Brenda Spriggs, MD, MPH, MBA
Most people experience a nosebleed, or epistaxis, at least once in their lifetime. Bleeding from the front, or anterior, nasal cavity accounts for most nosebleeds. Only 5 to 10 percent of epistaxis originates from the posterior nasal cavity near the back of the upper throat, according to the American Rhinologic Society. Most nosebleeds stop on their own without medical treatment and typically don’t represent a significant health concern. However, recurrent or unexplained nosebleeds may indicate a serious underlying disease, including cancer.
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Nasal and Paranasal Sinus Cancer
Recurring nosebleeds are a common symptom of a cancerous tumor in the nasal cavity or the sinuses, known medically as the paranasal sinuses. Squamous cell carcinoma (SCC) is the most common type of cancer in these areas. SCC arises from the lining tissue of the nose or sinuses. Less commonly, nasal and sinus cancers arise from bone, cartilage or another type of connective tissue. Melanoma is a rare cause of cancer in this area, accounting for less than 1 percent of cases according to the National Cancer Institute.
Nosebleeds due to nasal or sinus cancer usually recur, involve one side of the nose and typically do not cause heavy bleeding. Other common symptoms include a runny nose and one-sided nasal stuffiness, facial pain, tooth pain or ear pressure.
Nosebleeds may also be a symptom of leukemia. The term leukemia refers to a group of cancers arising from the blood-forming cells of the bone marrow. Depending on the type of leukemia, the bone marrow overproduces one type of cancerous blood cell while production of other blood cell types falls. This often leads to a markedly reduced number of blood platelets, which help stop bleeding. Therefore, people with leukemia often bruise or bleed easily, and may experience frequent nosebleeds. Acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) are the most common forms of leukemia among adults. Both occur most frequently in older adults.
Nosebleeds due to leukemia may be difficult to stop, although the bleeding typically isn’t heavy. In addition to nosebleeds and easy bruising, other possible symptoms of leukemia include fevers, night sweats, bone pain, swollen lymph nodes, fatigue, weakness and unintended weight loss.
Lymphoma refers to cancer arising from cells called lymphocytes in the body's lymph system, which includes the lymph nodes, spleen, tonsils, adenoids, thymus and a body-wide network of lymphatic vessels and tissues. Hodgkin disease and non-Hodgkin lymphoma (NHL) are the two main types of lymphoma. Since lymph nodes and other lymphatic tissues occur throughout the body, lymphoma can arise in virtually any location -- including the nose and sinuses. Nasal and paranasal lymphomas are usually the NHL type. Growth of cancerous lymphoid tissue in the nose or sinuses can erode into nearby blood vessels and cause nosebleeds. Less commonly, bone marrow involvement with advanced Hodgkin disease or NHL arising elsewhere in the body can lead to epistaxis due to reduced platelet production.
Symptoms associated with nasal or sinus lymphoma are similar to other cancers in these areas. Lymphomas arising outside of the nose or sinuses often cause generalized symptoms that resemble leukemia.
Warnings and Precautions
Only about 6 percent of nosebleeds require medical care to stop the bleeding, according to the American Rhinologic Society. However, it's important to seek immediate medical attention for a nosebleed that is heavy or will not stop within 10 to 15 minutes when applying firm but gentle pressure. Additionally, seek medical evaluation as soon as possible if you experience recurring nosebleeds. While cancer is among the less common causes of nosebleeds, it's important not to ignore this potential cancer warning sign.
Reviewed and revised by: Tina M. St. John, M.D.