Let's Talk About Nose and Sinus Cancers Signs and Symptoms
When is it more than just a sinus infection? We've got the answers to that and everything else you need to know about these rare but dangerous diseases.by Stephanie Wood Health Writer
If you’ve had a COVID-19 test or seen a video of one being administered (and who hasn’t at this point?), it may give you a new appreciation for all that’s going on up there. Your nose is basically a big tunnel that processes everything you breathe in, which makes it a magnet for less-than-healthy stuff in the air. Fortunately, cancers of the nose and sinuses fall into the rare disease category. But when they do occur, you don’t want to waste a minute. Whether you’re worried about yourself or a loved one, let’s get you up to speed.
Our Pro Panel
We went to some of the nation's top experts on head and neck cancers to bring you the most up-to-date information possible.
Salvatore M. Caruana, M.D.
Director of the Division of Head and Neck Surgery
New York-Presbyterian Hospital Columbia University Medical Center
New York, NY
Nadia Mohyuddin, M.D.
Head and Neck Surgical Oncologist, Associate Professor of Clinical Otolaryngology
Houston Methodist Hospital
J. Kenneth Byrd, M.D.
Chief of Head and Neck Surgery, Medical Director and Research Director
Georgia Cancer Center at Augusta University
Monthly nosebleeds are probably NBD, especially if they occur in winter months when heating can dry out the nasal cavity. And if you’re being treated for high blood pressure, or take a daily aspirin or blood thinners, nosebleeds can be a side effect. But if nosebleeds are accompanied by pain, headaches, or vision issues, or appear to be coming from the back of the nose rather than the front near the nostril opening, then you should get it checked out.
Most people with nose or sinus tumors will need surgery, with the goal of removing the entire tumor while also preserving the surrounding healthy tissue. Ideally this can be done with a minimally invasive approach that leaves no visible scar, but a traditional open surgery may be necessary depending on the size and location of the tumor. Reconstructive surgery may also be needed to repair any defects that were created by removing the tumor.
Although you make think of sinuses as two pockets on either side of your nose, your paranasal sinuses are comprised of four sets that completely surround your eyes. Tumors in any of these areas can put pressure on the eyes and invade the various structures around them causing excess tearing, swelling, bulging, pain, and double vision or even vision loss.
All cancer survivors are at risk for a recurrence down the road, so you’ll be monitored frequently for at least the next five years. You’re also at increased risk for a new, unrelated cancer, as well as soft-tissue sarcomas that develop in fat, muscle, nerves, fibrous tissue, blood vessels, or deep skin tissues anywhere in the body, but most start in the arms or legs.
What Are Nose and Sinus Cancers?
A sub-category of head and neck cancers, these rare diseases cause cells in and around the nose to grow and multiply abnormally, forming a tumor. There are only about 2,000 cases of nose and sinus cancers diagnosed in the U.S. each year—and that’s a good thing because this is not an easily treatable form of cancer.
The overall five-year survival rate is only 58%. You’re in luck if you catch it early, though: When confined to only the nose and the sinuses, the five-year survival rate rises to 84%.
Like other forms of head and neck cancer, nose and sinus cancers are most often caused by tobacco and alcohol use. They occur twice as often in men as women, and four out five cases are diagnosed in people age 55 and up. In very rare instances, the sexually transmitted human papillomavirus (HPV) has been linked to nose and sinus cancers, but most often HPV causes oropharyngeal (throat) cancer instead.
Because the nose and sinuses contain a variety of tissue and cell types, there can be different types of cancer in this area. A little more than half of all nose and sinus cancers are what’s called squamous cell carcinomas, which occur in the flat cells that line the interior mucosal surfaces of the head and neck.
Other forms of cancer that can occur here include adenocarcinomas (the second most common), which form in the salivary glands found in the nose and sinuses; lymphomas, which develop in the lymph tissue lining the nose and sinuses; and sarcomas, which occur in the muscle, connective tissue, and nose bone.
What Causes Nose and Sinus Cancers?
What sets nose and sinus cancers apart from their peers is their strong link to workplace inhalants and to a lesser degree, air pollution. Workers at nickel refineries, cutlery factories, battery manufacturers, chromium plating and production operations, leather workers, and wood workers are all at an increased risk from the chemicals and inhalants that they encounter on a regular basis. These include:
Dust from wood, textiles, and leather industries
Fumes from rubbing (isopropyl) alcohol
Solvent fumes (furniture and shoe manufacturing)
Where Do Nasal and Sinus Tumors Form?
If you’ve ever spent the months of April, May, and June blowing the heck out of your nose, you may have wondered how such a little body part can produce such copious amounts of snot.
Here’s your answer: Your nasal cavity is not as small as it looks on the outside. This large air-filled void extends both above and behind the nose that you see, which is why it’s possible to stick those virus-testing swabs way, way up there. The nasal cavity opens into the nasopharynx, or very top of the throat, which is where samples for lab testing are taken from.
So that’s your nose. What about your sinuses? Like most people, you probably think you have two sinuses—one on either side of your nose. Guess again. The inside of your nose houses four different sets of sinuses (yup, that’s eight total) known officially as your paranasal sinuses.
