Nasal Adenocarcinoma

Nasal adenocarcinoma is a malignant tumor arising from the glandular epithelial cells lining the nasal cavity and paranasal sinuses in dogs. This type of cancer represents one of the most common nasal tumors in canine patients, accounting for a significant proportion of sinonasal malignancies. Nasal tumors overall constitute approximately one to two percent of all cancers in dogs, and among these, adenocarcinoma is frequently diagnosed along with other carcinoma types. Understanding nasal adenocarcinoma is important for dog owners, as early recognition of symptoms can lead to earlier diagnosis and treatment, potentially improving outcomes and quality of life for affected dogs.

Nasal adenocarcinoma develops when the glandular cells lining the nasal passages and sinuses undergo malignant transformation and begin proliferating uncontrollably. The tumor typically grows within the nasal cavity, eventually destroying normal nasal structures including the delicate turbinate bones that humidify and filter inspired air. As the tumor enlarges, it can extend into adjacent structures including the paranasal sinuses, orbit, oral cavity, and potentially the brain through the cribriform plate. Local invasion is the primary pattern of disease progression, though metastasis to regional lymph nodes and distant sites can occur, particularly late in the disease course.

The impact of nasal adenocarcinoma on a dog's health progressively worsens as the tumor grows and invades local structures. Early tumors may cause relatively mild symptoms such as unilateral nasal discharge or occasional sneezing. As the disease advances, symptoms become more pronounced and distressing, including bloody nasal discharge, facial deformity, difficulty breathing through the nose, and pain. If the tumor invades the orbit, eye-related problems may develop. Extension into the brain causes neurological signs that indicate very advanced and serious disease. Quality of life deteriorates significantly without treatment, making timely intervention important for maintaining comfort and function.

Treatment of nasal adenocarcinoma typically involves radiation therapy, which is considered the treatment of choice for most cases due to the tumor's location and invasive nature. Surgery may play a role in selected cases, either as primary treatment or combined with radiation. Chemotherapy may be used as an adjunct to radiation or for palliation. Palliative care focusing on comfort and quality of life is important for all patients and may be the primary approach for dogs with advanced disease or when owners prefer supportive care. Prognosis for nasal adenocarcinoma is variable but generally guarded, with treatment able to provide meaningful extensions of quality life for many dogs. Veterinary oncology consultation is essential for treatment planning and providing realistic expectations about outcomes.

The primary causes of nasal adenocarcinoma in dogs are not definitively established, though several factors have been investigated as potential contributors. Environmental exposure to inhaled carcinogens has been proposed as a causative factor, with indoor exposure to secondhand tobacco smoke, wood dust, and urban air pollution suggested as potential risk factors. The nasal cavity is directly exposed to inhaled particles and chemicals, making it susceptible to carcinogenic effects from environmental pollutants. Chronic nasal inflammation from various causes has also been suggested as potentially promoting malignant transformation, though a direct causal relationship has not been proven.

Genetic and hereditary factors appear to play a role in susceptibility to nasal adenocarcinoma, as evidenced by strong breed predispositions. Dogs with longer noses, classified as dolichocephalic breeds, have significantly higher rates of nasal tumors than brachycephalic short-nosed breeds. This anatomical difference may relate to increased surface area exposure to inhaled carcinogens or to genetic factors associated with skull conformation. Specific genetic mutations driving nasal adenocarcinoma development have not been identified, but the strong breed associations suggest inherited factors influence cancer risk. Research into molecular genetics of canine nasal tumors may eventually reveal specific genetic markers.

Environmental and lifestyle factors that may contribute to nasal adenocarcinoma risk include living in urban environments with higher air pollution levels compared to rural settings. Studies have suggested associations between living with smokers and increased risk of nasal and respiratory cancers in dogs, though not all studies have confirmed this relationship. Exposure to certain industrial compounds, herbicides, and pesticides has been investigated as potential risk factors. Dogs living in older homes may have exposure to asbestos or other carcinogens present in building materials. Indoor air quality and ventilation may affect exposure to potential carcinogens that accumulate in enclosed spaces.

Risk factors for nasal adenocarcinoma include advancing age, with most cases diagnosed in dogs over seven years old and peak incidence around ten years of age. Dolichocephalic breed conformation is a significant risk factor, with long-nosed breeds substantially overrepresented among nasal tumor patients. Medium to large sized dogs appear more commonly affected than small breeds. Males may have slightly higher rates than females in some studies, though this is not consistent across all reports. Dogs with chronic nasal disease or histories of repeated nasal infections may have elevated risk, though whether chronic inflammation contributes to cancer development or simply causes similar symptoms leading to earlier detection is unclear.

