The short answer
These tumors sit beside the eye sockets, skull base and upper teeth, and NCI reports most present with advanced disease, with cure rates generally poor at 50% or below. Staging turns on what the tumor has reached rather than its size, and the exact cell type changes the treatment plan entirely.
NCI reports that most paranasal sinus tumors present with advanced disease and that cure rates are generally poor, at 50% or below.
Squamous cell carcinoma accounts for 70% to 80% of these cancers, with minor salivary gland tumors at 10% to 15%, lymphomas about 5%, and melanoma under 1% — each treated differently.
T category here is about what the tumor touches, and the T4a versus T4b split often marks the line between operable and not.
Most treatment failures occur within 2 years, and nearly 33% of patients go on to develop a second primary cancer in the aerodigestive tract.
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The full explanation.
A small space with expensive neighbors
The nasal cavity and the sinuses around it occupy a few cubic inches. Packed around that space are the eye sockets, the base of the skull, the brain, the nerves to the face, and the roots of the upper teeth.
That geography explains nearly everything about this cancer. A tumor here does not need to be large to be serious. It only needs to reach something.
Why it is usually found late
The early symptoms are the symptoms of a bad sinus infection. The National Cancer Institute (NCI) lists them: "blocked sinuses that do not clear, or sinus pressure. Headaches or pain in the sinus areas. A runny nose. Nosebleeds. A lump or sore inside the nose that does not heal."
Then NCI lists the ones that are not sinusitis: "a lump on the face or roof of the mouth. Numbness or tingling in the face. Swelling or other trouble with the eyes, such as double vision or the eyes pointing in different directions. Pain in the upper teeth, loose teeth, or dentures that no longer fit well. Pain or pressure in the ear."
Read that second list again. Facial numbness, double vision, and upper teeth that loosen or no longer fit a denture are not features of a cold. Neither is one-sided nasal blockage that never clears or repeated nosebleeds from the same side. Those deserve an endoscopic look, not another antibiotic.
The consequence of the delay is measurable. NCI reports that most of these tumors are advanced at diagnosis, and that cure rates are "≤50%" for most patients presenting that way.
Who tends to get it
NCI names specific jobs rather than vague exposures: "furniture-making. Sawmill work. Woodworking (carpentry). Shoemaking. Metal-plating. Flour mill or bakery work."
It also lists infection with human papillomavirus (HPV), being male and older than 40, and smoking. NCI notes that "a subgroup of paranasal sinus and nasal cavity SCCs are associated with human papilloma virus (HPV) infection," and that HPV-positive patients may have a better outlook than HPV-negative patients.
If you spent 30 years in a cabinet shop, say so at the first visit. That history changes how seriously an early symptom gets taken.
Where it starts, and what it is
By frequency, NCI ranks the sites this way. The maxillary sinus, under the cheek, is the most common. Then the ethmoid sinuses, between the eyes. Then the nasal cavity itself. The sphenoid and frontal sinuses are rare.
By tissue type, NCI gives these shares: squamous cell carcinoma at 70% to 80%, minor salivary gland tumors at 10% to 15%, malignant lymphomas at about 5%, and malignant melanoma at under 1%. Esthesioneuroepithelioma and sarcomas are rare.
Those percentages matter because the rarer types are treated by different playbooks. A lymphoma found in the sinus is treated as a lymphoma. Ask your team to name your exact histology, not just the location.
Staging measures what the tumor touches
Most cancers stage partly by size. Here, T stage is almost entirely about what structures the tumor has reached.
For the maxillary sinus, NCI describes T1 as limited to the lining with no bone erosion. T2 involves bone erosion or destruction, or extension to the hard palate or middle nasal meatus. T3 invades the posterior wall, tissues under the skin, the floor or inner wall of the eye socket, the pterygoid fossa, or the ethmoid sinuses. T4a, called moderately advanced, invades the contents of the eye socket, skin, pterygoid plates, or the cribriform plate at the skull base. T4b, called very advanced, reaches the orbital apex, the dura covering the brain, the brain itself, cranial nerves, or the nasopharynx.
For the nasal cavity and ethmoid sinuses, T1 is confined to one subsite. T2 involves two subsites or an adjacent region. T3 reaches the inner wall or floor of the eye socket, the maxillary sinus, the palate, or the cribriform plate. T4a and T4b again separate moderately advanced from very advanced by whether the orbital apex, dura, brain, or cranial nerves are involved.
