Paranasal sinus cancer is rare. It usually is squamous cell carcinoma but can also be adenocarcinoma, and it occurs most often in the maxillary and ethmoid sinuses. In most cases its cause is not known, symptoms develop late, and survival is generally poor.
(See also Overview of Head and Neck Tumors.)
Although rare in the United States, paranasal sinus cancer is more common in Japan and among the Bantu people of South Africa (1). Males over 40 years are affected most often.
The cause is uncertain, but chronic sinusitis is not believed to be a cause. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) may play a role in some cases. Risk factors include
Regular inhalation of certain types of wood, leather, and metal dust
Smoking tobacco
General reference
1. Rikitake R, Mizushima Y, Yoshimoto S, et al. Current status of head and neck sarcomas in Japan in 2016-2019: an analysis using the national cancer registry. Int J Clin Oncol 2024;29(5):564-570. doi:10.1007/s10147-024-02484-5
Symptoms and Signs of Paranasal Sinus Cancer
Because the sinuses provide room for the cancer to grow, symptoms usually do not develop until the cancer is well advanced. The following symptoms result from local pressure of the cancer on adjacent structures:
Pain
Nasal obstruction and discharge
Epistaxis
Diplopia
Ear pain or fullness
Facial paresthesias
Loose maxillary teeth below the affected sinus
Tumor is sometimes visible in the oral or nasal cavities.
Diagnosis of Paranasal Sinus Cancer
Endoscopy, with biopsy
CT and MRI
Endoscopy, CT, and MRI are most often used to locate and help stage the tumor. Biopsy confirms the cell type. Staging, which includes assessing tumor spread to the brain, face, neck, lungs, and lymph nodes, helps determine treatment.
Treatment of Paranasal Sinus Cancer
Surgery
Often radiation
Sometimes chemotherapy
Treatment for most early-stage paranasal sinus cancers is complete surgical excision (1). Recent advances in surgical techniques, particularly endoscopic techniques, can sometimes achieve complete tumor excisions, spare surrounding tissues, and achieve reconstruction.
If risk of recurrence is high, radiation therapy is given postoperatively. If surgical excision is not realistic or would cause excessive morbidity, radiotherapy plus chemotherapy may be used.
In some cases, chemotherapy is given to shrink the tumor; if the tumor responds well to the chemotherapy, it is resected surgically. If not, the tumor can be treated with radiation.
Treatment reference
1. National Cancer Institute: Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®)–Health Professional Version. updated July 2024.
Prognosis for Paranasal Sinus Cancer
The earlier paranasal sinus cancer is treated, the better the prognosis. Prognosis also depends on histology. Survival is improving but remains generally poor. Overall, about 40% of people will have recurrent disease, and 5-year survival is about 60% (1).
Prognosis reference
1. American Cancer Society medical and editorial content team: Nasal Cavity and Paranasal Sinus Cancer: Survival rates for Nasal Cavity and Paranasal sinus Cancers. Updated March 1, 2023. Accessed July 30, 2024.
