Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:

Subscribers log in here

Paranasal sinus cancer


A range of malignancies can develop in the paranasal (maxillary, ethmoid, sphenoid, frontal) sinuses (figure 1). Adenocarcinoma and squamous cell carcinoma of the maxillary sinus and ethmoid sinus are the most common of these tumors.

The epidemiology, clinical presentation, diagnosis, and management of these tumors are discussed here. Tumors arising in the nasal cavity are discussed separately. (See "Cancer of the nasal vestibule" and "Tumors of the nasal cavity".)


Cancers arising in the paranasal sinuses are rare, constituting approximately 3 percent of head and neck malignancies [1,2]. The majority of these tumors arise in the maxillary sinuses and most of the remainder start in the ethmoid sinuses. Cancers of the sphenoid and frontal sinuses are extremely rare. Paranasal sinus cancers are more frequent in males than females [1].

Factors associated with paranasal sinus cancers include:

Occupational exposures − including leather, textile, wood dust, and formaldehyde [2-6]


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Jun 30, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
  1. Persky MS, Tabaee A. Cancer of the nasal vestibule and paranasal sinus: Surgical management.. In: Head and neck cancer, Third, Harrison LB, Sessions RB, Hong WK (Eds), Lippincott, Williams, and Wilkins, Philadelphia 2009. p.454.
  2. Barnes L, Tse LLY, Hunt JL, et al. Tumours of the nasal cavity and paranasal sinuses: Introduction. In: Pathology and Genetics of Head and Neck Tumours, Barnes L, Eveson JW, Reichart P, Sidransky D. (Eds), IARC, Lyon 2005. p.9.
  3. 't Mannetje A, Kogevinas M, Luce D, et al. Sinonasal cancer, occupation, and tobacco smoking in European women and men. Am J Ind Med 1999; 36:101.
  4. Bonneterre V, Deschamps E, Persoons R, et al. Sino-nasal cancer and exposure to leather dust. Occup Med (Lond) 2007; 57:438.
  5. Battista G, Comba P, Orsi D, et al. Nasal cancer in leather workers: an occupational disease. J Cancer Res Clin Oncol 1995; 121:1.
  6. Luce D, Leclerc A, Bégin D, et al. Sinonasal cancer and occupational exposures: a pooled analysis of 12 case-control studies. Cancer Causes Control 2002; 13:147.
  7. Calderón-Garcidueñas L, Delgado R, Calderón-Garcidueñas A, et al. Malignant neoplasms of the nasal cavity and paranasal sinuses: a series of 256 patients in Mexico City and Monterrey. Is air pollution the missing link? Otolaryngol Head Neck Surg 2000; 122:499.
  8. Zheng W, McLaughlin JK, Chow WH, et al. Risk factors for cancers of the nasal cavity and paranasal sinuses among white men in the United States. Am J Epidemiol 1993; 138:965.
  9. Kim JY, Yoon JK, Citardi MJ, et al. The prevalence of human papilloma virus infection in sinonasal inverted papilloma specimens classified by histological grade. Am J Rhinol 2007; 21:664.
  10. Alos L, Moyano S, Nadal A, et al. Human papillomaviruses are identified in a subgroup of sinonasal squamous cell carcinomas with favorable outcome. Cancer 2009; 115:2701.
  11. Feng YF, Wu QL, Zong YS. Correlation of immunophenotype of sinonasal non-Hodgkin's lymphoma to Epstein-Barr virus infection. Ai Zheng 2007; 26:1170.
  12. Mitarnun W, Suwiwat S, Pradutkanchana J. Epstein-Barr virus-associated extranodal non-Hodgkin's lymphoma of the sinonasal tract and nasopharynx in Thailand. Asian Pac J Cancer Prev 2006; 7:91.
  13. Cantù G, Bimbi G, Miceli R, et al. Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment. Arch Otolaryngol Head Neck Surg 2008; 134:170.
  14. Myers LL, Nussenbaum B, Bradford CR, et al. Paranasal sinus malignancies: an 18-year single institution experience. Laryngoscope 2002; 112:1964.
