Treatment of Nasal Cavity and Paranasal Sinus Cancers, by Type and Stage

Most of the time, treatment of nasal cavity or paranasal sinus cancer is based on where it is and its stage (how far it has spread). But other factors, such as a person’s overall health and personal preferences, could also affect treatment options. Talk to your doctor if you have any questions about the treatment plan they recommend.

The staging of nasal cavity and paranasal sinus cancer is very complex. At this time, staging systems have only created for the most common cancers – maxillary sinus and nasal cavity/ethmoid sinus cancers. Treatment choices for less common cancers of the nasal cavity and paranasal sinuses are tailored to each patient depending on the tumor type, size, location, and the patient’s general medical condition and wishes.

Because nasal cavity and paranasal sinus cancers are rare, they've been hard to study well. Most experts agree that treatment in a clinical trial should be considered for any type or stage of nasal cavity and paranasal sinus cancer. That way people can get new treatments that are being studied.

What are treatment options for maxillary sinus cancer?

Stages 0, I, and II maxillary sinus cancer

The first step in treating most stage 0, I, or II maxillary sinus cancers is surgery to remove the cancer. In most cases, a maxillectomy (removal of bone and mucosa of the maxillary sinus) is done. Lymph nodes in the neck aren't removed.

Radiation might be needed after surgery for people with stage I and II cancers, if the cancer has features that make it more likely to come back, such as positive margins (cancer cells found at the edge of the removed tumor), or cancer growing into the area around the nerves (called perineural invasion).

Radiation is often recommended after surgery for adenoid cystic cancers, even if the margins are negative and there's no perineural invasion, because they have a high chance of coming back after treatment.

For some aggressive types of maxillary sinus tumors, such as undifferentiated cancer or esthesioneuroblastoma, chemotherapy might be recommended along with radiation treatment.

In cases where surgery to remove the cancer would be risky because of other medical problems, treatment may be radiation therapy alone or chemo given with the radiation.

Stages III and IV maxillary sinus cancer 

Stages III and IVA: People with stages III or IVA maxillary sinus cancer will have surgery to remove the tumor. If there are signs that the cancer has spread to the lymph nodes in the neck, these lymph nodes are removed as well. (This is called a neck dissection.)

After surgery, the area where the tumor had been removed is treated with radiation therapy. Sometimes the lymph nodes in the neck are also treated with radiation. This is more likely if the cancer has spread to a neck lymph node or if there are features that make it more likely the cancer will come back, such as a positive margin (cancer found at the edge of the removed tumor). Chemo may be given along with the radiation therapy. This has more side effects than getting either treatment alone, but it may help reduce the risk that the cancer will come back after treatment.

Stage IVB: Some cancers are stage IVB because the main tumor or the lymph nodes cannot be removed completely with surgery (are not resectable ). People with these cancers might be treated with radiation therapy alone, radiation with chemotherapy, or chemotherapy first then radiation, or chemotherapy first then chemo given with radiation. Radiation might also be given with targeted therapy. Surgery sometimes helps relieve sinus blockage, but it's not meant to cure or completely remove the cancer.

Stage IVB also includes some cancers where the main tumor and lymph nodes can be removed with surgery (is resectable). These cancers are treated like stage IVA cancers – surgery to remove the tumor and neck lymph nodes, followed by radiation and maybe chemo.

Stage IVC: These cancers have spread to organs beyond the head and neck, like the lungs or bones. The goal of treatment is usually to stop or slow the spread of the cancer for as long as possible and to help relieve any symptoms it may be causing.

Treatment for this stage varies, depending on where the cancer is, the problems it's causing, and a person’s general health. Chemo (or targeted therapy) is often the main form of treatment if a person can tolerate it because it reaches almost all parts of the body. Another option might be immunotherapy, either alone or along with chemo. Radiation therapy may be directed at areas of cancer that are causing problems. Because these cancers are very rare and hard to treat, clinical trials are a good option.

What are treatment options for nasal cavity cancer?

Stages 0, I, and II nasal cavity cancer

These cancers are in the nasal cavity but haven't spread to lymph nodes. They can be treated with surgery or radiation, but radiation after surgery is often recommended because there is a higher chance the cancer will come back if surgery or radiation alone is the only treatment.

Stages III and IV nasal cavity cancer

These cancers can be treated with surgery, and radiation is often given after surgery. If the cancer has spread to lymph nodes in the neck, these will be removed as well (called a neck dissection).

Another option is to treat with radiation, sometimes combined with chemo or targeted therapy.For some aggressive types of nasal cavity cancer or those that cannot be removed with surgery, chemotherapy first followed by chemotherapy plus radiation might be an option. More studies are being done to see if this approach is helpful.  

For more advanced cancers (those that have spread to other parts of the body), treatment options might include chemo, targeted therapy, immunotherapy, or some combination of these.

What are treatment options for ethmoid sinus cancer?

Because the ethmoid sinuses are close to the eye sockets and the skull base, operations for cancers in this area are often more difficult and more extensive than operations for maxillary sinus cancers.

