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Tumors in the Nose and Sinuses

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sinus anatomy

Last reviewed: October 4, 2026

Introduction

Tumors of the nose and paranasal sinuses are uncommon. They range from benign growths such as inverted papilloma and osteoma to a wide variety of cancers, each with its own behavior. Because the nose and sinuses are hollow, a tumor can grow for a long time before it causes symptoms, and early symptoms resemble those of ordinary sinus problems, so many cancers are found at an advanced stage [1].

Most benign tumors and many cancers can now be removed through the nostrils with endoscopes, with results that compare well to traditional open surgery in experienced hands. Cancers are usually treated with surgery followed by radiation, and some types are treated with chemotherapy first [1, 2, 3]. The sections below cover anatomy, evaluation, the types of tumors and their treatment. A numbered reference list is at the end of the page.

There are four pairs of sinuses surrounding the nasal cavity:

The maxillary sinuses, the largest of the paranasal sinuses, are under the eyes, in the maxillary bones.
The frontal sinuses, superior to the eyes, in the frontal bone, which forms the hard part of the forehead.
The ethmoidal sinuses, which are formed from several discrete air cells within the ethmoid bone between the nose and the eyes.
The sphenoidal sinuses are located behind (posterior to) the ethmoid sinuses, in the sphenoid bone.

The paranasal air sinuses are lined with respiratory epithelium (ciliated pseudostratified columnar epithelium), which has microscopic cilia, which are fingerlike projections that move in a coordinated fashion to sweep mucus over the surface toward the nasal cavity.

The nasal cavity is the air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities. Each nasal cavity is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract. The nasal cavity is divided in two by the vertical nasal septum. On the side of each nasal cavity are three horizontal outgrowths called turbinates, the inferior, middle, and superior turbinates. These turbinates warm and humidify airflow before it reaches the throat and lungs. The turbinates also disrupt the airflow, directing some air toward the olfactory epithelium between the middle turbinates and the septum.

Cancers of the paranasal sinuses comprise approximately 0.2% of all malignancies. About 80% of these malignancies arise in the maxillary sinus. Men are much more often affected than women. They most often occur in the age group between 40 and 70 years. Carcinomas are more frequent than melanomas and sarcomas. Metastases to the sinuses from a cancer starting elsewhere are rare.

In a SEER analysis of 13,295 patients with sinonasal cancer in the United States, the yearly incidence was about 0.8 per 100,000 people, 59% of patients were men, the nasal cavity was the most common site (46%) followed by the maxillary sinus, and squamous cell carcinoma was the most common type (42%) [4].

Workplace and other risk factors

Some occupational exposures are well-established causes, which partly explains why men are affected more often [1, 5]:

Wood dust, especially hardwood dust, is strongly linked to adenocarcinoma, which typically starts in the ethmoid sinuses. In several European countries this cancer is recognized as an occupational disease.
Leather dust, as in shoemaking, is also linked to adenocarcinoma.
Nickel and chromium compounds, welding fumes and some solvents are linked mainly to squamous cell carcinoma.
Formaldehyde, textile dust and tobacco smoke also contribute.

A work history is therefore part of the evaluation.

evaluation of sinonasal tumors

Because tumors within the nose or sinuses are not easily seen, they are often identified after significant growth has occurred. The symptoms that typically indicate a problem include nosebleeds, nasal airway blockage (especially if one sided and progressively worse), numbness on the cheek skin, double vision, excessive tearing from one eye (epiphora), difficulty opening the mouth widely (trismus), teeth not fitting together well (malocclusion), or development of a neck mass from spread to a neck lymph node. Physical exam, fiberoptic endoscopy, and imaging (CT, MRI, and/or PET-CT scan), and biopsy are commonly performed for evaluation, before a treatment strategy can be outlined.

Nasal endoscopy, with a thin scope placed in the nose in the office, shows the tumor directly. CT shows bone and is used to plan surgery. MRI is better for soft tissue, nerves, the eye socket, the skull base and the brain, and helps tell tumor apart from mucus trapped in a blocked sinus; the two are often used together [1, 3]. Imaging is done before a biopsy because some masses, such as a juvenile angiofibroma or brain tissue protruding into the nose (encephalocele), can bleed heavily or leak spinal fluid if biopsied without planning [1]. One-sided blockage that keeps getting worse, nosebleeds, or new numbness of the cheek or double vision call for a look inside the nose rather than repeated treatment for sinusitis (see sinusitis and CT).

types of sinonasal tumors

Benign sinonasal tumors include papillomas (inverting, fungiform, and cylindrical cell subtypes), osteomas (boney growths). Malignant (cancerous) sinonasal tumors include squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, and less commonly melanoma, sarcoma, or neuroendocrine cancers.