  15. Guntinas-Lichius O, Kreppel MP, Stuetzer H, et al. Single modality and multimodality treatment of nasal and paranasal sinuses cancer: a single institution experience of 229 patients. Eur J Surg Oncol 2007; 33:222.
  16. Blanco AI, Chao KS, Ozyigit G, et al. Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys 2004; 59:51.
  17. Harbo G, Grau C, Bundgaard T, et al. Cancer of the nasal cavity and paranasal sinuses. A clinico-pathological study of 277 patients. Acta Oncol 1997; 36:45.
  18. Chen AM, Daly ME, Bucci MK, et al. Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: are we making improvement? Int J Radiat Oncol Biol Phys 2007; 69:141.
  19. Cummings Otolaryngology-Head and Neck Surgery, 4th, Cummings CW Jr, Haughey BH, Thomas JR (Eds), Mosby, St. Louis 2004.
  20. Comprehensive Management of Head and Neck Tumors, 2nd, Thawley SE, Panje WR, Batsakis JG, et al (Eds), WB Saunders, Philadelphia 1999.
  21. Loevner LA, Sonners AI. Imaging of neoplasms of the paranasal sinuses. Neuroimaging Clin N Am 2004; 14:625.
  22. Das S, Kirsch CF. Imaging of lumps and bumps in the nose: a review of sinonasal tumours. Cancer Imaging 2005; 5:167.
  23. American Joint Committee on Cancer Staging Manual, 7th ed, Edge SB, Byrd DR, Compton CC, et al (Eds), Springer, New York 2010.
  24. Homma A, Hayashi R, Matsuura K, et al. Lymph node metastasis in t4 maxillary sinus squamous cell carcinoma: incidence and treatment outcome. Ann Surg Oncol 2014; 21:1706.
  25. Bogaerts S, Vander Poorten V, Nuyts S, et al. Results of endoscopic resection followed by radiotherapy for primarily diagnosed adenocarcinomas of the paranasal sinuses. Head Neck 2008; 30:728.
  26. Jansen EP, Keus RB, Hilgers FJ, et al. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys 2000; 48:27.
  27. Robbins KT, Ferlito A, Silver CE, et al. Contemporary management of sinonasal cancer. Head Neck 2011; 33:1352.
  28. Ganly I, Patel SG, Singh B, et al. Craniofacial resection for malignant paranasal sinus tumors: Report of an International Collaborative Study. Head Neck 2005; 27:575.
  29. Porceddu S, Martin J, Shanker G, et al. Paranasal sinus tumors: Peter MacCallum Cancer Institute experience. Head Neck 2004; 26:322.
  30. Jesse RH, Butler JJ, Healey JE, et al. Paranasal sinuses and nasal cavity. In: Cancer of the head and neck, MacComb WS, Fletcher GH (Eds), Williams & Wilkins, Baltimore 1967. p.329.
  31. Vrionis FD, Kienstra MA, Rivera M, Padhya TA. Malignant tumors of the anterior skull base. Cancer Control 2004; 11:144.
  32. McKay SP, Shibuya TY, Armstrong WB, et al. Cell carcinoma of the paranasal sinuses and skull base. Am J Otolaryngol 2007; 28:294.
  33. Howard DJ, Lund VJ, Wei WI. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience. Head Neck 2006; 28:867.
  34. Tiwari R, van der Wal J, van der Waal I, Snow G. Studies of the anatomy and pathology of the orbit in carcinoma of the maxillary sinus and their impact on preservation of the eye in maxillectomy. Head Neck 1998; 20:193.
  35. Van Tuyl R, Gussack GS. Prognostic factors in craniofacial surgery. Laryngoscope 1991; 101:240.
  36. McCaffrey TV, Olsen KD, Yohanan JM, et al. Factors affecting survival of patients with tumors of the anterior skull base. Laryngoscope 1994; 104:940.
  37. Carrau RL, Segas J, Nuss DW, et al. Squamous cell carcinoma of the sinonasal tract invading the orbit. Laryngoscope 1999; 109:230.
  38. Imola MJ, Schramm VL Jr. Orbital preservation in surgical management of sinonasal malignancy. Laryngoscope 2002; 112:1357.
  39. Essig GF, Newman SA, Levine PA. Sparing the eye in craniofacial surgery for superior nasal vault malignant neoplasms: analysis of benefit. Arch Facial Plast Surg 2007; 9:406.
