Nasal Cancer Health Article

Definition

Nasal cancer is any cancer that occurs within the nose, either in the nasal vestibule (the immediate interior of the nose, just beyond the nostrils), or the nasal cavity (the deep interior of the nose). Many different types of cancer can occur within the nose, and the type of treatment and the chance of cure will vary according the type of cancer that occurs.

Description

Nasal cancers are very rare, making up less than 2% of all tumors of the respiratory tract in the United States. Less than 50 cases a year are diagnosed in the United States. Although squamous cell carcinoma is the most common type of cancer that occurs within the nose, many other types can also occur, including adenocarcinoma, melanoma, different kinds of sarcomas, inverted papilloma, lymphoma, and esthesioneuroblastoma.

Squamous cell carcinomas arise from skin tissue. They are the most common type and are often the result of either cigarette smoking or occupational exposure to dusts or chemical fumes. Adenocarcinomas are malignancies that resemble glandular tissue. Nasal adenocarcinomas are also often associated with occupational exposure to dusts or chemical fumes. T-cell lymphomas (Non-Hodgkins) in the nasal area are strongly associated with a virus (Epstein-Barr virus, EBV). Although nasal T-cell lymphomas are fairly common in some parts of the world, they are very rare in the United States.

Inverted papillomas are associated with another virus (human papilloma virus, HPV) and arise from benign but locally invasive nasal polyps. They are rare, comprising only about 0.5% of all nasal tumors. Although a definite association with HPV has been shown, a tumor may require interaction of the virus with chemicals or other factors, which appear to cause transformation of the inverted papilloma into squamous cell carcinoma in the nose. Esthesioneuroblastoma is a very rare nasal tumor, with less than 200 cases reported in the last 25 years. They are tumors that arise in the nerves in the nose, and have occurred most commonly in teenagers and senior citizens.

Demographics

Although the overall risk of nasal cancer is quite low (since this type of cancer is very rare), relative risks for some specific groups are fairly high. For example, nasal T-cell lymphomas are virus-associated and occur in high incidence in Asia and South America. Nasal squamous cell carcinomas occur much more frequently in cigarette smokers and individuals who have occupational exposures to dusts or chemical fumes, especially in Europe. Consumption of salted and pickled foods creates an increased relative risk of nasal cancer in Asia. Nasal cancers are also more frequent in some African populations that use mahogany wood in cooking fires.

In the United States, nasal cancers are rare. There are no significant racial differences in incidence. Males experience all types of nasal cancer in significantly greater numbers than women, probably due to more occupational exposure to agents that can cause these types of cancer. Most nasal cancers occur in people over 40, although the rare esthesioneuroblastoma has occurred in relatively high percentages in adolescents.

Causes and symptoms

All cancers are caused when a genetic mutation is made in a gene that is involved in the control of cell division. This mistake can arise naturally, can be inherited, or it can be caused by a virus, by sunlight or other radiation, or by some chemical that a person is exposed to, usually through eating, drinking or breathing. For nasal cancers, all of these factors have been shown to play a part.

The use of tobacco products has been strongly associated with the occurrence of nasal adenocarcinomas and squamous cell carcinomas. Chronic occupational exposures to leather, wool, or wood dust or chemical mixtures, particularly nickel, dioxane, nitrosamine, chromium used in dye manufacturing, mustard gas, rubbing alcohol, or formaldehyde, have a demonstrated association with nasal adenocarcinomas and squamous cell carcinomas as well. Some rare nasal T-cell lymphomas have been shown to be very strongly associated with a virus (Epstein-Barr Virus, EBV). Some nasal malignancies (about 5%) begin as inverted papillomas, a locally aggressive tumor which does not usually metastasize but which may turn malignant. These are also thought to be caused by a virus, although a different one: Human papilloma virus (HPV). Some nasal cancers have a strong hereditary component: people with genetic alterations that cause hereditary retinoblastoma have a much higher incidence of nasal cancers than average, which indicates that the genetic change that caused their original disease may also contribute to nasal cancer.

People with nasal cancer may think that they have a cold or chronic sinus infections. They may experience a feeling of stuffiness or blockage in the nose, persistent nasal drainage, or frequent nose bleeds. Other symptoms can occur if the tumor has invaded other tissues around the nose, particularly the orbit of the eye or the base of the skull. Other symptoms which may occur include:

• double vision
• bulging of the eye
• a lump on the face or around the eye
• loose teeth
• frequent headaches

In advanced stages, patients with nasal cancers may suffer from fatigue, weight loss, lack of appetite (anorexia), and fever.