Understanding Nasal Cavity and Paranasal Sinus Cancers

It's possible for you to be diagnosed with cancer of the nose, or nasal cavity, and the four paranasal sinuses that surround it. It is a relatively rare type of cancer, though, accounting for between 3% and 5% of all head and neck cancer cases in the United States each year.

These head and neck cancers account for just 4% of cancers overall, so the nasal and paranasal sinus subtypes are a tiny fraction of them. They typically affect older people, with 80% of cases seen in those aged 55 and older, and are seen more often in people assigned male at birth.

This article discusses these cancers, their symptoms, and their possible causes. It also explains how nasal cavity and paranasal sinus cancers are diagnosed and treated.

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How Nasal Sinuses Work

A sinus is a space or hollow area in your body that doesn't hold or transport other contents, such as the blood within your veins. There are sinuses in the heart and other parts of the body too, but most people mean the nasal cavity and its four paired paranasal sinuses. These sinuses are called:

  • Maxillary sinuses, the largest type found on either side of the nose and under the eyes
  • Frontal sinuses, found above the eyebrows
  • Ethmoid sinuses, a linked network of smaller sinuses between your eyes
  • Sphenoid sinuses, found deep in the nose and behind the eyes

Healthy paranasal sinuses are typically filled with air, though they can be filled with mucus and other contents due to an infection or inflammation. This can interfere with the function of your sinuses, which includes filtering and warming the air you breathe and providing support for the skull.

Where Cancer Grows

The maxillary sinus is the most common site for nasal cavity and paranasal sinus cancers, and up to 90% of these cases are diagnosed as squamous cell carcinoma.

Less often, a cancer will affect the nasal cavity, the vestibule at the entrance of the nose, or the ethmoid sinuses. Rarely are these cancers found in the frontal or sphenoid sinuses.

Apart from the squamous cells, the sinuses and nasal passage are made up of many other types of cells. They include bone, nerve, and muscle cells, as well as melanocytes (skin cells) and the lymphocytes found in your immune system.

For this reason, many types of cancers affecting the sinuses can arise. Some examples include:

  • Melanoma, a type of skin cancer 
  • Sarcoma, which can affect bone, muscle, or skin
  • Lymphoma, a blood cancer involving your lymphocytes
  • Olfactory neuroblastoma, the most common (though rare) nasal cavity cancer in children

Most of the nasal cavity and paranasal sinus cancers are diagnosed as squamous cell carcinoma. Adenocarcinomas, which arise from gland structures and systems in your body, like your salivary glands, are the next most-common type.

Symptoms

One complication with the nasal cavity and paranasal sinus cancers is that many of the early symptoms are much the same as those you might find with a common cold or flu. They include:

Because these symptoms are so common, many people with these cancers do not seek treatment until a later stage when the cancer has advanced. In fact, a 2021 study of 184 of these cancer cases in Pakistan found more than 70% were initially diagnosed with stage IV disease.

At that point, the cancer has spread to nearby structures such as the eyes. It may cause more serious symptoms, such as nose bleeds or tooth pain, that cause people to see a healthcare provider.

Causes

Cancers of the nasal cavity and paranasal sinuses are caused by several factors. Among them are genetic changes, or mutations, you may have inherited.

Environmental exposure may also raise the risk of developing these cancers. In some cases, these exposures are linked to materials found in the workplace. They include:

  • Dust inhalation (nickel, chromium, leather, textiles, flour and wood)
  • Radiation (like radium found in painting dials of watches or radon exposure)
  • Glues and mineral oils
  • Formaldehyde

Lifestyle factors also may play a role. Smoking and alcohol use are known to be major risk factors for these cancers.

Some cases of nasal cavity and paranasal sinus cancers may be linked to another health condition. The link between human papillomavirus (HPV) and oral cancers is well-established, for example, but HPV also may contribute to these nasal and paranasal cancers too.

There is some research evidence linking the Epstein-Barr virus with a risk of these cancers, but scientists continue to try to better understand this relationship.

An underlying health condition, such as human papillomavirus (HPV) infection, may contribute to your risk of developing oral and nasal cavity cancers.

Diagnosis

The symptoms of nasal cavity and paranasal sinus cancers can seem much like those of another condition, especially in the early stages. Your healthcare provider will need to take a complete medical history, perform a physical exam, and rely on diagnostic test results.

