Introduction
According to Ref. 5 ( p. 516) nose cancer (medically termed “nasopharyngeal cancer”) in North America and Europe is less than 1 in 100,000 of the population per year.
Other ethnic groups, particularly of Chinese origin, have a much higher incidence of this cancer. There is a two-fold genetic risk for Chinese people as a result of a genetic weakness, but this is amplified by the ethnic preference for consumption of salted fish, which adds a 4-fold risk environmentally.
In addition the use of incense burning, which is deeply engrained into the way of daily living in Southeast Asia adds to the risk for nasopharyngeal cancer as this blog explains.
This is due to the production of nitrosamines in the stomach, a powerful carcinogen, which subsequently circulates through the blood to the sensitive nasal , pharynx and sinus membranes. Other environmental risks are living in trailers with formaldehyde fumes, exposure to tobacco smoke and consumption of hard liquor.
Certain industries such as nickel refining, isopropyl alcohol manufacturing, hardwood dust from furniture manufacturing, mustard gas, wood and textile manufacturing as well as exposure to polycyclic aromatic hydrocarbons (gas manufacturing) are all proven risks to the nasal and sinus passages for cancer development.
Signs and Symptoms
Cancer of the nose and the sinuses are often asymptomatic until late. As the nose cancers are more prominent in the nasal cavity they may be diagnosed earlier from an unexplained nose bleed. However, the sinus cancers are often hiding inside the maxillary or ethmoid sinuses. Some of the symptoms are nasal obstruction only on one side, pressure on one eye, excessive tearing of the eye where the tumor impinges the nerve going to the tear gland. There may be double vision, upper teeth that are loosening, or dentures in the upper gums that no longer fit because of a cancer pressing down from above.
Diagnostic Tests
Like with any other cancer a tissue biopsy must be done to diagnose the type of cancer. This can be done with a non-invasive fiberoptic nasopharyngeal endoscopy. CT scanning is done as well to help in the staging of nasal or sinus cancer.
Treatment
A combination of surgery and radiotherapy is usually necessary to control the cancer. If systemic metastases are present combination chemotherapy is also necessary. Despite all of this, the 3 year survival rates are usually in the 35% range and the 5 year survival rates in the 15% range. As the cancer usually is found only in a late stage at the time of diagnosis, these survival rates are poor (Ref. 5, p. 1297). Perhaps mass screening should be done in people with a high risk such as workers in high risk industries, smokers and Chinese ethnic groups with a higher risk.
References:
1. James Chin et al., Editors: Control of Communicable Diseases Manual, 17th edition, 2000, American Public Health Association.
2. Behrman: Nelson Textbook of Pediatrics, 16th ed., 2000, W. B. Saunders Company
3. J M Hickner et al. Ann Emerg Med 37(6): 703-710. June 2001.
4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001 Mosby, Inc.
5. Abeloff: Clinical Oncology, 2nd ed.,2000,Churchill Livingstone, Inc.
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
