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Paranasal Sinus Cancer

(Sinus Cancer)

By Bradley A. Schiff, MD, Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

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Paranasal sinus (PNS) 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.

Although rare in the US, PNS cancer is more common in Japan and among the Bantu people of South Africa. Men over 40 yr 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

Symptoms and Signs

Because the sinuses provide room for the cancer to grow, symptoms usually do not develop until the cancer is well advanced. Pain, nasal obstruction and discharge, epistaxis, diplopia, ear pain or fullness, facial paresthesias, and loose maxillary teeth below the affected sinus result from local pressure of the cancer on adjacent structures. Tumor is sometimes visible in the oral or nasal cavities.


  • 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.


The earlier the 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-yr survival is about 60%.


  • Surgery

  • Often radiation

  • Sometimes chemotherapy

Treatment for most early-stage cancers is complete surgical excision. 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 post operatively. 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.