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Diagnosis of nasal cavity and paranasal sinus cancer
Diagnosing cancer in the nasal cavity or a paranasal sinus usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for cancer in the nasal cavity or a paranasal sinus or other health problems.
The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as nasal cavity and paranasal sinus cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of nasal cavity and paranasal sinus cancer.
The following tests are commonly used to rule out or diagnose cancer in the nasal cavity or a paranasal sinus. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.
Health history and physical exam
Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about:
- symptoms that suggest cancer in the nasal cavity or paranasal sinuses
- the type of job you have (occupational exposure to wood, leather and nickel dust are risk factors for cancers of the nasal cavity and paranasal sinuses)
- a personal history of smoking
- exposure to radiation
A physical exam allows your doctor to look for any signs of cancer in the nasal cavity or paranasal sinuses. During a physical exam, your doctor may:
- look very closely at the nose, cheeks and eyes and inside the mouth to see if there are any changes, lumps or swelling
- check the face for any areas where there is a loss of feeling
- look for any lumps on the roof of the mouth or any loose upper teeth
- feel the neck for any lumps or swelling
- look inside the back of the nose with a thin, long-handled mirror placed in the mouth or a tube and light placed through the nostril (called rhinoscopy)
- check for vision changes
- do a neurological exam to check if the brain, spinal cord and nerves are working normally
Find out more about physical exam.
Complete blood count (CBC)
A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health. Doctors can also use a CBC to get a baseline measurement that they can use to compare blood counts during and after treatment.
Find out more about complete blood count (CBC).
Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs, such as the kidneys, are functioning. They can also help find abnormalities such as cancer that has spread to other areas of the body.
Find out more about blood chemistry tests.
Endoscopy is a procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs or structures in the body.
During diagnosis, doctors do endoscopy to look inside the nose, nasopharynx and lower part of the throat. They can also collect tissue samples during endoscopy. The following types of endoscopy may be done.
Nasal endoscopy allows a doctor to look inside the nose, nasopharynx and throat.
Nasal endoscopy is usually done in an ear, nose and throat (ENT) specialist’s office. The doctor (also called an otolaryngologist) may apply a topical anesthetic to the nose just before the nasal endoscopy. During the procedure, the doctor passes a flexible endoscope through the nose and down to the throat. After nasal endoscopy, your doctor may tell you not to eat or drink until the freezing is gone and the gag reflex returns. This usually takes about 1 hour.
Panendoscopy is a procedure that combines nasal endoscopy, laryngoscopy, esophagoscopy and sometimes bronchoscopy. Laryngoscopy uses an endoscope to examine the larynx. Esophagoscopy uses an endoscope to examine the esophagus. Bronchoscopy uses an endoscope to examine the airways in the lungs.
Doctors use panendoscopy to look inside the nose and at all the structures in the throat. It is usually done as part of the testing for head and neck cancers.
Panendoscopy is usually done under a general anesthetic in the operating room. This allows the doctor to thoroughly examine the throat and spares you the discomfort of being awake during the procedure. After the procedure, you won’t be allowed to eat or drink for about 1 hour. Your healthcare team will give pain-relieving medicines if you have a sore throat.
Find out more about endoscopy.
During a biopsy, the doctor removes tissues from the body so they can be tested in a pathology lab. The report from the pathologist will confirm whether or not cancer is present in the sample, the type of cancer and the grade (which describes how aggressive the cancer is).
The following types of biopsies are used to diagnose nasal cavity and paranasal sinus cancers.
Doctors can do a biopsy of the nasal cavity and throat during nasal endoscopy. An endoscopic biopsy is either done in the doctor’s office with local anesthetic or in the operating room under general anesthetic.
Fine needle aspiration
During a fine needle aspiration (FNA), the doctor uses a very thin needle and syringe to remove (aspirate) a small amount of fluid or cells. FNA may be used to collect a sample from a tumour. It may also be used to check a lump in the neck to see if the cancer has spread to the lymph nodes in the neck (called the cervical lymph nodes).
A transoral biopsy is done through the mouth. The doctor can remove a piece of tissue from a tumour that has grown into the mouth from the nasal cavity or paranasal sinuses using this method.
Find out more about biopsy and surgery for cancer in the nasal cavity or paranasal sinuses.
A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. The healthcare team may inject a dye (called a contrast medium) into a vein before the CT scan. The dye can help the doctor to see structures of the body better than without it. Tell your doctor or the radiology staff if you have had an allergic reaction to contrast medium in the past.
A CT scan is used to find a tumour in the nasal cavity or paranasal sinuses. Doctors also use a CT scan to see if the tumour has grown into the bones around the paranasal sinuses or the base of the skull. A CT scan can also find cancer that has spread to the lungs or lymph nodes.
Doctors can also use a CT scan to help measure response to treatment and check if cancer has come back, or recurred.
Find out more about CT scan.
An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is sometimes used to examine the sinuses to see if there is a blockage or an infection. The paranasal sinuses are normally filled with air. An x-ray will show if there is anything else in the sinuses.
You may also have a chest x-ray to see if cancer has spread to the lungs.
X-rays are being used less often to examine the sinuses. This is because CT scans are more available and show better detail of the sinuses.
Find out more about x-ray.
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into detailed pictures. The healthcare team may inject a dye (called a contrast medium) into a vein before the MRI. The dye can help the doctor to see structures of the body better than without it. MRI uses a different contrast medium than a CT scan. Tell your doctor or the radiology staff if you have had an allergic reaction to contrast medium in the past.
MRI is used to find a tumour in the nasal cavity or paranasal sinuses. Sometimes doctors can even tell the difference between a cancerous and non-cancerous tumour from an MRI.
Doctors can also use MRI to see if the tumour has grown into other structures around the sinuses, the base of the skull, nearby nerves and blood vessels, the eye, the brain or the coverings of the brain (called leptomeninges). It can also find cancer that has spread to the lymph nodes.
Find out more about MRI.
A bone scan uses bone-seeking radioactive materials (called radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if cancer that started in the nasal cavity or paranasal sinuses has spread to the bones.
Find out more about bone scan.
A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.
A PET scan may be used to look for cancer that has spread to other areas in the body.
Find out more about PET scan.
Questions to ask your healthcare team
The upper part of the pharynx (throat) behind the nose and above the soft palate (the back, soft part of the roof of the mouth).
The study of disease, including causes, development and effects on the body.
The symptoms, processes or conditions of a disease.
A doctor who specializes in the causes and nature of disease is called a pathologist. Pathologists help determine diagnosis, prognosis and treatment by studying cells and tissues under a microscope and using laboratory tests.
Pathological means referring to or having to do with pathology. It can also refer to something related to or caused by a disease, as in pathological fracture.
The membranes that cover and protect the brain and spinal cord.
The meninges are made up of 3 layers. The outer layer is called the dura mater. The middle layer is called the arachnoid mater. The inner layer is called the pia mater. Together, the arachnoid mater and pia mater are called the leptomeninges.
Meninges is the plural of meninx.