The mechanism by which nasal adenocarcinoma develops involves accumulation of genetic mutations in the glandular cells lining the nasal cavity and sinuses. These mutations affect genes controlling cell division, DNA repair, and programmed cell death. Environmental carcinogens may directly damage DNA or promote cellular changes increasing mutation rates. The nasal epithelium has high turnover rates, and repeated cycles of damage and repair may increase opportunities for mutations to occur and accumulate. Over time, mutated cells acquire the characteristics of cancer cells, including the ability to proliferate uncontrollably, invade surrounding tissues, and eventually spread to distant sites.

Early warning signs of nasal adenocarcinoma are often subtle and may be mistaken for common benign conditions such as allergies or upper respiratory infections. Initial symptoms typically include intermittent sneezing and mild nasal discharge, usually affecting only one side initially since most tumors begin unilaterally. The discharge may be clear or mucoid at first. Owners might notice occasional reverse sneezing or snorting as the dog attempts to clear nasal passages. Slight changes in breathing sounds or mild congestion may be present. These early signs are frequently dismissed or treated symptomatically without investigation, allowing the tumor to progress before diagnosis is established.

Common symptoms of nasal adenocarcinoma become more pronounced as the tumor grows within the nasal cavity. Nasal discharge typically becomes more persistent and often becomes blood-tinged or frankly bloody, which should always prompt veterinary evaluation. The discharge usually remains unilateral until the tumor extends across the nasal septum to involve both sides. Sneezing becomes more frequent and may be accompanied by visible blood or tissue. Progressive nasal obstruction causes noisy breathing, open-mouth breathing, or air hunger. Dogs may paw at their nose or face due to discomfort. Decreased appetite may occur because nasal obstruction impairs the sense of smell, which is closely linked to appetite in dogs.

Behavioral changes in dogs with nasal adenocarcinoma reflect discomfort and declining ability to breathe normally through the nose. Affected dogs may become less active and appear generally unwell. They may show reluctance to play or exercise due to respiratory compromise. Head shaking, face rubbing, and pawing at the nose suggest nasal irritation or pain. Dogs may become more irritable or withdrawn as the disease causes increasing discomfort. Eating and drinking behaviors may change, with dogs eating more slowly or showing decreased interest in food. Sleep may be disrupted by difficulty breathing, leading to restlessness. Overall demeanor typically declines as the disease progresses.

Physical signs of nasal adenocarcinoma that owners may observe include visible bloody nasal discharge, often more prominent from one nostril. Facial deformity may develop as the tumor expands and destroys nasal bones, causing swelling over the bridge of the nose or asymmetry between the two sides of the face. The affected eye may appear pushed outward or develop discharge if the tumor invades the orbit. Teeth may loosen if the tumor extends into the oral cavity and affects the maxilla. Weight loss occurs as appetite decreases and the disease advances. Open-mouth breathing indicates significant nasal obstruction.

Symptom progression in nasal adenocarcinoma follows a pattern of gradual worsening as the tumor grows and invades local structures. Unilateral symptoms may become bilateral as the tumor crosses the nasal septum. Nasal discharge becomes increasingly bloody and profuse. Facial deformity becomes more pronounced if bony destruction continues. Pain may increase, evidenced by reluctance to have the face touched and changes in eating behavior. If the tumor invades the orbit, eye-related problems including bulging, discharge, and vision changes may develop. Neurological signs including seizures, behavior changes, or circling can occur if the tumor extends through the cribriform plate into the brain, indicating very advanced and serious disease.

Emergency symptoms requiring immediate veterinary attention include severe hemorrhage from the nose, respiratory distress with inability to breathe adequately, sudden onset of neurological signs such as seizures or collapse, severe facial pain or swelling, and signs of shock. While nasal adenocarcinoma typically progresses gradually, acute complications can occur. Any dog with persistent or recurrent nasal symptoms, especially bloody discharge, should be evaluated rather than waiting for emergency symptoms to develop. Earlier diagnosis allows earlier treatment and better outcomes.

