New Straits Times : 26 September 2006 

Nose cancer may be the third most common cancer in men but it is the least talked about, says consultant ENT-head and neck surgeon Dr Koay Cheng Boon. KASMIAH MUSTAPHA writes.

IT is the least talked about cancer. Yet the prevalence of nasopharyngeal cancer or nose cancer is almost as high as other forms of cancers in the country although it affects a smaller group of people.

Consultant ENT-head and neck surgeon Dr Koay Cheng Boon says as in any form of cancer, nose cancer is a serious condition and early detection is vital to ensure higher chances of survival.

“If it is detected at stage one, patients can achieve five-year survival of between 80 and 90 per cent. But they have to know the symptoms which at earlier stage are similar to sinusitis and can often be overlooked.”

Dr Koay says symptoms include excessive nose discharge or blockage over a long period and blood in the mucus.

“If you see blood in your mucus or, when you cough, there is blood in the phlegm, it is something that you need to be concerned about. You have to see a doctor as soon as possible.”

Other symptoms include painless lump in the neck, decreased hearing or ringing in the ears, or unusual face pain or numbness, double vision or headache.

In the late stages there may be symptoms in the lungs, bones or liver.

Nose cancer is more common among the Chinese and only two per cent of the patients are non-Chinese. It affects males more than females and occurs in people between 20 and 40 years of age. It is the third most common cancer in men and the fifth among women.

“It is more common in the Chinese due to their genetic makeup. In Malaysia, out of 100 patients, 98 are Chinese. In my clinic, on average there are between two and three new cases a month. I believe in other hospitals there could be between 100 and 200 cases a month.”

On the level of awareness, Dr Koay says that people are aware of nose cancer and some of them come quite early to be treated. Unfortunately there are still some cases where the patients tend to ignore the symptoms until the cancer is at advanced stage.

“It is treatable if you come early. If you have the symptoms and you ignore them then it could be more difficult to treat.”

However, Dr Koay says if you are diagnosed with sinusitis, it does not mean that it will develop into nose cancer because the cancer is not related to the common nose infection, contrary to popular belief.

“People who suffer from chronic sinusitis do not get cancer. It is not related. Although early symptoms are similar, it does not mean if you have sinusitis, you will have nose cancer.”

He says people are also confused between sinusitis and rhinitis. One is infection of the sinus while the other is because you have a sensitive nose.

“When people sneeze and have runny nose, they are suffering from rhinitis which is a common problem due to allergy. It happens because you have a sensitive nose and react to things such as dust. It is treated with anti-histamine to reduce the allergy.

“Rhinitis cannot be cured. Bear in mind that the medicine is not to cure; sensitive nose is something that you are born with. Taking medicine is to control. Some patients do not understand this.”

Sinusitis, on the other hand, is a common condition when someone has flu. The nose gets runny and stuffy, and after a few days, the mucus turn green or yellow. Sinusitis is treated with antibiotics. The majority of acute sinusitis resolve after one to two weeks of treatment.

However, if the conditions persist for more than three months, it can become chronic sinusitis. Patients may need to be on longer courses of antibiotics. “If the medical treatment fails to treat the problem, the patient may need endoscopic sinus surgery to remove blockages in the sinuses.”

Endoscopic sinus surgery will allow mucus to drain properly out of the nose which can relieve nasal blockages and facial pain, improve breathing and improve sense of smell and taste.

Infection of sinuses, if untreated, can result in problems as it may affect other organs such as the eyes, brain and cause cavernous sinus thrombosis and skin abscess.

The diagnosis of sinusitis and its complications may require X-ray or CT scan of the sinuses for accurate assessment of the extent and severity of the disease.