untreated nasal cancer include:

1. Spread of Cancer: If left untreated, nasal cancer can grow and spread to other body parts, such as the lymph nodes, lungs, or bones.
2. Difficulty Breathing: As nasal cancer grows, it can cause blockages in the nasal passages, making it difficult to breathe through the nose.
3. Facial Deformity: If nasal cancer is left untreated, it can cause facial deformities and changes in the appearance of the nose and face.
4. Chronic Pain: As nasal cancer grows, it can cause chronic pain and discomfort in the face and sinuses.

When to See a Doctor? 

People should visit a healthcare professional if they experience any persistent or worsening symptoms related to the nose or sinuses.

While most nasal cancer symptoms can be caused by conditions other than nasal cancer, one must get an accurate diagnosis and proper treatment as early as possible.

Some of the common symptoms of nasal cancer to look out for include:

1. Chronic congestion or blockage in one side of the nose
2. Persistent nasal discharge or bleeding
3. Pain or pressure in the sinuses or around the eyes
4. Decreased sense of smell or taste
5. A lump or growth in the nose or on the face
6. Facial swelling or numbness
7. Persistent headaches or facial pain
8. Vision or hearing changes

Nasal and sinus cancer and its treatment can affect how people eat and drink. The healthcare provider may recommend meeting a dietician to help them cope.

Treatment for nasal cancer may cause difficulty swallowing, dry mouth, loss of taste, and weight loss. Some dietary recommendations for these problems are as follows:

1. Difficulty Swallowing: If the patient is experiencing difficulty swallowing after radiotherapy or surgery, they may include some soft savoury foods in their diet, such as:
   1. Soups
   2. Omelette or scrambled eggs
   3. Chicken in cream sauce
   4. Noodles
   5. Baked beans with grated cheese
2. Dry Mouth: Radiotherapy can cause a dry mouth, making eating uncomfortable. For a dry mouth, the following tips can help:
   1. Sucking on ice pops and ice cubes
   2. Moistening the food with sauces, creams, and gravy
   3. Taking small sips of water throughout the day
3. Loss of Taste: Radiotherapy and chemotherapy may also affect the taste buds. Some tips for dealing with taste changes include:
   1. Choosing foods that have strong flavours, such as adding lemon juice, garlic, herbs and spices
   2. Using chutneys or pickles to add flavour to food
   3. Avoiding very cold or hot foods
4. Weight Loss: People diagnosed with cancer may lose weight due to difficulty eating. Some tips for putting on weight include:
   1. Increasing protein (eggs, beans, milk, yoghurt, red meat, fish, etc.)
   2. High-calorie and protein smoothies and milkshakes

Nasal cancer is a relatively rare but serious disease that can significantly impact a person’s health and quality of life. Early diagnosis and treatment are crucial for improving the survival chances and reducing the risk of complications.

Individuals must be aware of nasal cancer symptoms, risk factors, and treatment options and seek medical attention if they suspect they may have the disease.

At HexaHealth, we understand the challenges that patients with nasal and sinus cancer face, and we provide them with the resources and support they need to manage the condition.

Our team of healthcare professionals can help patients navigate the complex medical system, coordinate their care, and provide them with access to recent treatments and technologies. 

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