Benign tumors

Inverted papilloma is a benign growth of the nasal lining that tends to come back if not completely removed, can push into nearby bone, and occasionally turns into cancer or occurs alongside one. A meta-analysis of 14 studies found that endoscopic surgery lowered the risk of recurrence by about 44% compared with open surgery [6], and a 2023 series of 139 patients treated endoscopically reported a recurrence rate of 5.8% [7]. Reported rates of cancer arising in or with inverted papilloma range from under 1% to about 6.5%: in a Finnish series of 296 patients, only 0.7% later developed sinonasal cancer [8], while the series above found 6.5% [7]. Long-term follow-up with nasal endoscopy is recommended.
Osteoma is a slow-growing bony growth, most often in the frontal or ethmoid sinus, usually found by chance on a CT scan. Most are watched; surgery is considered when one blocks a sinus, causes symptoms, grows, or approaches the eye socket or brain [1].
Juvenile nasopharyngeal angiofibroma is a benign but very vascular tumor that occurs almost only in adolescent boys, causing one-sided blockage and nosebleeds. It is diagnosed with imaging rather than biopsy and is usually removed endoscopically after its blood supply is blocked (embolization).

Cancers

Squamous cell carcinoma, the most common type, often in the nasal cavity or maxillary sinus [4].
Adenocarcinoma, often in the ethmoid sinuses and linked to wood and leather dust [1].
Olfactory neuroblastoma (esthesioneuroblastoma), which starts in the lining responsible for smell high in the nose and is staged with the Kadish system (A, limited to the nasal cavity; B, extending into the sinuses; C, extending beyond the sinuses; D, spread to lymph nodes or distant sites). It generally has a more favorable outlook than other sinonasal cancers.
Adenoid cystic carcinoma, a salivary-type cancer known for slow growth, spread along nerves and late recurrence (see salivary gland).
Mucosal melanoma and sinonasal undifferentiated carcinoma (SNUC), uncommon and aggressive types that are often treated with chemotherapy or immunotherapy in addition to surgery and radiation [1, 3].

Because these cancers behave so differently, an accurate diagnosis by an experienced head and neck pathologist, sometimes with molecular testing, is essential before treatment is planned.

Treatment for SINONASAL TUMORS

Benign tumors, such as inverted papilloma, are usually treated surgically, and with an endoscopic approach if the tumor location and extent is favorable. A benign sinus osteoma is typically not treated unless it is blocking the outflow of a sinus. Malignant tumors, when treatment is intended for cure, are often treated with surgery followed by radiation therapy or chemotherapy plus radiation therapy. Depending on the location of the tumor, the surgical defect may require tissue reconstruction or use of a special denture called an obturator.

Endoscopic or open surgery

Over the past two decades, endoscopic surgery through the nostrils has replaced open craniofacial resection for many sinonasal cancers [1]. At MD Anderson Cancer Center, 120 patients with sinonasal cancer treated endoscopically, with or without a small added craniotomy, had five- and ten-year disease-specific survival of 87% and 80% [2]. Comparisons with open surgery have found similar survival with fewer complications and shorter hospital stays after endoscopic surgery [9], including in a matched comparison limited to advanced T4 tumors involving the skull base [10] and in a 2025 comparison of the two largest European cohorts [11]. These are observational studies of selected patients treated at expert centers. Whatever the approach, the most important goal is complete removal with clear margins. Open or combined surgery remains the better choice when a tumor involves the eye, the facial skin, the palate or the brain beyond what can be safely reached through the nose [1]. More information is on the sinus surgery page.

