Tests for Nasal Cavity and Paranasal Sinus Cancers

Nasal cavity and paranasal sinus cancers are usually found because of signs or symptoms a person is having. The doctor will take a history and examine the patient. If cancer is suspected, the patient will be sent to see a specialist and tests will be done to be sure of the diagnosis.

Medical history and physical exam

Your doctor will ask questions about your medical history and the problems you've been having. A physical exam will be done so the doctor can look for signs of nasal cavity or paranasal sinus cancer, as well as other health problems.

During the exam, the doctor will carefully check the parts of your nose and sinuses that are causing problems. He or she will also check for numbness, pain, swelling, and/or firmness in your face and the lymph nodes in your neck. The doctor will look for changes in the symmetry of your eyes and face (both sides should be much the same), vision changes, and any other problems.

The doctor might also examine your nasal cavity with a headlight and small mirrors or even look inside your nose with a special tool called a nasal endoscope(This is a thin, flexible tube that allows the doctor to see into your nasal passages.)

If your doctor thinks you might have cancer of the nasal cavity or paranasal sinuses, you'll be sent to see an otolaryngologist (a doctor who specializes in diseases of the ear, nose, and throat; also called an ENT doctor). This doctor will carefully examine your nasal passages and the rest of your head and neck. This might include an exam of your throat, tongue, and mouth which can be done with small mirrors and a light or with a fiber-optic scope – a thin, flexible, lighted tube that's put in through your mouth or nose.

Imaging tests

Imaging tests use x-rays, magnetic fields, or other means to create pictures of the inside of your body. Imaging tests are not used to diagnose nasal cavity or paranasal sinus cancers, but they may be done for a number of reasons both before and after a cancer diagnosis, including:

  • To help look for a tumor if one is suspected
  • To see if a tumor can be safely biopsied without causing a lot of bleeding (covered below)
  • To learn how far cancer may have spread (metastasized)
  • To see if the cancer can be removed with surgery
  • To help see if treatment is working
  • To look for signs that the cancer has come back after treatment (recurred)


X-rays can show if there's any fluid or masses in the sinuses. (They should be filled with air.) This would suggest that something is wrong, but it may not be a tumor. Most of the time, an abnormal-looking sinus x-ray means there's an infection. Sinus x-rays are not often done because many doctors prefer to do a computed tomography (CT) scan instead.

If you've been diagnosed with nasal cavity or paranasal sinus cancer, a chest x-ray might be done to find out if the cancer has spread to your lungs, which is the most common site of spread other than lymph nodes.

CT (computed tomography) scan

A CT scan uses x-rays to make detailed 3-D cross-sectional images of the inside of your body. This test is very useful in identifying cancers of the nasal cavity and paranasal sinuses. Bony details show up well on a CT scan and it can show if a tumor has destroyed the bone around it. A chest CT might also be used to see if the cancer has spread to the lungs.

Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues and organs in the body.

MRI (magnetic resonance imaging) scan

MRI scans use radio waves and strong magnets instead of x-rays to make pictures of your insides. MRI scans are very helpful in looking at cancers of the nasal cavities and paranasal sinuses. They are better than CT scans in telling whether a change is fluid or a tumor. Sometimes they can help the doctor tell the difference between a tumor that's not cancer and one that is. They can also show if a tumor has spread into nearby soft tissues, like the eyeball, brain, or blood vessels.

Both CT and MRI scans help find cancers of the nasal cavities and paranasal sinuses and learn more about them. For instance, a CT scan can tell if the cancer is growing into bone, and an MRI can show the size and type of cancer. Both can show if it has spread to lymph nodes in the neck.

PET (positron emission tomography) scan

A PET scan uses a form of radioactive sugar that's injected into your blood. (Because cancer cells use glucose at a higher rate than normal cells, they will absorb more of the radioactive sugar.) A special scanner is then used to create pictures of the places where the radioactivity collected in your body. A PET scan is often done along with a CT scan using a machine that can do both scans at the same time (called a PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET with the detailed images from the CT scan. Though these cancers rarely spread, a PET scan gives helpful information about your whole body.

A PET scan may be used to look for possible areas of cancer spread, especially if there's a good chance that the cancer is more advanced. (Meaning it's bigger and more likely to have spread.) This test also can be used to help see if a change seen on another imaging test is or isn't cancer.


