Background: Cancers of the nasopharynx, nasal cavity, and accessory sinuses ("sinonasal") are rare in England, with around 750 patients diagnosed annually. There are no specific National Institute for Health and Care Excellence (NICE) referral guidelines for these cancers and no primary care research published.
Objective: To identify and quantify clinical features of sinonasal cancer in UK primary care patients.
Methods: This matched case-control study used UK Clinical Practice Research Datalink (CPRD) data. Patients were aged ≥40 years with a diagnosis of sinonasal cancer between January 1, 2000 and December 31, 2009 and had consulted their GP in the year before diagnosis. Clinical features of sinonasal cancer were analysed using conditional logistic regression. Positive predictive values (PPVs) for single and combined features were calculated.
Results: In total, 155 cases and 697 controls were studied. Nine symptoms and one abnormal investigation were significantly associated with the cancer: nasal mass; odds ratio, 95 (95% confidence interval 7.0, 1315, P = 0.001); head and neck lumps, 68 (12, 387, P < 0.001); epistaxis, 17 (3.9, 70, P < 0.001); rhinorrhoea, 14 (4.6, 44, P < 0.001); visual disturbance, 12 (2.2, 67, P = 0.004); sinusitis, 7.3 (2.2, 25, P = 0.001); sore throat, 6.0 (2.0, 18, P = 0.001); otalgia, 5.4 (1.6, 18, P = 0.007); headache, 3.6 (1.4, 9.5, P = 0.01); raised white cell count, 8.5 (2.8, 27, P < 0.001). Combined PPVs for epistaxis/rhinorrhoea, epistaxis/sinusitis, and rhinorrhoea/sinusitis were 0.62%.
Conclusion: This is the first primary care study identifying epistaxis, sinusitis, and rhinorrhoea as part of the clinical prodrome of sinonasal cancer. Although no PPVs meet the 3% NICE referral threshold, these results may help clinicians identify who warrants safety-netting and possible specialist referral, potentially reducing the number of advanced-stage diagnoses of sinonasal cancer.
Keywords: diagnosis; early detection of cancer; general practice; nasopharynx; paranasal sinuses; primary health care.
Sinonasal cancer occurs in the back of the nose or in the sinuses. It is rare in the United Kingdom, with most cases being diagnosed at an advanced stage. Delayed presentation and non-specific symptoms often lead to diagnosis at a later stage, with consequently poorer survival outcomes. Currently, there is no research describing the symptoms presented by these patients to their general practitioner (GP), nor referral guidelines for primary healthcare professionals. The aim of this study was to detect the symptoms of patients aged ≥40 years, diagnosed with sinonasal cancer in primary care. Three symptoms in the year before their diagnosis were linked with sinonasal cancer: nosebleeds, runny nose, and sinusitis. These symptoms may help GPs to identify possible sinonasal cancer patients earlier, though each symptom was low-risk on its own.
© The Author(s) 2021. Published by Oxford University Press.