Diagnosing Sinonasal Cancer

NYU Langone doctors can diagnose all types of sinonasal cancer, which develop in the nasal cavity and paranasal sinuses.

Most sinonasal cancers occur spontaneously, meaning they have no particular cause. However, workplace exposure to wood, textile or leather dust, or certain chemicals, such as arsenic, may increase the risk.

While smoking may cause sinonasal cancer, research is inconclusive. Regardless, NYU Langone doctors encourage smokers to quit, and offer effective Tobacco Cessation Programs to give you the support you need.

Early sinonasal cancer may cause no symptoms, which is why most tumors are found when they are advanced. When symptoms do occur, they may include recurrent nosebleeds, headaches, and unexplained nasal congestion—especially on one side. There may also be a noticeable mass in the nose that can interfere with breathing and cause eye tearing and a feeling of fullness in one ear.

Based on your symptoms and medical history, your doctor may perform a physical exam, in which he or she examines the face and the area around the nose for possible masses and swelling under the skin. He or she also checks areas of the neck where lymph nodes are located. Lymph nodes are small glands that make and store lymphocytes, white blood cells that help fight infection. Lymphocytes travel throughout the body through a network of vessels. Sinonasal cancer can spread to the lymph nodes through these vessels, causing the nodes to swell.

NYU Langone doctors may also conduct a variety of tests to determine the cause of your symptoms. Most commonly, sinonasal cancers are diagnosed using nasal endoscopy and biopsy. Imaging tests may be performed to determine the extent of the tumor and whether the cancer has spread.

Nasal Endoscopy

Nasal endoscopy allows doctors to examine the nasal and paranasal cavities. During the procedure, the doctor inserts a nasal endoscope—a thin, lighted tube with a lens at the tip that transmits images to a monitor—through the nose to look for tumors. It is performed in the doctor’s office. A local anesthetic spray is used to numb the nasal cavity, to minimize discomfort.

Biopsy

If your doctor identifies a suspicious growth during a nasal endoscopy, he or she may perform a biopsy—sometimes on the same day. A biopsy can often be performed in the doctor’s office.

Using small surgical tools inserted alongside the endoscope, your doctor removes a small piece of tumor for examination under a microscope. A pathologist examines the cells in the tumor tissue to determine whether any cancer is present and what type it is.

Local anesthesia is used during a biopsy, and you can go home the day of the procedure. You may experience some mild bleeding afterward.

Fine Needle Aspiration

If your doctor notices a swollen lymph node in the neck, he or she may perform a fine needle aspiration biopsy in the office. During this procedure, the doctor uses a small needle to withdraw fluid and cells to examine under a microscope for signs of cancer. He or she may use ultrasound—in which sound waves identify structures in the neck—to guide the needle.

CT and MRI Scans

After you have received a diagnosis, your NYU Langone doctor may use CT scans and MRI scans to determine the extent of the tumor and whether sinonasal cancer has spread. The nasal cavity and paranasal sinuses are alongside the eyes, brain, and major nerves and blood vessels, so your doctor must determine whether sinonasal cancer is affecting these structures. This information helps your doctor create a treatment plan.

A CT scan uses X-rays and a computer to create two- or three-dimensional images of the body. It can determine whether sinonasal cancer has spread to nearby lymph nodes, bones in the head, or other parts of the body. A special dye may be injected into a vein in the arm to enhance the CT image.

An MRI scan uses a magnetic field to create images of the body. It can detect whether tumors are growing into soft tissues, such as the eye, brain, or dura, the membrane that surrounds the brain. A special dye may be injected into a vein to enhance the images.