A biopsy is a procedure in which a doctor takes out a small piece of tissue (a sample) to be checked with a microscope. It's the only way to know for sure if you have nasal cavity or paranasal sinus cancer. If cancer is found, testing in the lab can also show what kind of cancer it is and how aggressive it is (how fast will it grow and spread). This information is needed to help plan the best treatment.

Doctors look closely at where the tumor is and the blood vessels around it when deciding where and how to do a biopsy.

Often, biopsies are done in the doctor’s office or clinic. Drugs are used to numb the area. If the tumor is in a hard-to-reach place or may bleed a lot, the biopsy will be done in the operating room. Many types of biopsies can be used to diagnose nasal cavity or paranasal sinus cancer.

Fine needle aspiration (FNA) biopsy

In this type of biopsy, the doctor puts a thin, hollow needle right into a tumor or lymph node to take out cells and/or a few drops of fluid. The doctor may repeat this 2 or 3 times to take several samples. The cells can then be checked under a microscope to see if they look like cancer.

An FNA biopsy is often used in patients with swollen lymph nodes in the neck. In these patients, FNA biopsy can show if the lymph node swelling is from cancer or if it's a response to an infection. If someone who has already been diagnosed with nasal cavity or paranasal sinus cancer has enlarged neck lymph nodes, a fine needle biopsy can tell if the lymph node swelling is caused by the spread of cancer.

Incisional and excisional biopsies

These types of biopsies remove more of the tumor using minor surgery. They're the more common types of biopsies done for nasal and paranasal sinus tumors. Biopsies of tumors in the nose may be done using special tools that are put into the nose. Biopsies of tumors that are deeper within the skull may require a more involved procedure (see below).

For an incisional biopsy, the surgeon cuts out a small piece of the tumor. For an excisional biopsy, the entire tumor is removed. In either case, the biopsy sample is then sent to the lab for testing.

Endoscopic versus open biopsy

For tumors deeper within the skull, how the biopsy is done depends on where it is and how big it is.

Endoscopic biopsy: Some tumors that are deep in the nasal passages may be reached using an endoscope – a thin, flexible lighted tube. Long, thin surgical tools can be passed through the endoscope to get a biopsy sample.

Open (surgical) biopsy: For tumors inside the sinuses, the doctor may have to cut through the skin next to the nose and through the underlying bones to reach them. These operations are covered in more detail in Surgery for Nasal Cavity and Paranasal Sinus Cancer.

Anesthesia for biopsies

Anesthesia is the use of drugs to help control pain during medical procedures. The type of anesthesia used depends on how the biopsy will be done.

Local anesthesia (numbing medicine) is often used for an incisional biopsy or needle biopsy. The drug can be injected into the skin and nearby tissues or even put right on the inside of the nose to numb the area while the biopsy is done.

Sedation (where you are made very drowsy) or general anesthesia (where you are in a deep sleep) may be needed for endoscopic biopsies. General anesthesia is needed for procedures that cut through the sinus bones.

See Testing Biopsy and Cytology Specimens for Cancer to learn more about different types of biopsies, how the tissue sample is used in the lab to diagnose diseases, and what the results will tell you.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Society of Clinical Oncology. Nasal Cavity and Paranasal Sinus Cancer: Diagnosis. Accessed at www.cancer.net/cancer-types/nasal-cavity-and-paranasal-sinus-cancer/diagnosis on November 14, 2017.

Banuchi V, Mallen J, Kraus D. Cancers of the nose, sinus, and skull base. Surg Oncol Clin N Am. 2015;24(3):563-577. 

Bossi P, Farina D, Gatta G, et al. Paranasal sinus cancer. Crit Rev Oncol Hematol. 2016;98:45-61. 

Farag A, Rosen M, Evans J. Surgical Techniques for Sinonasal Malignancies. Neurosurg Clin N Am. 2015;26(3):403-412.

Lund VJ, Clarke PM, Swift AC, et al. Nose and paranasal sinus tumours: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S111-S118.

National Cancer Institute. Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®)–Patient Version. August 19, 2016. Accessed at www.cancer.gov/types/head-and-neck/patient/paranasal-sinus-treatment-pdq on November 14, 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Head and Neck Cancers. Version 2.2017 -- May 8, 2017.

Unsal AA, Dubal PM, Patel TD, et al. Squamous cell carcinoma of the nasal cavity: A population-based analysis. Laryngoscope. 2016;126(3):560-565.

Last Medical Review: November 15, 2017 Last Revised: December 1, 2017

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