Tests for Nasal Cavity and Paranasal Sinus Cancers

Nasal cavity and paranasal sinus cancers are usually found because of signs or symptoms a person is having. If cancer is suspected, tests will be done, sometimes by specialists, to confirm the diagnosis.

Medical history and physical exam

You will be asked about your medical history, any problems you've been having, and possible risk factors such as where you work and what chemicals you work with. The doctor will physically examine you to look for signs of nasal cavity or paranasal sinus cancer, as well as other health problems.

During the exam, the doctor will carefully check your head and neck area, including the nose and sinuses, for numbness, pain, swelling, and/or firmness in your face and the lymph nodes in your neck. The doctor will look for changes in the symmetry of your eyes and face (both sides should be about the same), vision changes, and any other problems.

Exam by a specialist

If your doctor thinks you might have cancer of the nasal cavity or paranasal sinuses, you'll be sent to see an otolaryngologist (a doctor who specializes in diseases of the ear, nose, and throat; also called an ENT doctor). This doctor will carefully check your nasal passages and the rest of your head and neck.

They might also examine your nose, throat, tongue, and mouth areas which can be done with a headlamp and small mirrors (indirect endoscopy) or with a nasal endoscope (a thin, flexible, lighted tube that's put in through your nose). A biopsy (a piece of tissue) may be removed during the endoscopy if an abnormal area is seen. 

People with nasal cavity or paranasal sinus cancer also have a higher risk for other cancers in the head and neck region. So all areas of the head and neck will be looked at carefully for signs of cancer.

Imaging tests

Imaging tests use x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body. Imaging tests are not used to diagnose nasal cavity or paranasal sinus cancers, but they might be done for a number of reasons both before and after a cancer diagnosis, including:

• To help look for a cancer if one is suspected
• To see if a tumor can be safely biopsied without causing a lot of bleeding (see below)
• To learn how far the cancer might have spread (metastasized)
• To see if the cancer can be removed with surgery
• To help determine if treatment is working
• To look for signs that the cancer has come back after treatment (recurred)

X-rays

X-rays of the head area, mainly of the sinuses, can show if there's any fluid or masses in the sinuses (normal sinuses should be filled with air). This would suggest that something is wrong, but it may not be a tumor. Most of the time, an abnormal-looking sinus x-ray means there's an infection. Sinus x-rays are not often done because many doctors prefer to do a computed tomography (CT) scan instead which gives a more detailed picture than an x-ray.

If you've been diagnosed with nasal cavity or paranasal sinus cancer, an x-ray of the chest might be done to find out if the cancer has spread to your lungs, which is the most common site of spread other than lymph nodes in the neck.

Computed tomography (CT) scan

A CT scan (or CAT scan) uses x-rays to make detailed cross-sectional images of the inside of your body. This test is very useful in finding cancers of the nasal cavity and paranasal sinuses, measuring the size of the tumor, showing if it is growing into nearby tissues, and if it has spread to the lymph nodes in the neck. Bone details show up well on a CT scan and it can show if a tumor has damaged the bone around it. A chest CT might also be used to see if the cancer has spread to the lungs.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans show detailed images of the body. But MRI scans use radio waves and strong magnets instead of x-rays. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. They are better than CT scans in telling whether a change is fluid or a tumor. Sometimes they can help the doctor tell the difference between a lump that is cancer and one that is not. They can also show if a tumor has spread into nearby soft tissues, like the eyeball, brain, or blood vessels.

Positron emission tomography (PET) scan

A PET scan uses a slightly radioactive form of sugar (known as fluorodeoxyglucose or FDG) that's injected into your blood and collects mainly in cancer cells. A special scanner is then used to create pictures of the places where the radioactivity collected in your body.

A PET scan may be used to look for possible areas of cancer spread, or if a CT or MRI scan does not show an obvious tumor. This test also can be used to help see if a change seen on another imaging test is cancer or not.

PET/CT scan: A PET scan is often done along with a CT scan using a machine that can do both scans at the same time. This lets the doctor compare areas of higher radioactivity on the PET scan with the detailed pictures from the CT scan.

Bone scan

For a bone scan, a small amount of low-level radioactive material is injected into the blood and collects mainly in abnormal areas of bone. A bone scan can help show if a cancer has spread to the bones. This test isn’t needed very often because PET scans can usually show if cancer has spread to the bones.

Biopsy

In a biopsy, a doctor takes out a small piece of tissue (a sample) from the suspicious area to be checked closely in the lab. It's the only way to know for sure if you have nasal cavity or paranasal sinus cancer. If cancer is found, testing in the lab can also show what kind of cancer it is and how aggressive it is (how fast it will grow and spread). This information is needed to help plan the best treatment.

Doctors look closely at where the tumor is and the blood vessels around it when deciding where and how to do the biopsy.