The T4a versus T4b split is the practical hinge. It often marks the line between operable and not.
Lymph node staging follows the head and neck rules: N1 is a single node on the same side, 3 cm or smaller, without extranodal extension. N2 covers a single node over 3 cm up to 6 cm, or multiple same-side nodes, or nodes on both sides or the other side. N3 is a node larger than 6 cm, or obvious extranodal spread. NCI notes that node involvement is infrequent in these cancers.
Treatment, by stage
For stage I, NCI describes surgical removal for maxillary tumors, with radiation afterward if margins are close. Well-localized ethmoid tumors may be removed surgically, while unresectable ones get external-beam radiation. For the nasal cavity, NCI reports surgery and radiation give comparable cure rates.
Stages II and III generally combine both. NCI describes surgery followed by high-dose postoperative radiation, or radiation first followed by surgery. For ethmoid tumors, options include radiation alone or craniofacial resection with postoperative radiation. Concurrent chemoradiation may be considered for nasal cavity tumors.
Stage IV maxillary tumors are treated with high-dose radiation, sometimes with concurrent chemotherapy. Ethmoid tumors may get craniofacial resection with radiation before or after, with or without chemotherapy. For very advanced tumors, NCI notes that chemotherapy may be given first to shrink the tumor before definitive surgery or radiation.
What follow-up is actually hunting
NCI states that most treatment failures happen within 2 years, which is why visits are frequent early. Local and regional recurrence causes most deaths from this cancer.
Two other numbers shape surveillance. Distant spread is found in "20% to 40% of patients who do not respond to treatment." And nearly 33% of these patients develop a second primary cancer somewhere in the aerodigestive tract, meaning the mouth, throat, voice box, esophagus, or lungs. That is a strong argument for stopping smoking after treatment, not just before.
If the cancer does come back in the nasal cavity, NCI reports salvage is achievable in about 25% of patients. Chemotherapy options it lists include cisplatin, fluorouracil, and methotrexate combinations.
One test before fluorouracil
If fluorouracil or capecitabine is planned, ask about DPYD genetic testing. NCI notes that 1% to 2% of the population carries a variant affecting how these drugs are broken down, that testing costs less than $200, and that some genotypes call for a 50% dose reduction. NCI also notes the tradeoff: results take about 2 weeks, which is debated when treatment is urgent.
Questions worth asking
What is my exact histology and subsite? Was HPV testing done? What is my T category, and specifically is it T4a or T4b? Is the eye socket or skull base involved, and can the eye be preserved? Which comes first, surgery or radiation, and why? Will a head and neck surgeon, radiation oncologist, medical oncologist, and often a neurosurgeon review this together? Has DPYD testing been ordered? What is my follow-up schedule for the first two years?
Related pages
See also Cancer Staging, Pathology Reports, and Getting a Second Opinion.
Sources
Words to know
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Common questions
Why is this cancer so often found late?
Its early signs look like a stubborn sinus infection — blocked sinuses that do not clear, sinus pain, a runny nose, nosebleeds. NCI reports that most of these tumors present with advanced disease and that cure rates are generally 50% or below.
Which symptoms are not just sinusitis?
NCI lists a lump on the face or roof of the mouth, numbness or tingling in the face, double vision or eyes pointing in different directions, pain in the upper teeth or loose teeth or dentures that stop fitting, and pain or pressure in the ear. Those warrant an endoscopic look rather than another antibiotic.
Does the exact cell type matter?
Yes. NCI puts squamous cell carcinoma at 70% to 80%, minor salivary gland tumors at 10% to 15%, malignant lymphomas at about 5%, and melanoma at under 1%. A lymphoma found in the sinus is treated as a lymphoma, so ask for your histology, not just the site.
What raises the risk?
NCI names workplace dust and chemical exposures in furniture-making, sawmill work, carpentry, shoemaking, metal-plating and flour mill or bakery work, along with HPV infection, being male and older than 40, and smoking.
What is follow-up looking for?
Mostly local and regional recurrence, which causes most deaths from this cancer, and which NCI says usually shows up within 2 years. Follow-up is lifelong because nearly 33% of patients develop a second aerodigestive tract cancer.
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Sources last checked: 2026-07-22 what this meansLast updated: 2026-08-13Next planned review: 2027-07-22
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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