Nasal Malignancy

This guideline applies to adults aged 18 years and over.

Introduction

Sinonasal malignancy is cancer affecting the nasal cavity and sinuses. It is rare in the UK with around 460 cases diagnosed each year¹ and an incidence of 1:100,000.

Presentation is usually non-specific, often with unilateral symptoms that can mimic benign disease. The majority of nasal symptoms seen in primary care are attributable to common conditions such as rhinosinusitis, allergic rhinitis, and nasal polyposis.

Red flag features

Nasal cancer should be excluded in the context of new onset, persistent and/or rapidly progressive symptoms that can include

Nasal/ sinus
- Unilateral facial pain and/or swelling
- Unilateral bloody mucopurulent discharge/ unexplained epistaxis (simple epistaxis is also typically unilateral at presentation)
Orbital
- Unilateral bulging eye, visual disturbance, painful eye movements and/or double vision
Dental
- e.g. loosening of upper teeth

Please exclude other causes of simple epistaxis e.g. hypertension, trauma to anterior septum, nasal sprays

Risk factors for sinonasal malignancy

Male
Smoker
Viruses: Human Papilloma Virus (HPV), Epstein-Barr Virus (EBV)
Non-Hodkins Lymphoma
Southeast Asian or North African descent
First degree relative with sinonasal malignancy
Recurrent exposure to: wood dust, leather dust, nickel, formaldehyde, cloth fibres
Diet high in salt cured meats or fish

Investigations

No investigations are required or recommended prior to referral.

Referral Instructions

Refer any suspected nasal malignancy via E-RS on an URGENT basis clearly outlining the red flag symptoms. Referrals that do not clearly outline red flag symptoms will be downgraded to routine.

Do not send via Fast Track ENT Suspected Cancer.

References

Page Review Information

Review date	06 February 2026
Next review date	06 February 2027
GP speciality lead	Dr Jack Munro Berry
Contributors	Ms Aileen Lambert, Consultant ENT Surgeon Mr Neil Tan, Consultant ENT Surgeon