Radiation and chemotherapy

Radiation after surgery is recommended for most sinonasal cancers that are larger, higher grade or close to the margins. Proton therapy can reduce the dose to the eyes, optic nerves and brain and is used at some centers, although the evidence comes from small studies because these tumors are rare [3]. Chemotherapy before surgery or radiation (induction chemotherapy) is used for some advanced squamous cell carcinomas and for SNUC; how well the tumor responds helps decide the next step and may allow the eye to be preserved. The Italian SINTART 1 study showed that combining induction chemotherapy, surgery and photon, proton or carbon ion radiation is feasible, with better results in patients whose tumors responded [12]. Treatment at a center with a multidisciplinary skull base team is recommended [3].

Outcomes

In the SEER analysis, five-year disease-specific survival for all sinonasal cancers was 54%, highest for nasal cavity tumors (67%) and lowest for tumors involving several sinuses (38%) [4]. Olfactory neuroblastoma, adenocarcinoma and adenoid cystic carcinoma generally do better, while mucosal melanoma and SNUC do worse [1]. These figures describe large groups and do not predict an individual result.

additional links

Link to interactive American Cancer Society site with text and illustrations on sinonasal cancer.

Summary

Sinonasal tumors are uncommon; wood dust, leather dust and nickel are important workplace causes [1, 5].
One-sided blockage, nosebleeds, cheek numbness or double vision deserve an endoscopic exam and imaging, with CT and MRI often used together [1].
Inverted papilloma is benign but can recur and rarely becomes cancer; endoscopic removal lowers recurrence [6, 8].
Many sinonasal cancers can be removed endoscopically with outcomes similar to open surgery at experienced centers, usually followed by radiation [2, 11].
Outcome depends strongly on the tumor type and stage [4].

References

Llorente JL, López F, Suárez C, et al. Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances. Nat Rev Clin Oncol. 2014;11(8):460-72. doi:10.1038/nrclinonc.2014.97 PubMed 24935016
Hanna E, DeMonte F, Ibrahim S, et al. Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg. 2009;135(12):1219-24. doi:10.1001/archoto.2009.173 PubMed 20026819
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. Version 2.2026. nccn.org
Dutta R, Dubal PM, Svider PF, et al. Sinonasal malignancies: A population-based analysis of site-specific incidence and survival. Laryngoscope. 2015;125(11):2491-7. doi:10.1002/lary.25465 PubMed 26228792
d'Errico A, Zajacova J, Cacciatore A, et al. Exposure to occupational hazards and risk of sinonasal epithelial cancer: results from an extended Italian case-control study. Occup Environ Med. 2021;78(5):323-329. doi:10.1136/oemed-2020-106738 PubMed 33115924
Kim JS, Kwon SH. Recurrence of sinonasal inverted papilloma following surgical approach: A meta-analysis. Laryngoscope. 2017;127(1):52-58. doi:10.1002/lary.26222 PubMed 27531693
Yeom S, Lee DH, Lim SC. Clinical outcomes of sinonasal inverted papilloma: a retrospective analysis of 139 cases. J Laryngol Otol. 2023;137(10):1154-1157. doi:10.1017/S0022215123000361 PubMed 36876322
Viitasalo S, Ilmarinen T, Aaltonen LM, et al. Sinonasal inverted papilloma - malignant transformation and non-sinonasal malignancies. Laryngoscope. 2023;133(3):506-511. doi:10.1002/lary.30128 PubMed 35383941
Eloy JA, Vivero RJ, Hoang K, et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope. 2009;119(5):834-40. doi:10.1002/lary.20186 PubMed 19296496
Schur S, Hanna EY, Su SY, et al. Long-term oncological outcomes for endoscopic endonasal versus open surgical approaches for anatomically matched, locally advanced stage T4 sinonasal malignancies with skull base involvement. J Neurosurg. 2024;140(3):688-695. doi:10.3171/2023.7.JNS23786 PubMed 37877981
Chatelet F, Chevret S, Vinciguerra A, et al. Matching-adjusted indirect comparison of endoscopic and craniofacial resection for the treatment of sinonasal cancer invading the skull base. Eur J Cancer. 2025;220:115382. doi:10.1016/j.ejca.2025.115382 PubMed 40154209
Resteghini C, Castelnuovo P, Nicolai P, et al. The SINTART 1 study. A phase II non-randomised controlled trial of induction chemotherapy, surgery, photon-, proton- and carbon ion-based radiotherapy integration in patients with locally advanced resectable sinonasal tumours. Eur J Cancer. 2023;187:185-194. doi:10.1016/j.ejca.2023.03.033 PubMed 37164774

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