An ENT specialist, or otolaryngologist, may pay special attention to the results of:

  • Eye exams and eye motion, when a tumor is suspected
  • Any pain when pressing on, or palpating, the sinuses
  • A direct visual inspection, assisted by imaging technologies
  • The results of a tissue sample, or biopsy, of the site

Some of the imaging tests that may be used to confirm a nasal cavity cancer include:

A PET scan can be used to both diagnose a new cancer and see if, and how much, it has spread. It also can be used later to reassess a cancer to see how well treatment is working.

Staging

Cancers of the nasal cavity and paranasal sinuses are types of head and neck cancers. As with other types of cancer, a key part of the diagnosis rests on how much the cancer has grown and spread, also called its stage (Stage 0, I, II, III, and IV).

The TNM staging method is commonly used to describe the characteristics of a tumor. When using it:

  • The T stands for tumor and refers to the size of the primary tumor.
  • The N stands for lymph nodes, and any spread found in your lymphatic system.
  • The M stands for metastases, or the spread to more distant parts of the body.

The greater the stage, the more severe the head and neck cancer. In these stages:

  • Stage 0 cancer is carcinoma in situ and exists only in the place it started. If caught early, Stage 0 cancer is often curable.
  • Stage 1 cancer has spread throughout the mucosa, or outer layer of the nasal cavity or sinuses, but has yet to penetrate bone. There is no lymph node involvement or spread of the cancer.
  • Stage 2 cancer has made its way into bone. It has not spread to lymph nodes or distant body regions parts of the body.
  • Stage 3 cancer can refer to a tumor that has grown into bone and other structure more extensively and hit the lymph nodes.
  • Stage 4 cancer has spread a great deal to nearby structures and has metastasized.

Rarely do head and neck cancers—including nasal cavity and paranasal sinus tumors—spread to lymph nodes or distant body parts. However, that is the case in 20% to 40% of people who have these cancers but don't respond to conventional treatment.

Maxillary sinus cancers—the most common types of nasal cavity and paranasal sinus cancers—may go undetected for a long time. It's one reason why there are additional subtypes and steps in staging for these cancers.

Treatment

The treatment of nasal cavity and paranasal sinus cancers will depend on several factors. They include your overall health, as well as the stage and spread of the cancer.

An otherwise healthy person with stage 1 cancer may be cured with surgery alone, while a more advanced cancer may require other cancer treatment options. These treatments may include:

In people who have very advanced and incurable disease, treatment may be palliative with the goal of slowing the cancer's growth and extending quality of life.

Summary

Head and neck cancers are relatively rare when compared with the rates of other cancer types. The subset of nasal cavity and paranasal sinus cancers is even more rare, with maxillary sinuses most affected.

With these cancers, the typical symptoms are much like the common cold or similar respiratory infection. People often don't seek medical help until these symptoms persist for quite some time without going away. It's for this reason that many people with nasal cavity and paranasal sinus cancers receive a late diagnosis.

However, the earlier a diagnosis is made, the faster people receive appropriate care. This may lead to better outcomes and improve their chances of survival.

A Word From Verywell

Nasal cavity and paranasal sinus cancers are rare, and your healthcare provider may not initially suspect them. Be sure to raise your concerns, especially if you have exposures that create a risk, a family history of such cancer, or symptoms like a runny nose that doesn't go away.

Frequently Asked Questions

  • What Are the Survival Rates for Nasal Cavity Cancers?

    As of March 2022, the 5-year survival rate for people who have a localized cancer (one that hasn't spread) is 85%. For people with some spread near the site, it's 52%. Among people who have a nasal cavity and paranasal sinus cancer diagnosis with spread to lymph nodes and distant regions of the body, the 5-year survival rate is 42%.

  • Can Nasal Cavity and Paranasal Sinus Cancers Be Treated on a Genetic Basis?

    Research to identify the genetic changes involved in these cancers is ongoing, but there are not yet as many kinds of gene-based drug treatment options that exist for breast, lung, and other types of cancer. Combination approaches with immune checkpoint inhibitors, such as anti-PD-1 antibodies, and other targeted drug agents may one day improve treatment outcomes.

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