  40. Snyderman CH, Carrau RL, Kassam AB, et al. Endoscopic skull base surgery: principles of endonasal oncological surgery. J Surg Oncol 2008; 97:658.
  41. Tabaee A, Nyquist G, Anand VK, et al. Palliative endoscopic surgery in advanced sinonasal and anterior skull base neoplasms. Otolaryngol Head Neck Surg 2010; 142:126.
  42. Nicolai P, Battaglia P, Bignami M, et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22:308.
  43. Batra PS, Luong A, Kanowitz SJ, et al. Outcomes of minimally invasive endoscopic resection of anterior skull base neoplasms. Laryngoscope 2010; 120:9.
  44. 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; 135:1219.
  45. Futran ND, Mendez E. Developments in reconstruction of midface and maxilla. Lancet Oncol 2006; 7:249.
  46. Cordeiro PG, Santamaria E, Kraus DH, et al. Reconstruction of total maxillectomy defects with preservation of the orbital contents. Plast Reconstr Surg 1998; 102:1874.
  47. Genden EM, Okay D, Stepp MT, et al. Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report. Arch Otolaryngol Head Neck Surg 2003; 129:775.
  48. Kellman RM, Marentette L. The transglabellar/subcranial approach to the anterior skull base: a review of 72 cases. Arch Otolaryngol Head Neck Surg 2001; 127:687.
  49. Solero CL, DiMeco F, Sampath P, et al. Combined anterior craniofacial resection for tumors involving the cribriform plate: early postoperative complications and technical considerations. Neurosurgery 2000; 47:1296.
  50. Ganly I, Patel SG, Singh B, et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27:445.
  51. Janecka IP, Sen C, Sekhar LN, et al. Cranial base surgery: results in 183 patients. Otolaryngol Head Neck Surg 1994; 110:539.
  52. Ganly I, Gross ND, Patel SG, et al. Outcome of craniofacial resection in patients 70 years of age and older. Head Neck 2007; 29:89.
  53. Kassam AB, Prevedello DM, Carrau RL, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors' initial 800 patients. J Neurosurg 2011; 114:1544.
  54. Kono Y, Prevedello DM, Snyderman CH, et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol 2011; 32:77.
  55. Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005; 61:856.
  56. Brizel DM, Light K, Zhou SM, Marks LB. Conformal radiation therapy treatment planning reduces the dose to the optic structures for patients with tumors of the paranasal sinuses. Radiother Oncol 1999; 51:215.
  57. Patel SH, Wang Z, Wong WW, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol 2014.
  58. Hoppe BS, Stegman LD, Zelefsky MJ, et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting--the MSKCC experience. Int J Radiat Oncol Biol Phys 2007; 67:691.
  59. Madani I, Bonte K, Vakaet L, et al. Intensity-modulated radiotherapy for sinonasal tumors: Ghent University Hospital update. Int J Radiat Oncol Biol Phys 2009; 73:424.
  60. Licitra L, Locati LD, Cavina R, et al. Primary chemotherapy followed by anterior craniofacial resection and radiotherapy for paranasal cancer. Ann Oncol 2003; 14:367.
  61. Hoppe BS, Nelson CJ, Gomez DR, et al. Unresectable carcinoma of the paranasal sinuses: outcomes and toxicities. Int J Radiat Oncol Biol Phys 2008; 72:763.
  62. Hanna EY, Cardenas AD, DeMonte F, et al. Induction chemotherapy for advanced squamous cell carcinoma of the paranasal sinuses. Arch Otolaryngol Head Neck Surg 2011; 137:78.
  63. Lee MM, Vokes EE, Rosen A, et al. Multimodality therapy in advanced paranasal sinus carcinoma: superior long-term results. Cancer J Sci Am 1999; 5:219.
  64. Brasnu D, Laccourreye O, Bassot V, et al. Cisplatin-based neoadjuvant chemotherapy and combined resection for ethmoid sinus adenocarcinoma reaching and/or invading the skull base. Arch Otolaryngol Head Neck Surg 1996; 122:765.
