Nasal Bleeding: When to Worry About Cancer Risks

Q: Nasal Bleeding: When to Worry About Cancer Risks

Hello： If you have already undergone an endoscopic examination by an otolaryngologist, nasopharyngeal carcinoma can likely be temporarily ruled out. <br>If there are any abnormalities, the physician may recommend a nasopharyngeal biopsy. <br>Given the current situation, it is adv

Some questions to ask?

Hello, doctor.
Over the past two years, I've occasionally noticed blood streaks in the mucus from my left nostril, about every few months.
I visited an ENT specialist who performed a nasal endoscopy and found no abnormalities in my nasal cavity or throat, only that the mucosa in the left anterior nasal cavity was consistently red, with more fragile capillaries that are prone to rupture.
I have undergone nasal endoscopy five times in total over these two years (the last one was early last month), and I have not experienced any other concerning symptoms.

A few days ago, I noticed a low humming sound in my right ear, similar to a thumping noise, which lasted about five seconds and had a pulsing quality.
I began to worry about potential issues and went back to the ENT for an examination.
The doctor found no significant abnormalities and mentioned that it didn't seem like pulsatile tinnitus, advising me to relax and just monitor the situation.
However, I was still concerned.
Yesterday morning (not right after waking up), I felt the need to clear my throat and spit, and when I attempted to suction my nasal cavity to expel phlegm, I noticed blood in the phlegm, which was dark in color (about 2cm x 0.5cm of blood streaks).
This made me very anxious.
I continued to perform the suction and spitting action two or three more times, and the blood streaks were minimal afterward.

In the afternoon, I immediately went back to the ENT for another endoscopy.
The doctor only examined my right nasal cavity and stated that there were no concerning growths in the nasopharynx.
I asked if the other side of the nasal cavity needed to be checked, and the doctor explained that the nasal passages are interconnected, so this examination was sufficient.
The doctor advised me not to worry unless the bleeding persisted for more than a week, at which point further investigation would be warranted.
I am still worried, recalling that the night before, I had choked while eating and then forcefully sneezed, which may have caused the nasopharyngeal mucosal bleeding.
This morning, I spat again and found no blood.

Doctor, do you think my symptoms could indicate nasopharyngeal cancer? Should I undergo further testing, such as a CT scan or other examinations? Thank you.

Guang, 30~39 year old female. Ask Date: 2014/04/05

Dr. Zheng Jueyi reply Otolaryngology

Hello: If you have already undergone an endoscopic examination by an otolaryngologist, nasopharyngeal carcinoma can likely be temporarily ruled out.
If there are any abnormalities, the physician may recommend a nasopharyngeal biopsy.
Given the current situation, it is advisable to continue monitoring.
Wishing you safety and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2014/04/05

More Info

Nasal bleeding can be concerning, especially when it occurs frequently or is accompanied by other symptoms. In your case, you have experienced intermittent nasal bleeding with blood-streaked mucus, and you have undergone multiple nasal endoscopies that have not revealed any significant abnormalities. Your ENT specialist has reassured you that your nasal passages and throat appear normal, and the bleeding may be attributed to the fragile blood vessels in your nasal mucosa.

It's important to understand that there are many potential causes of nasal bleeding, ranging from benign to more serious conditions. Common causes include:
1. Dry Air: Dryness in the air, particularly during winter months or in arid climates, can lead to the drying and cracking of the nasal mucosa, making it more susceptible to bleeding.

2. Nasal Trauma: Forceful nose blowing, sneezing, or even minor trauma can cause small blood vessels in the nasal lining to rupture.

3. Allergies and Infections: Conditions such as allergic rhinitis or sinus infections can lead to inflammation and increased vascularity in the nasal passages, contributing to bleeding.

4. Structural Issues: Deviated septum or nasal polyps can also lead to localized irritation and bleeding.

5. Systemic Conditions: Conditions such as hypertension or blood clotting disorders can increase the likelihood of bleeding.

Regarding your specific concerns about nasopharyngeal cancer (NPC), it is essential to note that while nasal bleeding can be a symptom of NPC, it is not the only symptom, and many patients with nasal bleeding do not have cancer. Other common symptoms of NPC include:
- Persistent nasal obstruction
- Nasal discharge that may be bloody
- Ear symptoms such as hearing loss or a sensation of fullness
- Neck masses due to lymph node involvement
- Unexplained weight loss
Given that you have had multiple endoscopic examinations with no signs of malignancy, the likelihood of having NPC is low. Your ENT specialist's advice to monitor the situation and return for further evaluation if the bleeding persists for more than a week is prudent.
If you experience additional symptoms such as persistent ear ringing, significant changes in your hearing, or if the bleeding becomes more frequent or severe, it would be reasonable to discuss further imaging studies, such as a CT scan, with your doctor. CT scans can provide detailed images of the nasal passages and surrounding structures, helping to rule out any underlying issues that may not be visible through endoscopy.

In summary, while your symptoms can understandably cause concern, the absence of significant findings on your previous examinations is reassuring. Continue to monitor your symptoms, maintain good nasal hygiene, and consider using a humidifier if you are in a dry environment. If you have any new or worsening symptoms, do not hesitate to reach out to your healthcare provider for further evaluation.

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