Bleeding From The Nose – When Something Smells Fishy

It is not uncommon to experience occasional nose bleeds, which frequently settles with the simple manoeuvre of pinching the nose while breathing through the mouth.  Most situations of bleeding from the nose (epistaxis) is not related to cancer. Amongst causes of nose bleeding, the commonest is bleeding from the mucosa near the front of the nose (Little’s area), where there are abundant small blood vessels which can bleed from minor trauma when one blows the nose excessively or picks the nose when the mucosa is dry.  Dry weather conditions or prolonged exposure to dry air, for example in air-conditioned rooms, may also be contributory factors.  Other possible causes include inflammation from rhinitis, trauma to face or nose in sports injury or accidents, and use of certain medications like blood thinners.

When bleeding becomes frequent and recurrent, especially if there are no precipitating factors or if associated with other symptoms, consultation with a doctor may be necessary.  It may portend conditions which will require early medical intervention, infection of the sinuses, benign tumours or even cancers like nasopharyngeal cancer, commonly referred to as ‘Nose Cancer’ or ‘NPC’.  It is worth noting that NPC is more common in males than females and rises after the third decade of life to peak at 55 years old.

Nasopharyngeal cancer (NPC), as its name implies, refers to abnormal proliferation of cancerous cells in the nasopharynx, which is a small area at the deep end of the nasal cavity.  Some patients would say they have nose cancer but is actually referring to NPC. It is also the intersection with the upper part of the throat and the opening of a connection to the middle ear, accounting for some of the symptoms experienced by patients.  It is a cancer which occurs more commonly in East / South-east Asia, Middle East, North Africa and the Arctic and has been associated with the Epstein-Barr Virus (EBV) infection.

Symptoms of NPC may include the following:

  • Epistaxis (nose bleed)
  • Nose blockade / congestion
  • Reduced hearing of one or both ears
  • Tinnitus (ringing sound) in the ear(s)
  • Blood-stained saliva or sputum
  • Headaches, especially if one-sided
  • Visual problems like seeing double images
  • Altered sensation on one side of the face
  • Neck lumps

The diagnosis and confirmation of NPC is done via endoscopic examination and biopsy by an Ear, Nose and Throat (ENT) Surgeon, supplemented by scans and blood investigations.

Nasopharyngeal cancer is a highly treatable and potentially curable cancer especially if discovered early.  At OncoCare Cancer Centre, we have had patients presenting early for treatment and management. Unlike many other cancers of the head and neck, where surgery is the mainstay of treatment, NPC is usually managed using radiotherapy and/or chemotherapy depending on the extent of the disease.


“Expert knowledge means better care for cancer”


Dr Leong Swan Swan 

MBBS (Singapore)

M.Med (Singapore)

MRCP (United Kingdom)

FAMS (Medical Oncology)

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