  65. Samant S, Robbins KT, Vang M, et al. Intra-arterial cisplatin and concomitant radiation therapy followed by surgery for advanced paranasal sinus cancer. Arch Otolaryngol Head Neck Surg 2004; 130:948.
  66. Yoshimura R, Shibuya H, Ogura I, et al. Trimodal combination therapy for maxillary sinus carcinoma. Int J Radiat Oncol Biol Phys 2002; 53:656.
  67. Nishino H, Miyata M, Morita M, et al. Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy for maxillary sinus carcinoma. Cancer 2000; 89:1925.
  68. Bristol IJ, Ahamad A, Garden AS, et al. Postoperative radiotherapy for maxillary sinus cancer: long-term outcomes and toxicities of treatment. Int J Radiat Oncol Biol Phys 2007; 68:719.
  69. Dulguerov P, Jacobsen MS, Allal AS, et al. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001; 92:3012.
  70. Dirix P, Nuyts S, Geussens Y, et al. Malignancies of the nasal cavity and paranasal sinuses: long-term outcome with conventional or three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2007; 69:1042.
  71. Bhattacharyya N. Factors affecting survival in maxillary sinus cancer. J Oral Maxillofac Surg 2003; 61:1016.
  72. Wiseman SM, Popat SR, Rigual NR, et al. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases. Ear Nose Throat J 2002; 81:510.
  73. Enepekides DJ. Sinonasal undifferentiated carcinoma: an update. Curr Opin Otolaryngol Head Neck Surg 2005; 13:222.
  74. Mendenhall WM, Mendenhall CM, Riggs CE Jr, et al. Sinonasal undifferentiated carcinoma. Am J Clin Oncol 2006; 29:27.
  75. Rischin D, Porceddu S, Peters L, et al. Promising results with chemoradiation in patients with sinonasal undifferentiated carcinoma. Head Neck 2004; 26:435.
  76. Chen AM, Daly ME, El-Sayed I, et al. Patterns of failure after combined-modality approaches incorporating radiotherapy for sinonasal undifferentiated carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2008; 70:338.
  77. Mendenhall WM, Hinerman RW, Malyapa RS, et al. Inverted papilloma of the nasal cavity and paranasal sinuses. Am J Clin Oncol 2007; 30:560.
  78. Melroy CT, Senior BA. Benign sinonasal neoplasms: a focus on inverting papilloma. Otolaryngol Clin North Am 2006; 39:601.
  79. Lawson W, Patel ZM. The evolution of management for inverted papilloma: an analysis of 200 cases. Otolaryngol Head Neck Surg 2009; 140:330.
  80. Guillemaud JP, Witterick IJ. Inverted papilloma of the sphenoid sinus: clinical presentation, management, and systematic review of the literature. Laryngoscope 2009; 119:2466.
  81. Dragonetti A, Gera R, Sciuto A, et al. Sinonasal inverted papilloma: 84 patients treated by endoscopy and proposal for a new classification. Rhinology 2011; 49:207.
  82. Proulx GM, Caudra-Garcia I, Ferry J, et al. Lymphoma of the nasal cavity and paranasal sinuses: treatment and outcome of early-stage disease. Am J Clin Oncol 2003; 26:6.
  83. Hausdorff J, Davis E, Long G, et al. Non-Hodgkin's lymphoma of the paranasal sinuses: clinical and pathological features, and response to combined-modality therapy. Cancer J Sci Am 1997; 3:303.
  84. Logsdon MD, Ha CS, Kavadi VS, et al. Lymphoma of the nasal cavity and paranasal sinuses: improved outcome and altered prognostic factors with combined modality therapy. Cancer 1997; 80:477.
  85. Laskin JJ, Savage KJ, Voss N, et al. Primary paranasal sinus lymphoma: natural history and improved outcome with central nervous system chemoprophylaxis. Leuk Lymphoma 2005; 46:1721.
  86. Thompson LD, Wieneke JA, Miettinen M. Sinonasal tract and nasopharyngeal melanomas: a clinicopathologic study of 115 cases with a proposed staging system. Am J Surg Pathol 2003; 27:594.