The initial veterinary examination for a dog suspected of having nasal adenocarcinoma involves thorough assessment of the head, nasal cavity, and overall health. The veterinarian obtains detailed history including the duration and progression of nasal symptoms, which side is affected, character of any discharge, and associated problems such as facial changes or neurological signs. Physical examination includes evaluation of nasal airflow, assessment for facial asymmetry or swelling, examination of the eyes for evidence of orbital involvement, inspection of the oral cavity for palatal masses, and palpation of regional lymph nodes for enlargement. Overall health assessment and bloodwork provide information about systemic status.

Diagnostic imaging is essential for evaluating nasal tumors and planning treatment. Skull radiographs may show evidence of nasal cavity opacity and bone destruction but have limited sensitivity compared to advanced imaging. Computed tomography is the imaging modality of choice for nasal tumors, providing detailed evaluation of tumor extent within the nasal cavity and sinuses, bone involvement, orbital extension, and presence of cribriform plate invasion. MRI provides excellent soft tissue detail and is particularly valuable for evaluating potential brain involvement. Thoracic radiographs screen for pulmonary metastasis, though distant spread is relatively uncommon at initial diagnosis. CT and MRI findings guide treatment planning and help determine prognosis.

Differential diagnosis for dogs presenting with nasal disease includes several conditions that must be distinguished from nasal adenocarcinoma. Other nasal tumor types including squamous cell carcinoma, chondrosarcoma, fibrosarcoma, and lymphoma present similarly and require histopathological differentiation. Fungal rhinitis, particularly aspergillosis, can cause destructive nasal lesions mimicking cancer. Bacterial rhinitis, nasal foreign bodies, and dental disease with oronasal fistula can cause nasal discharge and should be ruled out. Nasopharyngeal polyps are benign growths that can cause similar symptoms. Thorough diagnostic evaluation including imaging and tissue sampling distinguishes between these conditions.

Definitive diagnosis of nasal adenocarcinoma requires histopathological examination of tumor tissue. Biopsy samples can be obtained through several methods. Rhinoscopy allows direct visualization of the nasal cavity and collection of tissue samples from visible masses. Blind nasal biopsy using cup forceps or core biopsy instruments may obtain diagnostic tissue. CT-guided biopsy can target specific lesions identified on imaging. In some cases, surgical exploration is needed to obtain adequate tissue. Cytological examination of nasal discharge or fine needle aspirates has limited utility for definitive diagnosis of nasal tumors. Pathology results confirm tumor type, grade, and characteristics that influence treatment recommendations and prognosis.

Emergency and immediate treatment for dogs with nasal adenocarcinoma addresses acute symptoms and complications while definitive treatment is planned. Dogs presenting with severe epistaxis may require supportive care including sedation to reduce blood pressure, cold compresses, and in severe cases blood transfusion. Respiratory distress from nasal obstruction may be temporarily palliated with anti-inflammatory medications, though definitive treatment is needed for lasting improvement. Pain management is provided for dogs showing signs of discomfort. Dogs with neurological signs from brain invasion require careful evaluation and stabilization. The goal of initial care is patient comfort and stability while diagnostic workup is completed and treatment planning occurs.

Radiation therapy is considered the treatment of choice for nasal adenocarcinoma in dogs due to the tumor's location, invasive nature, and relatively good radiation sensitivity. Definitive radiation protocols deliver curative-intent doses over multiple treatment sessions, typically three to five times weekly for three to four weeks. Modern radiation techniques including intensity-modulated radiation therapy and stereotactic radiation therapy allow more precise targeting while minimizing damage to surrounding normal tissues. Radiation therapy can effectively control nasal tumors, providing meaningful survival time extensions for many dogs. Side effects including mucositis, rhinitis, and dermatitis typically resolve after treatment completion.

Surgical treatment has a more limited role in nasal adenocarcinoma compared to some other cancers. Complete surgical excision of nasal tumors is rarely achievable due to the complex anatomy and invasive nature of these cancers. Rhinotomy with tumor debulking may be performed to reduce tumor volume before radiation or to palliate obstructive symptoms. Surgical resection alone generally provides shorter survival times than radiation therapy or combined modality treatment. However, surgery may be considered when radiation therapy is not available or feasible. The decision between surgical and radiation approaches depends on tumor extent, available resources, and owner preferences.

