How is Nasal and Paranasal Sinus Cancer Diagnosed?

Nasal and paranasal sinus cancer are rare head and neck cancers that arise from the nasal cavity or in the paranasal sinuses-the air-filled spaces around the nose. The sinuses included are the ethmoid, frontal, maxillary, and sphenoid sinuses. Since many presentations of nasal and paranasal sinus cancer mimic non-cancerous conditions like chronic sinusitis and nasal allergies, the disease may be overlooked during the initial stages of symptoms. Therefore, an accurate diagnosis is critically important to distinguish a cancerous lesion from other common nasal disorders and to determine the extent of cancer before treatment.

At Tender Palm Super Speciality Hospital, Gomti Nagar, Lucknow, our well-trained multidisciplinary team of experts provides comprehensive care for any suspected patient with Nasal and Paranasal Sinus Cancer. Our hospital offers world-class diagnostic services, from a specialist consultation and diagnostic nasal endoscopy to obtaining a definitive biopsy, sending it for pathology and other laboratory investigations, and finally undergoing sophisticated imaging tests.

Why is the Accurate Diagnosis of Nasal and Paranasal Sinus Cancer so important?

It is imperative to diagnose and distinguish a cancerous tumor in the nasal and paranasal region from many noncancerous conditions that present with similar symptoms. Nasal masses can result from infections, inflammations, allergies, polyps, or even benign tumors. Before commencing therapy, it is critical to establish a precise diagnosis, confirm the nature of the lesion, and assess the local extent and distant spread of the disease. Specialists would want to understand:

• Whether the lesion is benign or malignant?
• Which sinus or nasal region is involved?
• Has the tumor spread to adjacent structures?
• Are there any involvements of adjacent bones?
• Has the tumor invaded into the orbit (eye socket) or skull base?
• Is there any nodal spread?
• Has the cancer spread to organs other than the primary region?

An accurate answer to these questions requires expertise from the team, along with the use of different diagnostic modalities such as history taking, thorough physical examination, nasal endoscopy, pathology, radiology, and lab tests.

Who are the Specialists involved in Diagnosis of Nasal & Paranasal Sinus Cancer?

The diagnosis, detection, and control/management of Nasal and Paranasal Sinus Cancer require a collaborative effort from various subspecialties of medicine.

• Head & Neck Surgical Oncologist: Coordinates the overall diagnostic and treatment plan, takes a biopsy when necessary, and manages malignant cases.
• ENT (Ear, Nose & Throat) Specialist: Performs detailed evaluation and examination, makes an initial diagnosis.
• Surgical oncologist: Diagnoses malignant tumors and works in a multidisciplinary team.
• Radiologist: Analyzes the results of CT/MRI scans to determine the spread and extent of the tumor.
• Pathologist: Analyzes tissue samples obtained through biopsies to diagnose the condition and the type of cells involved.
• Ophthalmologist (as necessary): Assists in case of invasion into the orbit area.

What is the Initial Consultation Process?

The process begins with a thorough consultation with a specialist who reviews the patient's complaints of:

• Persistent nasal congestion
• Recurrent nasal bleeding (epistaxis)
• Nasal blockage
• Nasal discharge or symptoms like headache or facial pain
• Changes in smell (anosmia or Hyposmia)
• Facial swelling or pain
• Vision disturbances
• Eye pain or watering
• Changes in dental comfort
• Significant tobacco exposure
• Prior history of sinus infections or surgery
• Family history of cancers
• General medical history

This evaluation helps the doctor decide the next course of action for diagnostics.

What does the clinical exam entail?

During the examination, the specialist may carefully evaluate your external nose, the inside of your nose, mouth, face, eyes, neck, and lymph nodes. They will check for:

• Any facial swelling
• Masses inside the nose or sinuses
• Deformation of facial bones
• Presence of any swollen lymph node(s) in your neck.
• Eye movements
• Sensitivity of the face

Is nasal endoscopy necessary for you?

Yes.

Diagnostic Nasal Endoscopy

This is the mainstay for assessing the inside of your nasal cavity. It is a procedure in which the ENT or Head and Neck surgeon uses a thin, illuminated, flexible tube with a camera at the tip, which is gently introduced through the nasal cavity.

This endoscope helps to look into the nasal passages and openings of the paranasal sinuses under high magnification. During a nasal endoscopy, the surgeon can visualize:

• Nasal septum, turbinates, and mucosa in detail.
• Entry points of paranasal sinuses.
• Presence of tumors, polyps, ulcers, bleeding spots, and other lesions.
• Changes in the sinus openings.

Why can nasal endoscopy be painful?

Nasal endoscopy can usually be performed without causing significant discomfort or pain, especially with a topical local anesthetic spray applied before the procedure to reduce pain and swelling and provide clear visualization. In most cases, this diagnostic procedure is completed within a few minutes.

Which diagnostic method is the gold standard for diagnosing cancer of the nasal and paranasal sinuses?

Biopsy: A biopsy is a definitive method for diagnosing cancer.

