Diagnosis
If you have any symptoms of nasal cavity or paranasal sinus cancer, your doctor will conduct a physical examination and ask you questions about your general health, lifestyle, and family history. It may be necessary to see a physician who specializes in diseases of the head and neck. These physicians are trained to do specialized examinations of the head and neck and to diagnose cancer. Your doctor will thoroughly examine the nose and sinuses, and will ask you about any symptoms you are having. If your doctor suspects nasal cavity or paranasal sinus cancer, he or she may recommend any of the following diagnostic procedures:
Imaging Tests
Imaging tests produce pictures of the body and allow the doctor to determine if a tumor is present, as well as the size, location, and extent of the tumor. Imaging tests can also detect the spread of cancer into nearby structures.
X-Rays
The doctor may recommend an X-ray to look for any abnormal areas in the sinuses, though current practices generally recommend CT scans to evaluate for sinus disease.
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Computed Tomography (CT) Scan
If symptoms or examination raise concerns for the presence of cancer, your doctor may order a CT scan. A CT scanner rotates around your body taking pictures, and produces detailed cross-sectional images of your body. It allows doctors to pinpoint the exact location of the tumor and check for cancer spread.
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Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to create clear and detailed images of body parts. Magnetic waves affect the spin of the elements in the cells of the body and that energy is then released in a characteristic pattern, which is translated by a computer in order to show "slices" of the body. This test is very useful for examining specific areas of the body, especially the soft tissues in the head and neck region.
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Positron Emission Tomography (PET) Scan
For a PET scan, the doctor injects a radioactive substance into the patient's bloodstream, typically labeled sugar molecules. The sugars are collected in malignant (cancerous) cells at a much higher amount than in the rest of the patient's body. The doctor then uses a PET scanner to detect these areas of increased sugar uptake and to find locations concerning for cancer in the patient's body.
Biopsy
If any of these diagnostic tests indicate the presence of cancer, the doctor will conduct a biopsy to be certain. A biopsy is a procedure in which the doctor removes a tissue sample and a pathologist examines it under a microscope to determine if it contains cancer cells. A biopsy is the only way to be certain of a cancer diagnosis. The doctor may recommend the following types of biopsy, depending on the location and extent of the tumor:
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Nasal Endoscopy/ Nasopharyngoscopy
The doctor inserts an endoscope (a thin tube with a camera and light on the end) through the nose and into the nasal cavity, and uses it to look for any abnormal areas. This endoscope may either be flexible or rigid depending on the preference and area of concern. If the doctor notices anything suspicious, a special tool may be used along with the endoscope and used to remove a tissue sample for a biopsy. For some tumors in the nasal cavity, the doctor may be able to insert forceps into the nose to remove a part of the tumor for examination (incisional biopsy).
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Fine Needle Aspiration (FNA) Biopsy
The doctor uses a fine needle connected to a syringe to extract a tissue sample from a tumor or suspicious area. This tissue sample is then examined in a laboratory to determine if it contains cancer cells. While generally not used for sinonasal cancers, the doctor may perform this type of biopsy to determine if swollen lymph nodes are related to the spread of cancer or another cause.
Excisional Biopsy
For tumors deeper in the skull, the doctor may need to perform a more extensive biopsy procedure that requires cutting through the skin and sinus bones to reach the tumor, or deep endoscopic approaches which are too stimulating for in-office performance. In this case, the doctor usually removes the large majority of the tumor and sends it to a laboratory to confirm the diagnosis.