Chemotherapy may be used as an adjunct to radiation therapy or for palliation when radiation is not feasible. Various chemotherapy protocols have been used for nasal tumors with variable response rates. Toceranib, a tyrosine kinase inhibitor, has shown activity against some nasal tumors. Carboplatin and other platinum-based drugs may provide some benefit. Chemotherapy alone generally provides less tumor control than radiation therapy but may slow progression and maintain quality of life. Metronomic chemotherapy protocols using lower doses of drugs more frequently may provide modest benefit with minimal side effects.

Palliative care is an important component of management for all dogs with nasal adenocarcinoma and may be the primary treatment approach for advanced cases or when owners prefer supportive care. Pain management using appropriate analgesics addresses tumor-related discomfort. Anti-inflammatory medications may reduce swelling and improve nasal airflow. Antibiotic therapy addresses secondary bacterial infections that commonly complicate nasal tumors. Nutritional support helps maintain body condition. Humidification may ease breathing for dogs with crusting and obstruction. The goal of palliative care is maximizing comfort and quality of life for whatever time remains.

Treatment decisions for nasal adenocarcinoma involve consideration of tumor extent and stage, availability of radiation therapy, patient health status, and owner preferences and resources. Dogs with early-stage tumors without cribriform plate invasion have better prognosis and are good candidates for definitive radiation. Advanced disease with brain invasion carries poorer prognosis regardless of treatment. The dog's age, concurrent health conditions, and ability to tolerate anesthesia for radiation therapy influence treatment selection. Owner preferences regarding treatment intensity, potential side effects, and quality versus quantity of life are important considerations. Financial factors including the cost of radiation therapy and multiple veterinary visits affect feasibility for many families.

Recovery timeline following treatment for nasal adenocarcinoma varies depending on the treatment modality and individual response. Dogs undergoing radiation therapy experience acute side effects during and shortly after treatment, including nasal discharge, skin changes over the treatment field, and conjunctivitis if the eye is in the radiation field. These acute effects typically peak one to two weeks after completing radiation and then gradually improve over the following two to four weeks. Most dogs tolerate radiation therapy well overall and experience meaningful improvement in nasal symptoms as the tumor responds to treatment. Complete resolution of symptoms is not always achieved, but significant improvement is typical.

Post-treatment care following radiation therapy for nasal adenocarcinoma involves managing acute side effects and monitoring for tumor response. Anti-inflammatory medications and pain relievers keep dogs comfortable during the acute radiation reaction period. Antibiotic therapy may be prescribed if secondary infection develops. Eye medications protect and soothe the eyes if orbital tissues are in the radiation field. Soft, moist foods may be easier to eat if oral mucositis develops. Gentle cleaning of nasal discharge helps maintain comfort. Follow-up imaging, typically several weeks after completing radiation, assesses tumor response and establishes a baseline for monitoring. Regular recheck appointments track ongoing response and watch for recurrence.

Prognosis for dogs with nasal adenocarcinoma treated with radiation therapy is variable but generally guarded to fair. Median survival times with radiation therapy range from approximately twelve to eighteen months in various studies, with some dogs surviving significantly longer. Tumor stage at diagnosis significantly affects prognosis, with dogs having tumors confined to the nasal cavity faring better than those with extensive invasion or cribriform plate involvement. Tumor type, with some histological types responding better than others, also influences outcomes. Complete response to radiation and sustained tumor control correlate with longer survival. Dogs receiving radiation therapy generally have significantly longer survival times than those treated with surgery alone or palliative care.

Long-term outlook for dogs treated for nasal adenocarcinoma requires ongoing monitoring and realistic expectations. Many dogs experience local recurrence eventually, with progression-free intervals varying from months to years depending on individual response. Regular follow-up imaging, typically every three months initially, monitors for recurrence and guides decisions about additional treatment if needed. Quality of life assessment remains important throughout survivorship. Some dogs achieve excellent long-term tumor control and maintain good quality of life for years. Others experience earlier progression requiring treatment adjustments or transition to palliative care. Open communication with the veterinary oncology team helps navigate the post-treatment period and make appropriate decisions as the situation evolves.

Primary prevention of nasal adenocarcinoma in dogs is challenging given incomplete understanding of causative factors, but reducing exposure to potential respiratory carcinogens represents a prudent approach. Maintaining smoke-free environments protects dogs from secondhand tobacco smoke, which has been suggested as a potential risk factor for nasal tumors. Minimizing exposure to urban air pollution where possible and ensuring good indoor air quality through adequate ventilation may reduce inhalation of carcinogenic particles. Being aware of potential occupational or environmental carcinogen exposures and limiting dogs' contact with these substances represents reasonable risk reduction. While these measures cannot guarantee prevention, they address modifiable factors that may contribute to nasal cancer risk.

