Nasal and sinus cancer

What causes nasal and sinus cancer?

The exact causes of nasal and sinus cancer are not fully understood. However, doctors have identified certain risk factors that can raise a person's chances of developing it.

This cancer is more common in people who, because of their job, handle or breathe in certain chemicals or dust over many years. These include formaldehyde, wood dust and leather dust.

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

Some cases are linked to an infection called human papilloma virus, or HPV. HPVs are a group of common infections that can affect areas such as the inside of the mouth, the throat, the genital area or the anus. Certain high-risk types of HPV can increase the risk of some cancers.

Most people carry HPV at some point in their life, but most people with HPV never go on to develop nasal and sinus cancer.

It's worth knowing that nasal and sinus cancer is not infectious and cannot be passed on to other people.

For more on the causes and risk factors of head and neck cancer, you can look to Macmillan Cancer Support.

You usually start by seeing your GP first. If they feel your symptoms could be linked to cancer, they will refer you to a specialist head and neck doctor, and you will usually be seen within 2 weeks. This specialist may be an ear, nose and throat, or ENT, doctor.

The specialist will ask you about your symptoms and your general health, and you may be given some of the following tests.

Nasendoscopy is a test using a nasendoscope, which is a thin, flexible tube with a light and camera on the end. It lets your doctor look inside your nose, and also at the back of your nose and your throat.

To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells, known as a biopsy, from the area that looks abnormal. Your doctor may take this biopsy while examining you with the nasendoscope, or they might arrange for you to have a general anaesthetic so the biopsy can be taken that way. A doctor who specialises in analysing cells is called a pathologist, and they look at the sample under a microscope to check for cancer cells.

You may also have a fine needle aspiration, or FNA, to see whether there are any cancer cells in the lymph nodes of your neck. For this, the doctor passes a fine needle into the lump and withdraws, or aspirates, some cells into the syringe. Sometimes an ultrasound scan is used to help guide the needle into the right area. Macmillan Cancer Support have more information about tests for head and neck cancer, if you would like to read further.

Further tests may also be used to help diagnose nasal and sinus cancer, or to check whether it has spread. X-rays are used to take pictures of the inside of your body, and this is not painful and only takes a few minutes. A CT scan uses X-rays to build a three dimensional, or 3D, picture of the head and neck, while an MRI scan uses magnetism to build up a detailed picture of the head and neck instead. Waiting for test results can be a difficult time, and Macmillan Cancer Support have more information that can help with this too.

The results of your tests help your doctors learn more about the size and position of the cancer, and whether it has spread, and this process is called staging. The grade of the cancer gives an idea of how quickly it may develop. Knowing both the stage and grade of the cancer helps your doctors plan the best treatment for you.

The staging systems most often used for nasopharyngeal cancer are the TNM system and the number staging system, though the number system is less commonly used. 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, and it is numbered between 0 and 4 depending on the size and extent of the tumour. T0 means there are no signs of a tumour, though there may be abnormal cells that are pre cancerous, while Tis, or carcinoma in situ, means the tumour is in the top layer of cells lining the inside of the nasal cavity and has not grown any deeper. T1 nasal tumours are small and confined to one place in the nose, without having spread outside the nasal cavity. T2 nasal tumours have spread to parts of the surrounding tissue, and T3 nasal tumours are larger and have spread further into the surrounding tissue still. T4 nasal tumours have spread into nearby bones, nerves, tissue or areas of the skull, and T4 is further divided into T4a and T4b, with T4a being less locally advanced than T4b.

N describes whether the cancer has spread to the lymph nodes, and M describes whether the cancer has spread to another part of the body, which is called metastatic cancer.

The grade of nasal and sinus cancer describes how the cancer cells look under the microscope, and this gives an idea of how quickly the cancer might grow or spread. Macmillan Cancer Support have more information about the grading of head and neck cancer as well.

Treatment for nasal and sinus cancers includes surgery, radiotherapy and chemotherapy. Sometimes immunotherapies may be used as well.

A team of specialists meets to work out the best possible treatment plan for you. This is called a multidisciplinary team, or MDT.

Your doctor or specialist nurse will explain the different treatments, any possible side effects, and the support that will be available to you. They will also talk you through the things to think about when making treatment decisions, before you give your consent to have treatment.

