Treatment Options by Type, Location, and Stage of Nasal Cavity and Paranasal Sinus Cancer

Most of the time, the treatment of nasal cavity or paranasal sinus cancer is based on its location and its stage – how far it has spread in the body. But other factors, such as a person’s overall health and personal preferences, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.

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 suit each patient depending on the tumor type, size, location, and the patient’s general medical condition and desires.

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. This way people can get the best treatment available now and may also get the treatments that are thought to be even better.

Maxillary sinus cancer

Stages I and II

The first step in treating most stage 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. Surgery to remove lymph nodes in the neck isn't needed. Sometimes radiation is given before surgery to shrink the tumor and make it easier to remove.

After surgery, most people with these cancers are treated with radiation.

Radiation may not be needed for people with stage I cancers if the cancer was removed completely with negative margins (meaning that there were no cancer cells at the edge of the removed tumor), and the cancer was not growing into the area around the nerves (called perineural invasion).

For stage II cancers and stage I cancers that couldn’t be removed completely, had positive margins (cancer cells were found in the edges of the tissue removed), or had perineural invasion, radiation is often given after surgery. Some doctors may recommend chemotherapy (chemo) be give along with the radiation.

Radiation is recommended after surgery for cancers that are the type called adenoid cystic, even if the margins are negative and there's no perineural invasion.

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

Stages III and IV

Stages III and IVA: People with stages III or IVA maxillary sinus cancer are treated with 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.) Sometimes radiation is given before surgery to shrink the tumor and make it easier to remove.

After surgery, the area where the tumor had been 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. Chemo may be given along with the radiation therapy. This has more side effects than giving either treatment alone, but it may help reduce the risk that the cancer will come back after treatment. Sometimes radiation (maybe with chemo) is given before the surgery to try to shrink the tumor so that it can be more easily or more completely removed.

Stage IVB: Some cancers are stage IVB because the main tumor is not resectable (it cannot be removed completely with surgery). People with these cancers are usually treated with radiation therapy. They may also get chemo and/or targeted therapy. Surgery is sometimes done to help 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 can be removed with surgery (is resectable), but the cancer has spread to lymph nodes. These cancers are treated like stage IVA cancers – surgery to remove the tumor and neck lymph nodes, followed by radiation and maybe chemo. Sometimes radiation and chemo are given before the operation to try to shrink the tumor and make it easier to remove.

Stage IVC: These cancers have spread to organs beyond the head and neck. Cancers in this stage are very hard to cure. The goal of treatment is usually 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 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 all parts of the body. 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.

Nasal cavity cancer

Stages I and II

These cancers are in the nasal cavity without spread to lymph nodes. They can be treated with surgery or radiation. Radiation is often recommended after surgery.

Stages III and IV

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.

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 I and II

These cancers can be treated with surgery to remove the tumor. Surgery is typically followed by radiation therapy (sometimes with chemo). This may help lower the chance of the cancer coming back later. Sometimes chemo and radiation therapy are given before surgery to shrink the tumor and make it easier to remove without damaging nearby tissues.

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.

Stages III and IVA

These cancers are usually 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 and chemo. This might be followed by surgery if the tumor shrinks enough.

Advanced ethmoid sinus cancers

For tumors that cannot be removed with surgery (are unresectable) or for people who are unable or don’t want surgery, the first treatment is usually radiation therapy. Sometimes chemo is given with the radiation treatments.

Cancers that have spread to distant parts of the body are very hard to cure, so the goal of treatment is usually to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing. This is called palliative or supportive care.

Treatment 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 all parts of the body. 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.

Sphenoid sinus cancer

The sphenoid sinuses are very difficult to reach with surgery. Cancers in this location are generally treated with radiation therapy. Chemo and/or targeted therapy may be added as well.

Melanoma

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 usually given after surgery.

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

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

Sarcoma

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.

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 and/or targeted therapy, 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, but these cancers are very difficult to cure. 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 pros and cons of each treatment.

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

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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

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#section/_76 on November 20, 2017.

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

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

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.