Breeding considerations for nasal adenocarcinoma prevention relate primarily to skull conformation, as dolichocephalic long-nosed breeds have significantly elevated risk compared to brachycephalic short-nosed breeds. This breed predisposition likely relates to both genetic factors and increased nasal surface area exposure to inhaled substances. While breeders cannot change skull conformation within breeds, awareness of cancer risk helps inform breeding decisions that prioritize overall health. Prospective owners of predisposed breeds should be aware of increased nasal tumor risk as their dogs age. No specific genetic tests for nasal cancer susceptibility are currently available, but general attention to health and longevity in breeding programs supports population health.

Nutritional and lifestyle factors that support overall health may provide indirect benefits for cancer prevention, though specific dietary interventions for nasal cancer prevention are not established. Feeding balanced, high-quality diets supports immune function and cellular health. Maintaining appropriate body weight through diet and exercise promotes overall vitality. Providing regular exercise and mental stimulation supports general wellbeing. Avoiding unnecessary exposure to pesticides, herbicides, and household chemicals that might be inhaled reduces potential carcinogen contact. While these measures are general health recommendations rather than specific nasal cancer prevention, they support the body's ability to resist disease.

Regular health maintenance provides the best opportunity for early detection of nasal tumors when treatment is most likely to be effective. Annual or bi-annual veterinary examinations allow assessment of nasal health and discussion of any concerns. Prompt evaluation of nasal symptoms including discharge, sneezing, and bleeding rather than assuming benign causes ensures early investigation of potential tumors. Owners of predisposed breeds should be particularly vigilant about nasal symptoms as their dogs age. Maintaining awareness of nasal adenocarcinoma symptoms enables earlier recognition and veterinary consultation.

Early intervention when nasal symptoms develop is crucial for maximizing treatment options and outcomes. Owners noticing persistent or recurrent nasal discharge, especially if blood-tinged or unilateral, should seek veterinary evaluation promptly. Chronic sneezing that does not resolve with symptomatic treatment warrants further investigation. Facial swelling or asymmetry should be evaluated urgently. Early-stage nasal tumors confined to the nasal cavity have better prognosis than advanced tumors with extensive invasion. Delaying evaluation allows tumor growth and invasion that worsen prognosis and limit treatment options.

Daily management of a dog with nasal adenocarcinoma requires attention to respiratory comfort, symptom monitoring, medication administration, and quality of life. Keeping the home environment clean and free of airborne irritants including smoke, dust, and strong fragrances reduces additional stress on the respiratory system. Maintaining comfortable temperature and humidity supports easier breathing. Providing soft bedding and comfortable resting spots allows the dog to position themselves for optimal breathing. Medications should be given consistently as prescribed. Daily monitoring of nasal discharge character and amount, breathing effort, appetite, and overall demeanor helps track disease status. Gentle cleaning of the nose helps maintain comfort and airflow.

Home environment modifications support comfort for dogs with nasal tumors. Air purification reduces particulate matter that could irritate the nasal passages. Humidification may help loosen secretions and ease breathing in dogs with crusting. Elevating food and water bowls slightly may make eating and drinking more comfortable. Avoiding strong scents from cleaning products, air fresheners, and other sources reduces nasal irritation. Providing quiet, comfortable spaces for rest away from household activity allows undisturbed sleep. Non-slip flooring helps dogs maintain stability if weakness develops from illness.

Maintaining quality of life is the central goal of management for dogs with nasal adenocarcinoma at any stage of disease. Even dogs with serious illness can experience good quality of life with appropriate symptom management and supportive care. Gentle activities appropriate to the dog's current condition provide mental stimulation and maintain the human-animal bond. Short outings in comfortable weather allow continued enjoyment of outdoor experiences. Favorite foods and activities adapted to any limitations keep dogs engaged and happy. Quality time with family provides emotional support and comfort. Focus on what brings the dog joy and find ways to provide positive experiences within constraints of illness.

Ongoing monitoring for dogs with nasal adenocarcinoma involves regular assessment of respiratory status, local disease, and quality of life indicators. Tracking nasal discharge amount and character helps identify changes that may indicate progression or secondary infection. Watching for new facial swelling, eye changes, or neurological signs identifies potential tumor growth. Monitoring appetite, activity level, and overall demeanor provides quality of life assessment. Scheduled veterinary appointments allow professional evaluation and imaging when indicated. Any sudden changes or new symptoms should prompt veterinary contact.