Your treatment will depend on:

• the position of the cancer
• the stage and grade of the cancer
• the type of cell the cancer started in
• your general health

You will usually be given advice on preparing for treatment, sometimes called prehabilitation. This helps improve your fitness and diet, and helps you get ready mentally before treatment begins. If you smoke, this support can also help you quit.

Treatment for nasal and sinus cancer may include the following.

Surgery is usually the main treatment for nasal and sinus cancer. If the affected area is small and has not spread, the surgeon may be able to remove the tumour along with a small area of tissue around it.

If the cancer is larger, the surgeon may also need to remove nearby tissue or bone that is affected.

Sometimes the area needs to be rebuilt using tissue, skin or bone taken from elsewhere in the body. This is called reconstructive surgery. If the surgeon needs to remove part of the roof of the mouth, a special piece of plastic called an obturator is fitted into the missing area. This covers the gap in the roof of the mouth and helps you speak and eat.

Some lymph nodes in the neck may also be removed, in a procedure called a neck dissection. This is carried out at the same time as surgery for the nasal and sinus cancer, with the aim of lowering the chance of the cancer returning.

Depending on the type of operation, some people may have a feeding tube put in before or during surgery. This can usually be taken out once you are able to swallow normally again. If you are likely to need one, your team will discuss this with you ahead of the operation.

Macmillan Cancer Support has more information on recovering from head and neck surgery.

Radiotherapy uses high-energy rays to destroy cancer cells. It is usually given after surgery to lower the chance of the cancer coming back. It may also be used to treat cancer that has reached the neck or lymph nodes, or to reduce the risk of it returning in that area.

If tests show that surgery may not be able to remove all of the cancer, radiotherapy may instead be used as the main treatment for nasal and sinus cancer. Occasionally, it is given together with chemotherapy for certain types of nasal and sinus cancer, a combination known as chemoradiation.

Radiotherapy may also be used to control symptoms such as pain, if the cancer has spread to other parts of the body.

You may notice side effects during treatment and for a few weeks afterward. These usually ease gradually once treatment is finished.

Chemotherapy uses anti-cancer drugs to destroy cancer cells. It may be used if a nasal and sinus cancer has spread or has come back after earlier treatment.

It is occasionally combined with radiotherapy, as chemoradiation, for certain types of nasal and sinus cancer. The chemotherapy drug most commonly used for this cancer is cisplatin.

Immunotherapies are treatments that work by helping the immune system find and attack cancer cells. An immunotherapy drug may be used for some nasal and sinus cancers, in certain situations. Your doctors will be able to tell you whether immunotherapy could be helpful for your particular case.

Some treatments may be given to you as part of a clinical trial.

After nasal and sinus cancer treatment

Once treatment is complete, you will have regular follow-up appointments with your specialist doctor. These may continue for several years.

You may also have regular follow-up appointments with your multidisciplinary team. This can include a:

• speech and language therapist (SLT)
• dietitian
• restorative dentist
• dental hygienist
• and sometimes a physiotherapist

If you notice any problems or new symptoms between appointments, let your doctor or nurse know as soon as possible.

Long-term or late effects

Some treatment side effects may take a long time to improve after treatment finishes, or they may become permanent. These are called long-term effects.

Other side effects can develop months or even years after treatment has finished. These are known as late effects.

Macmillan Cancer Support have more information about late effects of head and neck cancer treatment.

Sex life

Head and neck cancer and its treatment can sometimes have an effect on your sex life.

If you’re worried about this, talk to your doctor or nurse.

Macmillan Cancer Support have more information on cancer and sex.

Fertility

Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you’re worried about this, it’s important to talk with your doctor before you start treatment.

Macmillan Cancer Support have more information about:

• fertility in women after treatment
• fertility in men after treatment
• LGBTQ+ people and cancer treatment

Wellbeing and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it’s best to avoid smoking or reduce the amount of alcohol.

Eating well and keeping active can improve your health and wellbeing. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan head and neck cancer forum – you can talk to others affected by head and neck cancer, ask questions and share your experience

Further support and information is available through The Swallows. The Swallows is a national head and neck cancer support charity. It offers support to people affected by head and neck cancer, their carers, friends and relatives.

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