The Full Story: Nasal Cavity and Paranasal Sinus Cancers

It's Best to Catch These Cancers Early on

head anatomy

Fortunately, malignant neoplasms, or cancerous tumors, of the nasal cavity and paranasal sinuses are relatively rare.

About 3 percent of malignant cancers of the head and neck affect the nasal cavity and paranasal sinuses. Overall, these cancers make up about 0.5 percent of all malignant cancers. Furthermore, men are more likely to fall ill with these cancers, and 4 of 5 people affected are aged 55 years and older.

Just because something is rare, however, doesn't mean that it's unimportant. To those with malignant neoplasms of the nasal cavity and paranasal sinuses--approximately 2000 Americans are newly diagnosed each year--as well as all their loved ones, these cancerous tumors are very serious.

Specifically according to the American Cancer Society, the 5-year survival rates, or percentage of people alive 5 years after an initial diagnosis, of either nasal or paranasal sinus cancers ranges from 35 to 63 percent based on stage or severity.

What Is the Nasal Cavity?

Your nose is connected to your mouth via the nasal cavity.

What Are the Paranasal Sinuses?

Sinuses are spaces or hollow areas in our body. The nasal cavity opens up into four paired paranasal sinuses, which surround the nasal cavity.

The maxillary sinuses are the biggest sinuses rest in the cheek area. Each maxillary sinus flanks the nose itself and lie under the eyes.

The frontal sinuses lie above the eyebrows.

The ethmoid sinuses are a network of interlinking smaller sinuses composed of mucous tissue and thin bones. These sinuses lie between your eyes.

The sphenoid sinuses lie deep in the nose and are behind the eyes.

The sinuses do lots of things including the following:

  • filter and warm air
  • provide support for the skull
  • lighten the skull
  • help produce your voice

Typically, the paranasal sinuses are filled with air. However when infected and inflamed, these sinuses can fill with blood, pus, and mucus--all of which cause discomfort and pain.

Where Do Nasal Cavity and Paranasal Sinus Cancers Grow?

Most nasal cavity and paranasal sinuses occur at the level of the maxillary sinus. Less commonly, these cancers hit the nasal cavity, nasal vestibule (located at the entrance of the nose) and ethmoid sinuses. Rarely do these cancers affect the frontal or sphenoid sinuses.

From Which Cells Do Nasal Cavity and Paranasal Sinus Cancers Arise?

The sinuses and nasal canal are lined by many different types of cells and cellular structures including the following:

  • squamous cells
  • glandular cells and small salivary glands
  • undifferentiated cells
  • melanocytes
  • lymphocytes (immune cells)
  • nerve cells
  • bone cells
  • muscle cells

Any of these cells can give rise to cancer, which explains why both nasal and paranasal cancers can potentially have varied histology, or cellular make-up, and treatment.

For instance, melanoma (a type of skin cancer); sarcoma (bone, muscle or skin cancer); lymphoma (blood cancer involving lymphocytes); and esthesioneuroblastoma (or cancer arising from the olfactory nerve) can all cause nasal and paranasal cancers.

However, many of these diverse cancer types rarely occur. Instead, squamous cell cancer is the most common cause of nasal and paranasal cancers. More than 50 percent of these cancers are derived from squamous cells. The second most common type of nasal cavity or paranasal sinus cancer is adenocarcinoma, which arises from glandular cells.

What Are the Signs and Symptoms of Nasal Cavity and Paranasal Sinus Cancers?

Cancers of the nasal cavity and paranasal sinuses present much the same as noncancerous conditions affecting this area (think upper respiratory infections like cold or flu or sinusitis). Eventually, however, the tumors grow, and exert a mass effect, impinging on nearby anatomical structures like the eyes and brain.

Here are some initial symptoms of nasal cavity and paranasal sinus tumors:

  • runny nose
  • congestion
  • obstruction
  • sinus fullness
  • sinus tenderness

After the tumor grows and eats into surrounding structures, the following can happen:

  • nose bleeding;
  • facial pain;
  • tooth pain (if the tumor grows big enough to press up against the palate, the upper teeth can hurt);
  • eye problems (for example, double vision, impaired eye movement and visual loss)/

Unfortunately, many people who present or are finally referred to an ENT (ear, nose and throat) specialist with nasal cavity and paranasal sinus cancers do so later, after they start experiencing symptoms that either they or their primary care physicians can no longer attribute to cold, flu, sinusitis (sinus infection) or so forth.

In fact, many times these people have tried several courses of antibiotics to no avail. Ultimately, by the time most present with these cancers, the severity increases and the prognosis, or outlook, becomes more guarded.

What Causes Nasal Cavity and Paranasal Sinus Cancers?

Cancers of the nasal cavity and paranasal sinuses are caused by a combination of genetics (think inherited mutations) and environmental exposure.

Several risk factors for head and neck cancers, including nasal cavity and paranasal sinus cancers, have been elucidated. These risk factors make it more likely that a person will develop disease.

Here are some risk factors for these cancers:

  • smoking;
  • alcohol use;
  • dust inhalation (Nickel, leather, textiles, flower and wood);
  • radiation (like radium found in painting dials of watches or radon exposure);
  • glues;
  • formaldehyde;
  • mustard gas;
  • cutting oils;
  • mineral oils;
  • chromium;
  • preserved foods;
  • HPV (human papilloma virus which also causes genital warts);
  • Epstein-Barr virus;
  • Paan (a type of mild stimulant found in India);
  • poor oral health (weak risk factor);
  • Asian ancestry.

Several of these risk factors occur as a result of occupational exposure. For instance, people who work in factories that produce leathers, metals, oils and so forth are at particular risk secondary to exposure resulting from inhalation.

By far, the most common risk factors that give rise to nasal cavity and paranasal sinus cancers are smoking and drinking heavily--especially when combined.

