5 The cancer patient with sneezing and/or nasal discharge
Nasal neoplasia accounts for 1% of tumours in dogs, is considered less common in cats and has also been reported in rabbits. Therefore, although not particularly common in general practice, such cases can generate a diagnostic challenge for practitioners due to the difficulty in directly visualizing the tumour mass. The prevalence of tumour type varies between dogs and cats (dogs: epithelial > mesenchymal > lymphoid; cats: lymphoid > epithelial >mesenchymal; see Box 5.1) and the clinical signs that nasal cancer patients present with can also vary. However, in the majority of cases the clinical signs will be gradually progressive, meaning that patients presenting with recurring or worsening clinical signs warrant further or repeated evaluation. The increasing availability of advanced imaging modalities such as MRI and CT scanning have improved our ability to make accurate and early diagnoses, so the referral of patients to suitably equipped specialist centres with clinical signs that may be attributable to nasal tumours should be considered if possible.
Box 5.1 Common malignant and benign tumours of the nasal cavity
Common malignant tumours of the nasal cavity | Benign tumours of the nasal cavity |
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CLINICAL CASE EXAMPLE 5.1 – CANINE NASAL ADENOCARCINOMA
Case history
The relevant history in this particular case was:
Diagnostic evaluation
The dog was anaesthetized and an intraoral radiograph was suggestive of the presence of a soft-tissue mass (Fig. 5.2). The dog was then given an MRI scan, which clearly showed the presence of an intranasal tumour as shown in Figure 5.3.
A complete blood count and whole blood clotting time had been assessed and found to be normal before the diagnostic imaging procedure, so whilst remaining under anaesthesia, rigid biopsy forceps were used to obtain several pieces of the tumour for histopathology as shown in Figure 5.4. The histopathology returned to show the mass was an adenocarcinoma.
Theory refresher

Figure 5.5 An elderly springer spaniel with typical mucoid nasal discharge associated with a nasal tumour.
Courtesy of Dr Richard Mellanby, University of Edinburgh
Examination
General clinical examination in a nasal tumour patient is often unremarkable but particular attention should be paid to careful visual examination of the nares and palpation along the entire nasal planum, periorbital region and over the location of the frontal sinuses. Nasal airflow should always be assessed in both nostrils (either by placing a chilled microscope slide near the nostrils, or simply assessing whether there is movement of strands of cotton wool) as there is frequently markedly reduced or absent airflow on the affected side. The presence of unilateral nasal discharge or epistaxis is highly suspicious for a nasal tumour in a middle-aged to older medium- to large-breed dog. Other aspects of the clinical examination to evaluate include careful palpation of the submandibular lymph node chain (local metastases are reported to occur in only 10% of patients at initial diagnosis but these cases need to be identified due to the implications for further evaluation and for the treatment) and a visual oral examination.
Biopsy
Direct visualization of a mass may also be possible using either a flexible or rigid endoscope. Identification of a mass via any imaging modality, however, does not generate a specific diagnosis, so tissue biopsy for histopathology is always required for definitive diagnosis. Cytological analysis of nasal wash fluid frequently fails to produce adequate samples and therefore this technique should not be relied on as the sole means of diagnosis and is a practice the authors now rarely use, although it can occasionally prove to be useful. Biopsies can be obtained using flexible endoscopic biopsy forceps (although these only produce small tissue samples), cup forceps or a Volkman spoon. When obtaining biopsies it is essential to ensure the tip of the biopsy instrument is not advanced beyond the medial canthus so as to avoid penetrating through the cribiform plate into the cranial cavity. Obtaining these tissue samples will result in haemorrhage that may seem significant, but this usually stops within a few minutes. It is recommended to assess the platelet count and a whole blood clotting time as a minimum data base before undertaking a nasal biopsy procedure.