Caregiver support is essential for owners managing a dog's nasal cancer diagnosis and ongoing treatment. The emotional challenges of caring for a pet with cancer can be significant. Connecting with others facing similar situations through support groups provides emotional support and practical advice. Open communication with the veterinary oncology team about concerns, treatment effects, and goals ensures appropriate care planning. Understanding realistic expectations about disease progression helps prepare emotionally. Planning for end-of-life care in advance allows thoughtful decision-making. Practicing self-care while providing dedicated pet care benefits both owner and dog throughout the disease course.

Dolichocephalic breeds with long, narrow skulls have significantly elevated risk for nasal tumors including adenocarcinoma compared to brachycephalic short-nosed breeds. Breeds commonly reported as predisposed include Collies, Shetland Sheepdogs, German Shepherds, Golden Retrievers, Labrador Retrievers, Airedale Terriers, and other long-nosed breeds. The reasons for this predisposition likely include greater nasal surface area providing more exposure to potential carcinogens and possibly genetic factors associated with skull conformation. Among predisposed breeds, older dogs have highest risk, with most cases occurring in dogs over eight years of age and peak incidence around ten to eleven years.

Moderate risk for nasal adenocarcinoma extends to medium-nosed mesocephalic breeds and mixed breed dogs with heritage from predisposed breeds. Border Collies, Beagles, and many other medium-nosed breeds have intermediate risk. Large dogs overall may have higher risk than small dogs, though size may be confounded with nose length. Mixed breed dogs can develop nasal tumors based on their individual anatomy and genetic background. Male dogs have been reported in some studies to have slightly higher risk than females, though this is not consistent across all reports. Urban dogs may have elevated risk compared to rural dogs due to air pollution exposure.

Screening recommendations for breeds at increased risk of nasal tumors emphasize owner awareness and prompt evaluation of any nasal symptoms. Routine screening imaging is not typically recommended in the absence of symptoms due to the relative rarity of nasal tumors even in predisposed breeds. However, owners of high-risk breeds should be educated about symptoms including nasal discharge, sneezing, and facial changes, and should seek veterinary evaluation promptly if these develop. Regular veterinary examinations provide opportunity to discuss any concerns and assess nasal health. For dogs of predisposed breeds developing nasal symptoms, earlier and more thorough investigation rather than prolonged symptomatic treatment may lead to earlier tumor detection.

Several other nasal tumor types occur in dogs and must be differentiated from adenocarcinoma through histopathological examination. Squamous cell carcinoma is another common nasal epithelial malignancy with similar clinical presentation and behavior. Chondrosarcoma arises from cartilage and may occur in the nasal cavity. Fibrosarcoma and osteosarcoma can also affect nasal and sinus structures. Lymphoma occasionally presents as nasal masses. Transmissible venereal tumor can rarely involve the nasal cavity. These different tumor types may have varying responses to treatment and prognosis, making accurate histopathological diagnosis important for treatment planning and providing appropriate expectations.

Non-neoplastic conditions may present with similar symptoms and must be differentiated from nasal adenocarcinoma. Fungal rhinitis, particularly aspergillosis and cryptococcosis, causes destructive nasal lesions that can mimic cancer both clinically and on imaging. Bacterial rhinitis and secondary infections complicate many nasal conditions. Nasal foreign bodies cause localized inflammation and discharge. Dental disease with oronasal communication produces nasal discharge. Nasopharyngeal polyps are benign growths causing nasal obstruction. Allergic rhinitis causes chronic nasal symptoms. Thorough diagnostic evaluation including imaging and tissue sampling distinguishes cancer from these other conditions.

Potential complications of nasal adenocarcinoma include local tumor progression with destruction of facial bones and invasion of adjacent structures. Orbital invasion causes eye problems including exophthalmos, vision changes, and pain. Extension through the cribriform plate into the brain causes serious neurological complications including seizures, behavior changes, and death. Chronic epistaxis can cause anemia requiring supportive care. Secondary bacterial infections are common and require antibiotic treatment. Aspiration pneumonia may occur if bloody secretions are inhaled. Cachexia and declining body condition accompany advanced disease. Recognition of these complications guides appropriate supportive care and helps inform discussions about prognosis and quality of life.