It is a procedure where a small tissue sample is taken from the suspected tumor area. This is usually done with either an endoscopic instrument guided by images captured through the endoscope, or sometimes in an open surgery setting, or image-guided. This tissue sample is sent to a certified pathology/laboratory for microscopic testing to confirm the presence of cancer cells, the type of cell, and malignancy or benign nature.

What types of Biopsy are used?

Based on the location/site and appearance/size of the tumor, a medical specialist may consider endoscopic biopsy, incisional biopsy (taking a part of the lesion for testing), image-guided biopsy (with the help of a scan image for guiding the biopsy needle), and open biopsy (only when other options are not feasible).

What happens after biopsy?

Histopathological examination (HPE): The pathology specialist examines the tissue sample from the biopsy. They use special stains to confirm if the tissue is normal or abnormal (malignant). The examination helps identify the type and grade of cancer. This information is critical in deciding the course of treatment for cancer patients.

How can they confirm the diagnosis by immunohistochemistry (IHC)?

The pathology specialist uses IHC to confirm specific types of nasal and sinus cancer, especially when a tumor looks similar under the microscope but behaves differently. Special antibody stains are used to check the presence or absence of specific markers that help identify individual tumors accurately and distinctly.

Which imaging tests are used for Nasal & Paranasal Sinus Cancer diagnosis?

CECT - Enhanced computed tomography (CECT)

CECT gives detailed imaging of your nasal passages, sinuses and bones surrounding them, as well as extending into the skull base and areas surrounding your eyes. It helps us understand the extent and local invasion of the tumor.

MRI

Magnetic resonance imaging (MRI): MRI provides better imaging of your soft tissues, such as the brain and optic nerve. If the tumor has spread towards the eyes or brain, MRI becomes essential for complete assessment of local extent and depth of tumor. It helps the physician assess the whole region of involvement with greater accuracy and in a more comprehensive manner.

PET-CT Scan

PET-CT is a combination of an anatomical scan and metabolic scanning and may be recommended for:

• Advanced stages
• Recurring tumours
• The distant spread to other sites.
• For staging before you are ready for treatment.

Ultrasound

Neck Ultrasound can detect any abnormal or swollen cervical lymph nodes and may help guide fine needle aspiration.

Is FNAC being performed?

Yes, when enlarged lymph nodes are present.

Fine Needle Aspiration Cytology (FNAC)

This involves the use of fine needles to remove fluids from the lymph nodes and examine them microscopically to find out if the cancer has metastasized. FNAC is performed to establish whether the cancer has metastasized from the original location in the nose and sinuses.

Are blood tests required?

Blood tests are not required for diagnosis of Nasal and Paranasal Sinus Cancer, and they don’t show whether there is cancer in your nasal and paranasal sinus regions.

We have some routinely performed blood investigations such as:

• CBC (Complete blood picture)
• LFT (Liver Function Test)
• KFT (Kidney Function Test)
• BS (Blood Sugar )
• Coagulation Profile
• Electrolytes

These investigations would help us to prepare for any future surgery and treatment.

Why is involvement of Lymph nodes important?

Spread of certain types of nasal and sinus cancers can happen in different levels of the Lymph nodes present in your neck. These are examined during various assessments including:

• Clinical assessment
• Ultrasound
• CT Scan
• MRI Scan
• PET-CT scan
• FNAC (if indicated). Your lymphatic system is evaluated to assess the local status of cancer and prepare for staging.

What is staging for Nasal & Sinus Cancer?

After all test reports are available, a committee comprising various consultants evaluates the cancer, and the disease is staged based on the TNM international staging system.

• 'T' represents the primary Tumour Size and Extension.
• 'N' indicates if any of the regional Nods are positive.
• 'M' indicates whether there is metastasis, i.e., whether the Cancer has spread to any of the organs outside this regional zone (such as lungs or bone, etc.)

Based on the TNM staging, a precise line of Treatment is planned for the cancer.

What Diagnostic services for Sinus Cancer are available at Tender Palm Super Speciality Hospital?

• Various types of consultations by specialized specialists, including Head & neck surgical oncologists and ENT specialists.
• Extensive clinical exercise
• Diagnostic Nasal Endoscopy procedures
• Endoscopy-based biopsy
• Histopathology reports
• IHC (Immunohistochemistry)
• FNAC (Fine Needle Aspiration Cytology)
• Laboratory workup to standard
• Digital X-ray
• Ultrasound.
• Contrast-Enhanced (CECT)
• MRI
• PET- CT scan through our integrated diagnostic network
• Multidisciplinary review

The whole workup is consolidated at one place and provides a comprehensive diagnosis for such tumors.

Why choose Tender Palm Super Speciality Hospital for Nose and Sinus Cancer Diagnosis in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Nasal & Paranasal Sinus Cancer Diagnosis services in Lucknow, India at an affordable cost. We use high-quality nasal endoscopy, imaging, and biopsy facilities to closely examine the nasal cavity and sinuses for accurate and early detection of cancerous changes. Our expert ENT and oncology team, known for providing the best diagnostic care, ensures a safe procedure, quick reporting, and reliable results to guide timely and effective treatment.

To seek an Expert Consultation for Nose and Sinus Cancer Diagnosis in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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