These air-filled sacs produce mucus, sometimes lots of it, and their exact mission is a little unclear. While we know that the job of the nose is to help you breathe and smell, why do we need sinuses? They help moisturize the nasal cavity for certain, and it’s also thought they might be there to help balance out the weight of the skull and protect it from damage during a fall or a hit. The four types of paranasal sinuses are:
Maxillary sinuses are located in the cheeks, above the teeth, below the eyes, and to the side of each nostril.
Ethmoid sinuses sit between the eyes and nasal septum on each side.
Frontal sinuses live above the eyes and behind the forehead.
Sphenoid sinuses are located behind the nose at the base of the skull.
Tumors are more likely to form in the nasal cavity, but when they do occur in the sinuses, it’s usually the maxillary sinuses, which are the largest. The ethmoid sinuses are the second most common site, with cancer of the frontal and sphenoid sinuses falling into the extremely rare category.
What Are Signs and Symptoms of Nose and Sinus Cancers?
The unfortunate truth is, nose and sinus tumors rarely cause symptoms early on, hence the gloomy prognosis. When people are diagnosed early it’s often by accident while they’re undergoing tests for something else. By the time many cases are found, tumors have grown large enough to block the airway and may have spread to nearby areas or other parts of the body.
When symptoms do arise, they frequently seem like other sinus-related issues that people commonly get, adding to the delay in diagnosis. One red flag is that these symptoms don’t disappear with the usual treatment of decongestants and so on. All that said, it’s still worth knowing what to watch for, especially if you’re exposed to risky inhalants at work, or you have a history of tobacco and alcohol use.
Signs of nose and sinus cancers (starting with the most common) are:
Nasal congestion that won’t go away
Sinuses that are blocked and do not clear
Chronic sinus infections that do not respond to treatment with antibiotics
Blockage of only one side of the nose
Nosebleeds, particularly only on one side
Pus draining from the nose
Decreased or lost sense of smell
Numbness or pain in parts of the face
Frequent headaches or pain in the sinus region
Pain above or below the eyes
Swelling around the eyes or other trouble like persistent tearing or bulging of one eye
A lump or sore in the nose that doesn’t heal
Pain in the upper teeth
Problems with dentures, such as poor fit or discomfort
Symptoms of more advanced disease include:
A tumor growing out of the nose
A growth in the roof of the mouth
Loosening or numbness of teeth
Change in vision or double vision
Swelling in the mouth, jaw, or neck
A brain infection, such as meningitis or encephalitis
When to Call the Doctor
Before you panic, know this: Just because you have some of these symptoms, it doesn’t mean you have nose or sinus cancer. There are non-cancerous causes of these issues, too, but you won’t know for sure until you get things checked out by a specialist. It’s also worth noting that having chronic sinus infections does not necessarily put you at risk for nose or sinus cancer. The danger is when symptoms are written off as sinus infections when, in fact, they are signs of cancer.
So, should you give your M.D. a call? The general rule of thumb for all head and neck cancer symptoms is to see your doctor if they persist for more than two weeks. That’s about how long a typical upper respiratory illness lasts, so symptoms like congestion, sore throat, or earache should clear up on their own—or with antibiotics if it’s bacterial—by that point. If they hang around longer, that’s a clue that something else could be going on.
The other red flag is when a symptom occurs only in one nasal cavity or sinus. Here’s why: The head and neck are what’s known as paired systems—their construction is symmetrical, or the same on both the left and the right. So persistent congestion on only one side of the nose, for instance, is cause for concern. You can start by seeing your primary care physician, who may then refer you to an otolaryngologist, a doctor who specializes in disorders of the ear, nose, and throat (ENT).
Remember, early is always better. If something seems like it’s not right—even if it doesn’t perfectly fit the parameters we’ve laid out here—it’s always better to seek help sooner than later.
- Nose and Sinus Cancer Statistics: American Society of Clinical Oncology. (2020). “Nasal Cavity and Paranasal Sinus Cancer: Statistics.” cancer.net/cancer-types/nasal-cavity-and-paranasal-sinus-cancer/statistics
- Nose and Science Cancer Overview: Thyroid, Head, and Neck Cancer Guide. (2020). “Nose & Sinus Cancer.” thancguide.org/cancer-types/nose-sinus/
- Chronic Sinusitis and Nose and Sinus Cancer: JAMA Otolaryngology—Head & Neck Surgery. (2017). “Chronic Sinusitis and Risk of Head and Neck Cancer in the US Elderly Population.” jamanetwork.com/journals/jamaotolaryngology/fullarticle/2551873
- Sinus Cancer and Vision: Indian Journal of Ophthalmology. (2015). “Sinonasal Carcinoma Presenting as Chronic Sinusitis and Sequential Bilateral Visual Loss.” ncbi.nlm.nih.gov/pmc/articles/PMC4550987/
- Second Cancers: American Cancer Society. (2017). “Second Cancers After Nasal Cavity and Paranasal Sinus Cancer.” cancer.org/cancer/nasal-cavity-and-paranasal-sinus-cancer/after-treatment/second-cancers.html