How Are Nasal Cavity and Paranasal Sinus Cancers Diagnosed?

Because the symptoms of nasal cavity and paranasal sinus cancers can be pretty nonspecific--particularly early on--an ENT (ear, nose and throat) physician, or otolaryngologist, will need to directly visualize and biopsy, or sample, the tumor, or mass, to figure out what is.

Before doing or ordering diagnostic tests, a physician will first do a head and neck exam. If tumor is suspected, special attention is paid to results of the eye exam, such as extraocular eye movements.

Furthermore, the sinuses and nasal cavity are examined closely, both by means of visualization and palpation or touch. Specifically, pressing on the areas of the sinuses can elicit pain in case of pathology or disease.

Here are different diagnostic tests that can performed to help diagnose these cancers and plan appropriate treatment:

  • nasal endoscopy (a flexible tube consisting of a camera and light which is used to look inside the nasal cavity)
  • CT
  • MRI
  • X-ray
  • PET scan

Of these tests, X-ray and CT scans are good at determining whether the cancer has spread to structures in the vicinity of the nasal cavity. Whereas, PET scan is used to figure out whether these cancers have spread or metastasized. Obviously, it's worse for the patient when these cancers spread to other parts of the body.

Staging of Nasal Cavity and Paranasal Sinus Cancers

More generally, cancers of the nasal cavity and paranasal sinuses are types of head and neck cancers. As with other types of cancer, head and neck cancers are diagnosed using stages: Stage 0, I, II, III and IV. These stages are further subdivided based on specific characteristics of the tumor. The greater the stage, the more severe the cancer. Moreover, these stages are determined using TNM staging.

The T in TNM stands for primary tumor and refers to the size of the tumor.

The N in TNM stands for lymph node involvement.

The M in TNM stands for metastases or distant spread.

It's rare for cancer of the nasal cavity or paranasal sinuses to spread into the lymph nodes or metastasize and spread to some distant site. However, these tumors can spread into surrounding structures, and if they press into the brain, death can result.

Let's take a closer look at these various stages of head and neck cancer.

  • A Stage 0 cancer is carcinoma in situ and exists only in the place it started. If caught early, Stage 0 cancer is often curable.
  • A Stage 1 cancer has spread throughout the mucosa, or outer layer of the nasal cavity or sinuses, but has yet to penetrate bone. Furthermore, there is no lymph node involvement or metastases present. According to the American Cancer Society between 1998 and 1999, the 5-year survival rate for people with Stage 1 nasal cavity and paranasal sinus cancer was 63 percent.
  • A Stage 2 cancer has made its way into bone. However, Stage 2 cancers have not spread to the lymph nodes or metastasized to distant parts of the body. The 5-year survival rate for people with Stage 2 nasal cavity and paranasal sinus cancers is 61 percent.
  • A Stage 3 cancer can refer to a tumor that has grown into bone and other structure more extensively and hit the lymph nodes. The 5-year survival rate for Stage 3 nasal cavity and paranasal sinus cancers is 50 percent
  • A Stage 4 cancer can refer to a tumor that has spread extensively into surrounding structures and lymph nodes as well as having thrown off metastases. The 5-year survival rate for Stage 4 nasal cavity and paranasal sinus cancers is 35 percent.

Rarely do head and neck cancers--including nasal cavity and paranasal sinus tumors--involve the lymph nodes or throw off distant metastases. However, 20 to 40 percent of people who have these cancers and don't respond to conventional treatment exhibit metastases.

Of note, maxillary sinus cancers--the most common types of nasal cavity and paranasal sinus cancers--have their own specific staging. Maxillary sinus cancers can stay silent for quite a while because the maxillary sinus is big, and it takes time for the cancer to make its way out of this relatively large space.

In addition to being staged, tumors are also graded, or categorized histologically, using tissue and cell samples from biopsy. Lower-grade tumors are well differentiated and higher-grade tumors are less differentiated or undifferentiated. Undifferentiated tumors typically carry worse prognoses because they divide and spread more rapidly than do well-differentiated tumors.

Treatment of Nasal Cavity and Paranasal Sinus Cancers

The treatment of nasal cavity and paranasal sinus cancers depends on the stage or severity of the cancer and your general medical condition.

For instance, an otherwise healthy person with Stage 1 cancer may be cured with surgery alone. However, a person with more advanced disease may need surgery, chemo, and radiation therapy. Finally, in people who have very advanced disease that is incurable, surgery may serve to slow tumor growth and extend survival. In other words, care for people with life-threatening illness can be palliative.

Here are some treatment options for people with these cancers:

  • surgery
  • chemotherapy
  • radiation therapy
  • targeted therapy
  • palliative care

People with more advanced disease may need several types of specialists on board to provide treatments, such as an ENT, neurosurgeon, medical oncologist and radiation oncologist.

If you or a loved one suspects cancer of the nasal cavity or paranasal sinuses, it's imperative that you consult a physician and discuss your concerns. Early on during the course of these cancers, when symptoms are nonspecific, your physician will probably exhibit a low index of suspicion for such cancer--especially because these cancers are rare.

However, if you have family history of such cancer, have been exposed to risk factors, have had symptoms like runny nose or nasal obstruction that don't go away even after rounds of antibiotics or are experiencing visual changes or other problems that indicate tumor spread, it's imperative that you see an ENT or tell your primary care physician that you want to see an ENT.


Fischman ML, Rugo HS. Occupational Cancer. In: LaDou J, Harrison RJ. eds. CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 5e. New York, NY: McGraw-Hill; 2013. 

Mandpe AH. Chapter 17. Paranasal Sinus Neoplasms. In: Lalwani AK. eds. CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e. New York, NY: McGraw-Hill; 2012. 

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