The diagnosis of sinonasal cancer can be difficult and overwhelming. Further testing will be necessary to obtain a diagnosis and determine the best course of treatment.
As described in the anatomy section, the nose and sinus cavities are made up of multiple components that can be difficult to see and examine in an office setting. While a mass on the nasal septum is readily visible with a proper light, a mass in the maxillary sinus may not be visible at all without the help of endoscopy or various imaging studies.
An endoscope is a device that allows doctors to examine inside the body. It is made up of a thin flexible or rigid tube with a camera and light attached on the end. The lenses inside the endoscope provide magnification, allowing doctors to detect even small changes in the lining of the nasal passageways.
“Endoscopy” is simply the process of using an endoscope to visualise a particular part of the body. Doctors have specific types of endoscopic tools such as laryngoscopes, hypopharyngoscopes, bronchoscopes, and esophagoscopes – each designed to evaluate a different portion of the upper aerodigestive tract or throat. Sinonasal endoscopy is a way to look far inside and around the nose as well as the sinus openings. This procedure is useful for providing information about the size and position of a suspected tumour. However, unless a patient has had prior sinus surgery, it can be challenging to see inside the paranasal sinuses even with an endoscope.
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. A biopsy of a suspicious growth in the nasal cavity or sinuses is usually needed prior to treatment. There are a few different techniques that can be used to take a biopsy in the nose. These can include:
- Endonasal endoscopic biopsy (in office).
- Endoscopic endonasal biopsy (in the operating room).
- Open surgical biopsy.
- Fine needle aspiration biopsy of a related neck mass.
Imaging scans, also known as radiologic studies, provide the doctor with an inside view of the body. Imaging of the head and neck will be required to determine the extent as well as the behaviour of a growth, and is a vital step prior to treatment of any tumour in the nose or sinus cavities. The most common imaging tests used are CT and MRI scans. A more advanced imaging study called a PET/CT may also be performed to evaluate if a nasal cancer has spread to other sites in the body, as well as to determine if lymph nodes in the neck are likely to harbour cancer cells.