In October 2023, shortly after uprooting from her long-term home in Essex, Massachusetts, Barbara Doyle, then 70, started experiencing massive nosebleeds. Doyle and her husband, Craig, had just moved to Snohomish, Washington, to be closer to their first grandchild, Auggie, their son, Adam, and his husband, James.
Doyle thought a difference in air moisture levels in the Pacific Northwest was causing the nosebleeds, but when they kept happening, she decided to go to urgent care. Finding nothing obvious, the doctors there referred her to an ear, nose and throat expert (ENT).
The ENT thought there might be a polyp in her sinus and scheduled her for surgery. On a trip back to Essex to see family before the surgery, Doyle experienced an unstoppable nosebleed.
Her son-in-law James, a primary care physician, took her to the ER, where they inserted a device called a rhino rocket — which swells upon contact with moisture to provide gentle, firm compression — and kept her overnight.
An ENT in Essex said she should see her Seattle-area specialist immediately upon her return.
“He told me, ‘Polyps don’t bleed like this,’” Doyle said. “In retrospect, I think he was preparing me for something worse.”
Instead of surgery to remove a polyp, the Seattle ENT ordered a biopsy, which revealed that Doyle had sinonasal squamous cell carcinoma, an extremely rare cancer of the sinuses.
“We were all stunned and taken aback,” Doyle said. “It felt surreal. My son was speechless. My son-in-law wanted me to have the best possible care, so he called Dr. Ian Humphreys, an ENT and sinus cancer expert at UW Medicine, who saw me immediately.”
“Barbara’s case is an example of how a common problem like a nosebleed can signify a more serious concern,” said Humphreys. “Her experience was severe. We met at a time where the tumor had progressed to surrounding structures, but I was confident that we could surgically remove this cancer safely as that provides the best chances for cure when combined with additional therapy.”
As with many rare cancers, there is not a lot of data on sinonasal squamous cell carcinoma, Humphreys said, and it’s not known exactly why these cancers develop. Her tumor lay immediately against her right tear duct, within the sinuses, and had eroded bone in her skull extending to the outer layer of the brain (called the dura mater, Latin for “tough mother”).
After determining there was no evidence that the cancer had spread, they planned the delicate surgery.
“Dr. Humphreys got the entire tumor and didn’t touch my eye or brain,” Doyle said. “He’s my lifesaver. He even had a neurosurgeon stand by, just in case. I’m so impressed with their care.”
To eliminate any remaining cancer cells, radiation and chemotherapy were prescribed as next steps to decrease the chances of recurrence. Receiving the two treatments concurrently is often the preferred way to treat these rare types of sinus cancer. Because the sinus area contains many critical organs, Doyle’s care team recommended proton therapy, which can precisely target areas at risk of harboring cancer cells while avoiding radiation to surrounding healthy tissue like her eyes, ears and brain.
Six weeks after surgery, she started weekly chemotherapy and daily proton therapy on the UW Medicine - Northwest campus.
“Everyone at the proton therapy center was so kind and so wonderful and so supportive,” Doyle said. “They made me feel comfortable with the experience, even when they fitted me for a mask that made me feel like Hannibal Lecter and was a bit frightening. But my radiation oncologist, Dr. Jay Liao, put me at ease. He kept telling me how well I was doing, how strong I was. I asked ‘Can I survive this?’ and he said ‘Yes, you can!’ It felt like I’d come to Washington for a reason.”
“Barbara had a cancer that was in a very challenging location to treat,” Liao said. “Her treatment required a delicate balance of treating the cancer aggressively to provide the best chances for cure, while minimizing the potential for side effects. We are fortunate to have a very collaborative and skilled multidisciplinary team, experienced in navigating each of the steps of treatment — from carefully planned endoscopic surgery to the precise delivery of proton radiation and concurrent chemotherapy. This can be intensive and requires a lot of supportive care. Barbara was really an inspiring individual. She always impressed me with her unwavering positive attitude and outlook.”
Doyle said she considers herself lucky to have had very few side effects from treatment. She lost her eyebrows and eyelashes, and a small spot of hair at her nape, but they’ve all grown back since then. She experienced sensitivity in her mouth and still suffers from dry mouth but considers it manageable.
Even the chemotherapy had few side effects, she said, not even nausea.
“I felt ravenous because I was also receiving steroids,” she said.
Doyle finished treatment on October 31, 2024, “graduating” from treatment by ringing the bell in the proton facility’s lobby and receiving a challenge coin with her unique graduating number and certificate. She also received an origami crane ornament made by a previous patient.
“It was all as reassuring and supportive as it could have been during such a difficult time for patients and families,” she said.
Since then, Doyle and all her family have moved back to Massachusetts, and she spends a lot of time with Auggie. She receives regular MRI scans as follow-up care and so far, everything looks clear.
Doyle’s family acted as her caregivers, which was a change for Doyle, who is the main caregiver for her husband, who suffers from MS and a bad back.
“You do really need someone to lean on, to have someone who’s there to be supportive, someone to hold your hand and listen to you cry,” she said. “But you must remain positive. Positive energy will help you through this. Even if you have an occasional bad experience, try to be strong. Sometimes you will feel sorry for yourself, but then it’s good to rally. That’s why it’s good to have lots of supportive people around you.”
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