Nasal and sinus tumours

What are nasal and sinus tumours?

A nasal or sinus tumour is an abnormal growth that starts inside your nasal cavity (the space behind your nose) or your paranasal sinuses (the small, air-filled spaces around your nose). These growths can be non-cancerous (benign) or cancerous (malignant).

What are the symptoms of nasal and sinus tumours?

Nasal and sinus tumours often affect just one side, and early symptoms can be easy to mistake for a cold or sinus infection. You might notice:

• A blocked or stuffy nose on one side that doesn't clear up
• Nosebleeds, or blood-stained mucus running from your nose or down the back of your throat
• A reduced or lost sense of smell
• Sinus infections that keep coming back or don't improve with antibiotics
• Headaches.

As a tumour grows or spreads, you might also develop:

• Changes to your eyes, such as double vision, watering, bulging or reduced vision
• Pain, numbness or a feeling of pressure in your face, cheek or upper teeth, or teeth that feel loose or dentures that no longer fit
• A lump in your neck, or a growth on your face, nose or the roof of your mouth
• Difficulty opening your mouth
• Changes to your voice, or pain, pressure or hearing problems in one ear.

What are the causes of nasal and sinus tumours and who is at risk?

Doctors don't fully understand what causes nasal and sinus tumours. They happen when genes that control how cells grow and divide become damaged, though it's often not clear why this happens. Things that can raise your risk include:

• Smoking, or regularly breathing in other people's smoke
• Working in a job where you breathe in wood dust, leather dust, textile dust, nickel, formaldehyde, paint fumes, asbestos or certain solvents
• Human papillomavirus (HPV), a common infection spread through skin-to-skin contact, often during sex
• Previous radiotherapy to treat retinoblastoma (a rare eye cancer that affects young children).

Anyone can develop a nasal or sinus tumour. Cancerous ones are more common in people aged 55 and over, and men are around twice as likely to be affected as women.

Are there different types of nasal and sinus tumours?

Nasal and sinus tumours are grouped by where they start.

• A nasal tumour begins in your nasal cavity, just behind your nose. Around half of these are cancerous and half are not.
• A paranasal sinus tumour begins in one of the air-filled sinus chambers around your nose, most often the maxillary sinus in your cheekbone. Sinus tumours are more often cancerous than nasal cavity tumours.

Non-cancerous types include nasal polyps and haemangiomas (growths made up of blood vessels). Cancerous types include squamous cell carcinoma, adenocarcinoma, neuroblastoma, adenoid cystic carcinoma and sarcoma.

How are nasal and sinus tumours diagnosed?

If you see a GP about these symptoms, they'll examine the inside of your nose, mouth and throat, and check the glands in your neck for swelling. They may arrange blood tests or an X-ray and will refer you to a specialist if they think your symptoms could be cancer. A specialist will usually carry out further tests, which may include:

• Nasal endoscopy: examining inside your nose and throat using a thin, flexible tube with a camera and light.
• Biopsy: taking a small sample of tissue or cells to check for cancer under a microscope. If the area is at high risk of bleeding, this may be done under anaesthetic in an operating theatre.
• An ultrasound scan, to check the lymph nodes in your neck for changes.
• A CT or MRI scan, to see the size of the tumour and whether it has spread. CT scans are better at showing changes to bone, while MRI gives a clearer picture of soft tissue and nerves.

You'll usually get the results of a nasal endoscopy or ultrasound scan on the same day. A biopsy result can take 1 to 2 weeks.

How are nasal and sinus tumours treated?

Your treatment team will recommend a plan based on the size and location of the tumour, whether it has spread, and your age and general health. Non-cancerous tumours are usually removed with surgery alone. Cancerous tumours are usually treated with a combination of surgery, radiotherapy and chemotherapy.

Non-surgical treatment

Radiotherapy uses beams of radiation to kill cancer cells. Chemotherapy uses medicine to do the same, and the two are sometimes combined into a single course called chemoradiation. You might be offered:

• Radiotherapy after surgery, to lower the chance of the cancer coming back
• Radiotherapy on its own, usually only if the cancer is caught at an early stage, or to ease symptoms if a cure isn't possible
• Chemotherapy before surgery, to help shrink the tumour
• Chemotherapy, or chemoradiation, if the cancer comes back or has spread.

Surgical treatment

Surgery aims to remove as much of the tumour as possible, sometimes along with some healthy tissue to make sure it's all gone. Depending on where the tumour is, your surgeon may operate endoscopically, through your nostrils using a camera and specialist tools, or through open surgery. Your surgical team may include ear, nose and throat (ENT) specialists, oral surgeons and neurosurgeons.

If cancer has spread to lymph nodes in your neck, you may need these removed too, through a separate cut in your neck (a neck dissection). Your surgeon will repair or rebuild any damage, sometimes during the same operation and sometimes with further surgery afterwards.

In more extensive cases, you may need a prosthetic, such as an artificial nose. Some scarring and changes to your appearance are common after surgery, though scars often fade with time.

If your cancer cannot be cured, treatment aims to control it, manage your symptoms, and help you live as well as possible for as long as possible. You'll be referred to a palliative care or symptom control team, who can also support you and your loved ones.

When should I see a doctor?

See a GP straight away if you suddenly develop vision problems, such as double vision. You should also see a GP if you have any of the symptoms above, such as a blocked nose, nosebleeds or a lost sense of smell, that get worse or don't go away after a few weeks.

Many of these symptoms are common and are usually caused by something other than cancer. But it's worth getting them checked, because finding cancer early can make it easier to treat.

If your GP thinks your symptoms could be cancer, they'll refer you urgently to a specialist. This doesn't necessarily mean you have cancer, but it means you'll be seen quickly for further tests.