What Causes Bleeding from the Nose?
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. Some common causes of a bleeding nose include:
- Dry mucosa: Often resulting from dry weather conditions or prolonged exposure to dry, air-conditioned environments.
- Rhinitis: Inflammation from allergies or infections can cause the mucosa to become fragile and prone to bleeding.
- Physical trauma: Accidents, sports injuries, or any impact to the face or nose can cause bleeding.
- Medications: Use of blood thinners or other medications that affect blood clotting can lead to easier bleeding.
Addressing Nose Bleeds
To manage a nosebleed effectively, follow these steps:
- Position yourself correctly: Sit upright and lean slightly forward. This posture prevents the blood from draining into your throat, which could lead to choking or nausea.
- Clear the nasal passages: Gently blow your nose to expel any blood clots, as these can continue to cause bleeding if not cleared.
- Apply pressure to your nose: Use your thumb and index finger to pinch the soft part of your nostrils firmly. This compresses the bleeding point in the nasal septum, halting the blood flow. Maintain this pressure for 10 to 15 minutes while breathing through your mouth to allow the bleeding to stop effectively.
- Repeat if necessary: If the bleeding persists after the initial 15 minutes, repeat the pinching step for another 10 to 15 minutes. Avoid checking frequently if the bleeding has stopped, as this can disrupt the clotting process.
- Aftercare: Once the bleeding has ceased, avoid any actions that could strain the blood vessels in your nose, such as blowing your nose, bending over, or lifting heavy objects.
However, 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’.
What is Nasopharyngeal Cancer?
Nasopharyngeal cancer (NPC), as its name implies, refers to the 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. The nasopharynx 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.
Nose cancer occurs more commonly in East / Southeast Asia, Middle East, North Africa and the Arctic and has been associated with the Epstein-Barr Virus (EBV) infection. 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.
In Singapore, specifically, nasopharyngeal cancer is significant both in incidence and as a cause of cancer mortality among males. According to the Singapore Cancer Registry Interim Annual Report from 2010-2014, there were 1,103 reported cases of nasopharyngeal cancer, making it one of the most common cancers. During the same period, it also accounted for 578 deaths, underlining its impact. Additionally, it was prominently recorded among Chinese residents, with 984 cases and among Malay residents, with 93 cases, indicating a higher prevalence in these ethnic groups within Singapore.
Nose Cancer Symptoms
Nasopharyngeal cancer can manifest through a variety of symptoms, some of which may appear benign, like headaches and tinnitus. However, when these are experienced alongside more alarming signs such as nose bleeding, blood-stained saliva, or a persistent fishy smell in the nose, they warrant a prompt consultation with a cancer specialist in Singapore to rule out NPC. Symptoms of NPC may include the following:
- Epistaxis (nose bleeding)
- 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
Diagnosis of NPC
The diagnosis of Nasopharyngeal Cancer begins when a patient presents symptoms that suggest the presence of cancer. To confirm NPC, an array of diagnostic procedures is employed:
- Initial examination: A comprehensive medical history is taken, and a physical exam is conducted, focusing particularly on the head, neck, nose, mouth, and throat areas. The examination aims to identify any abnormalities that may indicate NPC.
- Endoscopic examination: During this essential procedure, a nasendoscopy is conducted, utilising a slender, flexible tube equipped with a light and camera (endoscope) inserted through the nose. This enables direct visualisation of the nasopharynx to evaluate any abnormal growths or conditions.
- Biopsy: If abnormal tissue is observed during the nasendoscopy, a biopsy is performed. A small sample of tissue from the nasopharynx will be taken and analysed under a microscope to detect the presence of cancer cells. For lumps in the neck, a similar procedure may be conducted to determine if they are related to NPC.
- Imaging tests: Various imaging tests may also be used, including CT scans and MRI scans of the head and neck, which provide detailed images and help determine the size, location, and impact of the tumour on surrounding tissues. PET scans, which may be combined with CT scans (PET/CT), help identify cancer spread and check for tumours in other parts of the body. Bone scans, although less common, may be performed to see if the cancer has spread to the bones.
Treating Nasopharyngeal Cancer
Nasopharyngeal cancer is a highly treatable and potentially curable cancer, especially if discovered early. An effective treatment plan relies on a comprehensive understanding of the available treatment options and how they work to combat the disease. Treatment options for nasopharyngeal cancer include:
- Radiation Therapy: Intensity-Modulated Radiation Therapy (IMRT) is the cornerstone for treating nasopharyngeal cancer. It allows precise radiation beams to conform to the shape of the tumour, minimising damage to surrounding healthy tissue and improving treatment outcomes.
- Chemotherapy: Often used in conjunction with radiation therapy, chemotherapy involves using drugs to kill cancer cells or stop them from growing. It can be effective in controlling disease spread, particularly in advanced stages.
- Surgery: While less common due to the tumour's location and complexity, surgery may be employed to remove cancerous lymph nodes or residual cancer post-radiotherapy.
- Immunotherapy: Immunotherapy treatment uses the body’s immune system to fight cancer. Drugs like checkpoint inhibitors are used to help the immune system recognise and destroy cancer cells.
- Palliative Care: Aimed at improving the quality of life for patients with advanced disease, palliative care focuses on managing symptoms and providing support to patients and their families.
Reducing the Risk of Nasopharyngeal Cancer
While the exact causes of NPC remain unclear, certain preventive measures may help lower the likelihood of developing this disease:
- Limit salt-cured and preserved foods: Consuming excessive amounts of salted fish and other preserved foods has been associated with a higher risk of NPC. Therefore, consider reducing your intake of these foods and opt for fresher alternatives.
- Increase antioxidant-rich foods: Enhance your diet with fresh fruits, green vegetables, and foods rich in antioxidants to help reduce your overall cancer risk.
- Avoid tobacco smoke: Exposure to tobacco smoke, including passive smoking, could increase the risk of many types of cancers, including NPC. As such, if you smoke, seek help to quit and avoid environments where tobacco smoke is prevalent.
- Limit alcohol consumption: Being linked to various types of cancers, reducing alcohol intake could potentially decrease the risk of various cancers.
- Prevent infections: Certain infections, such as Epstein-Barr virus (EBV) and human papillomavirus (HPV), have been linked to NPC. While an EBV vaccine is not yet available, receiving an HPV vaccine and practising safe behaviours to avoid HPV infection might help prevent NPC and other related cancers.
Professional Solutions to Address Your Bleeding Nose
Identifying the severity of a nose bleed is crucial, especially when accompanied by other symptoms that could indicate more serious conditions like nasopharyngeal cancer. For those unsure about their symptoms, learning more through our patient education collection can provide valuable insights and guidance.
At OncoCare Cancer Centre, we have had patients in Singapore presenting early for cancer 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. If you’re unsure how to manage daily living post-diagnosis, check out our guide to understand how life and work change after your cancer diagnosis, along with finding your options and support systems.
