Nasal Cavity and Paranasal Sinus Cancer

Nasal cavity and paranasal sinus cancer begins in the hollow space inside the nose (the nasal cavity) or in the air-filled spaces around the nose called the paranasal sinuses. These sinuses include the maxillary sinuses in the cheekbones, the frontal sinuses in the forehead, the ethmoid sinuses between the eyes, and the sphenoid sinuses deep behind the nose.

Like other cancers, these can grow into nearby tissue and, in some cases, spread to other parts of the body.

Types & Stages

Several types of cancer can develop in this area, and they can behave very differently. The main types include:

• Squamous cell carcinoma. The most common type, starting in the cells that line the nasal cavity and sinuses.
   
• Salivary-gland type cancers. These include adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma.
   
• Undifferentiated carcinoma. A fast-growing cancer with cells that look very abnormal.
   
• Melanoma. A cancer that starts in pigment-producing cells and can grow and spread quickly.
   
• Esthesioneuroblastoma (olfactory neuroblastoma). A cancer that begins in the nerve linked to the sense of smell.
   
• Lymphoma. A cancer that starts in immune system cells.
   
• Sarcoma. A cancer that starts in muscle, bone, cartilage, or fibrous tissue.

These cancers are not described with a single simple number. Instead, doctors look at:

• The size and location of the tumor
• Whether it has grown into nearby structures, such as the eye socket, mouth, skull base or brain
• Whether it has reached lymph nodes in the neck
• Whether it has spread to other parts of the body

This helps your care team plan the best treatment.

Signs & Symptoms

These cancers are often found because of problems they cause, and symptoms frequently affect just one side.

Visit a doctor if you are experiencing any of these symptoms:

• Ongoing nasal blockage or congestion, often on one side
• Nosebleeds
• Drainage or post-nasal drip
• Facial pain or numbness
• A reduced sense of smell
• Loose or numb teeth
• A lump on the face, the roof of the mouth or inside the nose
• Watery eyes or a bulging eye
• Vision changes
• Ear pressure or hearing loss
• Headache
• Trouble opening the mouth
• A lump in the neck

Many of these symptoms are more often caused by conditions that are not cancer, such as infections. Still, symptoms that do not go away, do not respond to treatment or affect only one side should be checked by a healthcare provider.

Diagnosis

Tests and procedures used to diagnose nasal cavity and paranasal sinus cancer may include:

• Nasal endoscopy. Your doctor uses a thin, lighted tube with a camera to look inside the nose and sinuses.
   
• Biopsy. A small sample of tissue is removed and examined under a microscope by a pathologist. This is the only way to confirm cancer. The sample is often taken during a nasal endoscopy.
   
• Imaging tests. A CT scan, MRI, PET scan, or X-ray may be used to show the size and location of the tumor and whether it has spread.

Treatment

Treatment depends on the type, size and location of the tumor, whether it has spread and your overall health. Surgery is often the main treatment and is commonly combined with radiation therapy and sometimes chemotherapy or other medicines. Your care team can help explain the benefits and risks of each option.

Treatment may include:

• Surgery. Some tumors can be removed through the nose using endoscopic surgery, which uses a thin, lighted tube and leaves no visible scar. Larger or more advanced tumors may require open surgery. Depending on how far the cancer has spread, surgery may also involve the upper jaw, skull base, eye socket, or nearby tissue. Reconstructive surgery may be needed in some cases to help restore appearance and functions such as eating and speaking.
   
• Lymph node removal. Lymph nodes in the neck may be removed if cancer has spread there or is likely to spread.
   
• Radiation therapy. Radiation uses high-energy beams to kill cancer cells. It is often combined with surgery.
   
• Other treatments. Chemotherapy or other medicines may be used in select cases, especially for more advanced cancer.

Clinical trials may also be an option. These studies test new treatments or new ways to use current ones. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of these cancers is not always known. Some factors may raise the risk, including:

• Workplace exposures. Breathing in certain substances at work may increase risk, such as wood dust, leather dust, textile dust, flour, nickel, chromium and mustard gas. Less clear links include glues, formaldehyde and solvents.
   
• Tobacco use. Smoking raises the risk, especially of squamous cell cancer.
   
• HPV. Human papillomavirus (HPV) has been found in some of these cancers, though more research is needed.
   
• Being male. These cancers are more common in men than in women.
   
• Older age. Most people diagnosed are older than 55.
   
• Race. These cancers are reported more often in white people than in Black people.
   
• Prior radiation treatment. People treated with radiation for hereditary retinoblastoma, a childhood eye cancer, have a higher risk.

Having a risk factor does not mean you will develop this cancer, and some people with the disease have no clear risk factors. Talk with your healthcare provider about your personal risk.

Screening

There is no routine or simple screening test to find nasal cavity and paranasal sinus cancers early.

Because these cancers are rare and there is no screening test, it is important to pay attention to your body and report symptoms that do not go away, especially those that affect only one side of the nose or face.

If you have symptoms that are new, lasting, or unusual for you, talk with a healthcare provider about whether further evaluation is needed.

This information is for general education only and is not a substitute for medical advice. Please consult a qualified healthcare provider for diagnosis, treatment recommendations, and guidance based on your personal health history.