Often, biopsies are done in the doctor’s office or clinic. Drugs are used to numb the area. If the tumor is in a place that is hard to get to or may bleed a lot, the biopsy will be done in an operating room. Many types of biopsies can be used to diagnose nasal cavity or paranasal sinus cancer and are described below. See Testing Biopsy and Cytology Specimens for Cancer for added information.

Fine needle aspiration (FNA) biopsy

In this type of biopsy, the doctor puts a thin, hollow needle right into a tumor or lymph node to take out cells and/or a few drops of fluid. The doctor may repeat this to take several samples. The cells can then be checked closely in the lab to see if they are cancer.

An FNA biopsy is often used in patients with swollen lymph nodes in the neck. In these patients, An FNA biopsy can show if the lymph node swelling is from cancer or if it's from an infection. If the FNA does not show cancer, it only means that cancer was not found in that lymph node. There could still be cancer in other places. If you're having symptoms that might be from a nasal cavity or paranasal sinus cancer, you could still need other tests to find the cause of the symptoms.

FNA biopsies might also be useful in some patients already diagnosed with nasal cavity or paranasal sinus cancer. If the person has a lump in the neck, an FNA can show if the mass is cancer. FNA might also be used in patients whose cancer has been treated by surgery and/or radiation therapy, to help find out if a neck mass in the treated area is scar tissue or if it is the cancer that has come back (recurrence).

Incisional and excisional biopsies

These types of biopsies remove more of the tumor using minor surgery. They're the more common types of biopsies done for nasal and paranasal sinus tumors. Biopsies of tumors in the nose may be done using special tools that are put into the nose. Biopsies of tumors that are deeper within the skull may require a more involved procedure (see below).

For an incisional biopsy, the surgeon cuts out a small piece of the tumor. For an excisional biopsy, the entire tumor is removed. In either case, the biopsy sample is then sent to the lab for testing.

Endoscopic versus open biopsy

For tumors deeper within the skull, how the biopsy is done depends on where it is and how big it is.

Endoscopic biopsy: Some tumors that are deep in the nasal passages may be reached using an endoscope – a thin, flexible lighted tube. Long, thin surgical tools can be passed through the endoscope to get a biopsy sample.

Open (surgical) biopsy: For tumors inside the sinuses, the doctor may have to cut through the skin next to the nose and through the underlying bones to reach them. These operations are covered in more detail in Surgery for Nasal Cavity and Paranasal Sinus Cancer.

Lab tests of biopsy samples

Biopsy samples (from endoscopy or surgery) are sent to a lab where they are looked at closely. If cancer is found, more lab tests may be done on the biopsy samples to help better classify the cancer and possibly find specific treatment options.

Tests for certain proteins on tumor cells: If the cancer has spread (metastasized) or come back, doctors will probably look for certain proteins on the cancer cells. For example, cancer cells might be tested for the PD-L1 protein, which may predict if the cancer is more likely to respond to treatment with certain immunotherapy drugs.

Other pre-treatment tests

Other tests may be done in people diagnosed with nasal cavity or paranasal sinus cancer. These tests are not used to diagnose the cancer, but they might be done to see if a person is healthy enough for certain treatments, like surgery or chemotherapy.

Quit smoking: It is very important to quit smoking before any treatment for nasal cavity or paranasal sinus cancer. If you quit smoking cigarettes before being diagnosed, it is important to not start during treatment. Smoking during treatment can cause a poor response to radiation treatment, poor wound healing, poor tolerance to chemotherapy, and a higher chance of dying.  

Blood tests: A complete blood count (CBC) looks at whether your blood has normal numbers of different types of blood cells. For example, it can show if you are anemic (have a low number of red blood cells), if you could have trouble with bleeding (from a low number of blood platelets), or if you are at increased risk for infections (because of a low number of white blood cells). This test could be repeated regularly during treatment, as many cancer drugs can lower the number of blood cells produced by the bone marrow. Blood chemistry test results can help show how well your liver or kidneys are working.

Pre-surgery: If surgery is planned, you might also be given an electrocardiogram (ECG) to make sure your heart is working well. Some people having surgery also may need lung tests known as pulmonary function tests (PFTs).

Dental exam: Your cancer care team might have you see your dentist before any radiation is given since it can damage the saliva (spit) glands and cause dry mouth. This can raise the chance of cavities, infection, and breakdown of the jawbone. The dentist might also pull some teeth before radiation that they think might cause problems during treatment.

Hearing test: The most commonly used chemotherapy drug in treating nasal cavity and paranasal sinus cancer, cisplatin, can affect your hearing. Your hearing will most likely be checked (with an audiogram) before starting treatment. Your doctor may also change your chemotherapy plan if you already have difficulty hearing.

Nutrition and speech tests: If you have lost a lot of weight because of the cancer, you might have a nutritionist who will evaluate your nutrition status before, during, and after your treatment to try and keep your body weight and protein levels as normal as possible. You might also visit with a speech therapist who will test your ability to swallow and speak depending on the location of the cancer. They might give you exercises to do during treatment to help strengthen the muscles in the head and neck area so that you can eat and talk normally after cancer treatment.