Diagnosis of nasal cavity and paranasal sinus cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing nasal cavity or paranasal sinus cancer 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 nasal cavity or paranasal sinus cancer 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 usually used to rule out or diagnose nasal cavity and paranasal sinus cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests, including a dental exam, to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest nasal cavity or paranasal sinus cancer
• contact with wood, leather or nickel dust at work
• smoking

Your doctor may also ask about a family history of:

• nasal cavity and paranasal sinus cancer
• risks for nasal cavity and paranasal sinus cancer
• other cancers

A physical exam allows your doctor to look for any signs of nasal cavity and paranasal sinus cancer. During a physical exam, your doctor may:

• look very closely at your nose, cheeks and eyes and inside the mouth to see if there are any changes, lumps or swelling
• check your face for any areas where there is a loss of feeling
• look for any lumps on the roof of your mouth or any loose upper teeth
• feel your neck for any lumps or swelling
• check for changes in your vision or restriction in eye movements
• check if the brain, spinal cord and nerves are working normally

Find out more about physical exams.

An endoscopy allows a doctor to look inside the body using a rigid tube with a light and lens on the end. This tool is called an endoscope.

A nasal endoscopy allows the doctor to look inside the nose, nasopharynx and throat.

A nasal endoscopy is usually done in an ear, nose and throat (ENT) specialist's office. The doctor may put a numbing spray in the nose just before the nasal endoscopy. During the procedure, the doctor passes a rigid endoscope through the nose and the throat. After the 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 an hour.

Find out more about an endoscopy.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample.

An endoscopic biopsy is when a biopsy of the nasal cavity and throat is taken during a nasal endoscopy. This type of biopsy is usually done for tumours deep in the nasal passage.

A surgical biopsy uses surgery to remove either a small piece of a tumour (called an incisional biopsy) or the whole tumour (called an excisional biopsy) in the nasal cavity or paranasal sinus.

A fine needle aspiration (FNA) 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 cervical lymph nodes).

Find out more about biopsies.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to find a tumour in the nasal cavity or paranasal sinuses. Doctors can 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.

Find out more about CT scans.

An x-ray uses small doses of radiation to make an image of parts of the body on film. It is used to see if there is a blockage or an infection 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 look at the sinuses. This is because CT scans are more available and show better detail of the sinuses.

Find out more about x-rays.

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 3D pictures.

An MRI is used to find a tumour in the nasal cavity or paranasal sinuses. An MRI can show 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. It can also find cancer that has spread to the lymph nodes.

Sometimes an MRI is used to help doctors tell the difference between a cancerous and non-cancerous tumour of the nasal cavity and paranasal sinuses.

Find out more about MRIs.

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 3D colour images of the area being scanned.

A PET scan may be used to look for cancer that has spread to other areas of the body.

Find out more about PET scans.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.