Can chemotherapy or Tamoxifen worsen nasal polyps?

Question

Hello doctor,

I am a 58-year-old woman currently undergoing treatment for hormone-positive breast cancer, and over the past month, I’ve been dealing with worsening nasal blockage that turned out to be a nasal polyp on my right side.

I have been having constant stuffiness, a reduced sense of smell, and occasional headaches that are making it harder to sleep. My ENT said the polyp measures about 1.8 cm on nasal endoscopy, and the CT scan of my sinuses showed mild mucosal thickening as well.

Since starting chemotherapy, my white blood cell count dropped to 3,200/µL, and I am worried that this low immunity is making the symptoms worse. I have also been experiencing frequent sneezing and watery discharge, which my doctor said may be due to chronic inflammation.

My latest blood test showed an eosinophil count of 8 %, which is slightly high and may be related to the polyp. I was prescribed a nasal steroid spray, but I am unsure if it is safe to use while I am on Tamoxifen.

My recent PET-CT for cancer staging did not show anything serious, but the persistent nasal obstruction is affecting my breathing, especially at night. I am also feeling more tired lately, with a hemoglobin of 10.4 g/dL, and I am not sure if this is from chemo or disturbed sleep.

Could you please help me understand whether nasal polyps can worsen during breast cancer treatment and what steps I should take to manage them safely?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com

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I have read your query and understand your concerns.

Nasal polyps arise from chronic inflammation and are not directly worsened by hormone-positive breast cancer treatment such as Tamoxifen.

However, chemotherapy-related immunosuppression can increase inflammation or infection risk, which may aggravate nasal symptoms.

Nasal steroid sprays are generally safe, effective in reducing polyp size and congestion, and have no known contraindication with Tamoxifen.

Your raised eosinophil count and mucosal thickening indicate ongoing inflammatory activity contributing to the persistence of the polyp.

Management of nasal polyps during chemotherapy focuses on regular use of intranasal corticosteroids, prompt treatment of infections, and close symptom monitoring. Systemic steroids are usually avoided unless necessary, as they may further suppress immunity.

Fatigue and low haemoglobin levels are common during chemotherapy, but can be worsened by poor sleep due to nasal obstruction. Improving nasal airflow may help enhance sleep quality and reduce daytime tiredness.

Nasal polyps are benign inflammatory growths and are not directly caused or worsened by Tamoxifen or breast cancer itself. Although rare cases of sinus metastasis exist, a normal PET-CT (positron emission tomography–computed tomography) makes this highly unlikely in your situation.

Intranasal corticosteroids have minimal systemic absorption and are considered safe for long-term use at prescribed doses. No interactions with Tamoxifen or increased adverse effects have been documented.

Supportive measures such as saline nasal irrigation help remove allergens and inflammatory mediators, improving symptom control. Elevated eosinophils suggest eosinophilic nasal polyposis, which often requires consistent anti-inflammatory treatment.

You should continue your nasal steroid spray and saline irrigation as advised by your ENT (ear, nose, and throat), as they are safe alongside Tamoxifen.

Monitor symptoms closely, report any signs of infection promptly, and maintain regular ENT and oncology follow-up for comprehensive care.

Please get back in touch as further evaluation may be needed.

Thanks and regards.