Nasal and sinus cancer

Nasal and sinus cancer are rare types of head and neck cancer. They start inside the nose or in the paranasal sinuses.

The space inside your nose is called the nasal cavity. It warms, moistens and filters the air as you breathe in. The bones around the nasal cavity have small hollow spaces in them, and these are the paranasal sinuses. They affect the sound and tone of your voice.

Macmillan Cancer Support has more information on what cancer is.

The exact causes of nasal and sinus cancer aren't known. But some risk factors can increase the chances of developing it.

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

Smoking tobacco may also increase the risk.

Some cases may be linked to an infection called human papilloma virus (HPV). HPVs are a group of common infections that can affect areas like the inside of the mouth, the throat, the genital area or the anus. Some types of high-risk HPV can increase the risk of certain cancers.

Most people have HPV at some time during their life. But most people with HPV don't develop nasal and sinus cancer.

Nasal and sinus cancer isn't infectious, so it can't be passed on to other people.

Macmillan Cancer Support has more information about the causes and risk factors of head and neck cancer.

You usually start by seeing your doctor. If they think your symptoms could be linked to cancer, they'll refer you to a specialist head and neck doctor. You'll usually see a specialist within 2 weeks. This may be an ear, nose and throat (ENT) specialist.

The specialist doctor will ask you about your symptoms and your general health. You may then have some of the following tests.

A nasendoscope is a thin, flexible tube with a light and a camera on the end. Your doctor uses it to look inside your nose, and also at the back of your nose and your throat.

To diagnose nasal and sinus cancer, your doctor needs to take a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. Sometimes the doctor can do it while they're examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic so the biopsy can be taken.

The sample then goes to a pathologist, a doctor who specialises in analysing cells. The pathologist looks at it under a microscope to check for cancer cells.

With nasal and sinus cancer, you may have a fine needle aspiration (FNA) to see whether there are any cancer cells in the lymph nodes of your neck.

The doctor passes a fine needle into the lump and draws (aspirates) some cells out into a syringe. Sometimes an ultrasound scan is used to support the doctor in guiding the needle to the correct area.

Doctors may use these tests to help diagnose nasal and sinus cancer, or to check whether the cancer has spread.

An X-ray takes pictures of the inside of your body. It doesn't hurt, and it only takes a few minutes.

A CT scan takes X-rays from different angles and puts them together to build a three-dimensional (3D) picture of your head and neck.

The results of your tests help your doctors learn more about the size and position of the cancer, and whether it has spread. This is called staging.

The grade of the cancer gives an idea of how quickly it may develop.

Knowing the stage and grade helps your doctors plan the best treatment for you.

For nasopharyngeal cancer, the staging systems used most often are the TNM system and the number staging system. The number system is less commonly used.

TNM stands for tumour, node and metastases.

The "T" in staging stands for tumour. It describes how big the tumour is and whether it has grown into nearby tissues like bones, muscles or nerves. The number goes from 0 to 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. Tis (carcinoma in situ) means the tumour is in the top layer of cells lining the inside of the nasal cavity, and it has not grown any deeper.

T1 nasal tumours are small and sit in one place in the nose. They have not spread outside the nasal cavity.

T2 nasal tumours have spread to parts of the surrounding tissue.

T3 nasal tumours are larger and have spread further into the surrounding tissue.

T4 nasal tumours have spread into nearby bones, nerves, tissue or areas of the skull. T4 is divided into T4a and T4b, and T4a is less locally advanced than T4b.

N tells you whether the cancer has spread to the lymph nodes.

M describes whether the cancer has spread to another part of the body. Doctors call this metastatic cancer.

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

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor or specialist nurse will explain the different treatments, any possible side effects and the support you will have. They'll also talk to you about the things you should consider when making treatment decisions, before you agree (consent) to have treatment.

Your treatment will depend on:

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

You'll usually be given advice about preparing for your treatment (sometimes called prehabilitation). This helps improve your fitness and diet, and gets you ready mentally before treatment. If you smoke, it can also help you stop smoking.

Treatment for nasal and sinus cancer may include the following.

Surgery is usually the main treatment. If the area is small and hasn't spread, the surgeon may be able to remove the tumour and a small area around it.

If the cancer is larger, they may also need to remove nearby areas of tissue or bone affected by the cancer.

Sometimes they need to rebuild the area with tissue, skin or bone taken from somewhere else in the body (reconstructive surgery). If the surgeon has to remove part of the roof of the mouth, they fit a special piece of plastic (obturator) into the missing area. This covers the gap in the roof of the mouth and helps you speak and eat.

You may also have some lymph nodes in the neck removed. This is called a neck dissection, and it's done at the same time as the surgery to remove the nasal and sinus cancer. It aims to reduce the risk of the cancer coming back.

Depending on your operation, some people may have a feeding tube put in before or during surgery. It can usually be removed once you're able to swallow. If you're likely to need one, your team will discuss it with you before your operation.

Radiotherapy uses high-energy rays to destroy cancer cells. It's usually given after surgery to reduce the chance of the cancer coming back. It may also be used to treat cancer in the neck or lymph nodes, or to reduce the risk of the cancer coming back in this area.

If tests show that surgery may not be able to remove all the cancer, you may have radiotherapy as the main treatment for nasal sinus cancer. Occasionally, radiotherapy may be given with chemotherapy for some types of nasal and sinus cancer. This is called chemoradiation.

Radiotherapy may also be used to control symptoms, like pain, if the cancer has spread to other areas of the body.

You may have side effects during radiotherapy and for a few weeks after it. These usually get better slowly once treatment finishes.

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

It may occasionally be given with radiotherapy (chemoradiation) for some types of nasal and sinus cancer. The chemotherapy drug most often used is cisplatin.

Immunotherapies are treatments that use the immune system to find and attack cancer cells. An immunotherapy drug may be used to treat some nasal and sinus cancers in certain situations. Your doctors can tell you if immunotherapy drugs may be helpful in your situation.

You may have some treatments as part of a clinical trial.

Once your treatment for nasal and sinus cancer is over, you'll see your specialist doctor for regular follow-up appointments. These may go on for several years.

You may also have regular follow-up appointments with your multidisciplinary team (MDT). The team includes a:

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

If you have any problems, or you notice new symptoms between appointments, tell your doctor or nurse as soon as you can.

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

Macmillan Cancer Support has more information about:

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

Even if you already live a healthy life, you may want to make some positive changes during and after treatment for nasal and sinus cancer. If you smoke or drink alcohol, for example, it's best to avoid smoking and to cut down on alcohol.

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

Macmillan Cancer Support also has more 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, where you can talk to others affected by head and neck cancer, ask questions and share your experience

The Swallows also offers further support and information. It is a national head and neck cancer support charity, and it supports people affected by head and neck cancer, their carers, friends and relatives.

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