Stages 0, I, and II ethmoid sinus cancer

These cancers are often treated first with surgery to remove the tumor. Surgery is typically followed by radiation therapy (sometimes with chemo), especially if the tumor has features that make it more likely to come back, such as positive margins (cancer cells found at the edge of the removed tissue) or perineural invasion (cancer cells found around a nerve). This may help lower the chance of the cancer coming back later.

For some very small cancers that are unlikely to spread, some doctors may recommend surgery only, but not all doctors agree with this.

Radiation therapy instead of surgery may also be an option for people with small tumors or people who are not healthy enough to have surgery.

For some aggressive types of ethmoid sinus tumors, such as undifferentiated cancer, chemotherapy may be recommended along with radiation treatment.

Stages III and IVA ethmoid sinus cancer

These cancers are often treated with surgery. If lymph nodes in the neck are enlarged, they will also be removed in an operation called a neck dissection. Surgery is typically followed by radiation therapy, sometimes along with chemo.

Another option may be to start treatment with radiation therapy given with chemotherapy. This might be followed by surgery if the tumor shrinks enough.

In some cases, chemotherapy might be given first, followed by radiation alone or radiation given along with more chemotherapy. In other cases, chemotherapy is given first, followed by surgery, then radiation (with or without chemo).

Stage IVB and IVC  ethmoid sinus cancers

Stage IVB: For tumors that cannot be removed with surgery (are unresectable) or for people who can't have or don’t want surgery, the first treatment is usually radiation therapy. Sometimes chemo is given with the radiation treatments. In some cases, if the person is healthy enough, chemotherapy can be given first then radiation or chemo with radiation. If someone is too weak for those treatment options, radiation alone or one chemotherapy drug might be tried.

Stage IVC: The goal of treatment for cancers that have spread to distant parts of the body, like the lungs or bones, is to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.

Treatment for this stage depends on where the cancer is, the problems it's causing, and a person’s general health. Chemo (and/or targeted therapy) is often the main treatment if a person can tolerate it because it reaches almost all parts of the body. Another option might be immunotherapy, either alone or along with chemo. Radiation therapy may be directed at areas of cancer that are causing problems. Because these cancers are hard to treat, clinical trials of newer treatments are a good option for some people.

What are treatment options for sphenoid sinus cancer?

The sphenoid sinuses are very difficult to reach with surgery. Cancers in this location are generally treated with radiation therapy. chemo, targeted therapy, and/or immunotherapy might be used as well.

What are treatment options for melanoma of the nasal cavity or paranasal sinus area?

Most melanomas of the nasal cavity or paranasal sinuses are treated with surgery to remove the tumor and a rim of normal tissue around it. Lymph nodes in the neck may also be removed in an operation called a neck dissection. Radiation therapy is often given after surgery.

For cancers that can’t be removed, radiation therapy, chemo, or other treatments (immunotherapy or targeted therapy) may be used. A melanoma that forms in the nasal cavity or a paranasal sinus is different in many ways from a melanoma skin cancer, but it's often treated the same way when it is advanced.

For more information about the treatment of advanced melanomas, see Melanoma Skin Cancer.

What are treatment options for sarcoma of the nasal cavity or paranasal sinus area?

Like other cancers of the nasal cavity and the paranasal sinuses, surgery is the main treatment for most types of sarcoma. In some cases radiation and/or chemo may also be used.

Rhabdomyosarcoma is a type of sarcoma that is most common among infants and young children. It's usually treated with a combination of surgery, radiation therapy, and chemo. For more information about the treatment of rhabdomyosarcoma, please see Rhabdomyosarcoma.

For other types of sarcoma, see Sarcoma: Adult Soft Tissue Cancer.

What are treatment options for recurrent nasal cavity or paranasal sinus cancer?

Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place the cancer first started), regional (in nearby lymph nodes), or distant (spread to distant organs such as the lungs). Options for treating recurrences depend on the location and type of cancer, as well as the treatment used the first time.

For a local recurrence, if radiation was the first treatment for the cancer, surgery may be used. If the first treatment was surgery without radiation, radiation therapy may be tried. Chemo and/or targeted therapy may be used with radiation, or it may be used by itself to treat recurrences that are not controlled by radiation therapy or surgery.

In a regional recurrence, the cancer comes back in the lymph nodes in the neck. This is often treated with surgery to remove many lymph nodes in the neck (a neck dissection) that are on the same side as the cancer. This may be followed with radiation to the neck, sometimes combined with chemo and/or targeted therapy.

Recurrent melanomas or sarcomas of the nasal cavity or paranasal sinuses are treated by surgery, if possible. Depending on the exact type of cells forming the cancers, chemo or other treatments may also be given.

When a nasal cavity or paranasal sinus cancer comes back in other organs, it's often treated with chemo, targeted therapy, and/or immunotherapy, although radiation could also be an option if it wasn’t given before.

Treatments for recurrent nasal cavity or paranasal sinus cancer may temporarily shrink cancers and help relieve symptoms. If further treatment is recommended, it’s important to talk to your doctor so that you understand what the goal of treatment is – whether it's to try to cure the cancer or to keep it under control for as long as possible and relieve symptoms. This can help you weigh the risks and benefits of each treatment.

Because these cancers are hard to treat, clinical trials of new treatments are a good option for some people.