Symptoms of Sinus Cancer
Early detection of sinus cancer is challenging as symptoms often mimic common sinus conditions, with pain typically absent until advanced stages involving skull base or nerve involvement, which is why sinonasal tumors are commonly large at presentation. 1
Common Initial Symptoms
Nasal symptoms:
- Nasal obstruction (often unilateral)
- Rhinorrhea (nasal discharge)
- Epistaxis (nosebleeds)
- Anosmia (loss of smell)
Early nonspecific symptoms:
- Persistent purulent rhinorrhea
- Postnasal drainage
- Facial pain/pressure
- Headache
Advanced/Late Symptoms
When sinus cancer progresses, more concerning symptoms develop:
Cranial nerve involvement:
- Visual disturbances/diplopia
- Cranial nerve palsies (particularly VI nerve)
- Sphenocavernous syndrome (with sphenoid sinus involvement)
Local invasion signs:
- Facial swelling/asymmetry
- Proptosis (bulging of the eye)
- Trismus (difficulty opening mouth)
- Intractable headache
- Facial numbness or pain
Symptoms by Sinus Location
Maxillary Sinus Cancer
- Cheek swelling (50-80% of patients on initial examination) 2
- Nasal obstruction
- Nasal discharge
- Epistaxis
- Pain typically occurs late
Sphenoid Sinus Cancer
- Headache (often severe and intractable)
- Visual disturbances
- Cranial nerve palsies
- Symptoms remain nonspecific until sinus wall is penetrated 3
Ethmoid Sinus Cancer
- Common nasal complaints that represent an uncommon disease 4
- Nasal obstruction
- Rhinorrhea
- Epistaxis
- Orbital symptoms with advanced disease
Diagnostic Challenges
Sinus cancer symptoms frequently overlap with benign conditions:
- Symptoms are similar to chronic sinusitis, resulting in delayed diagnosis 2
- Pain is generally absent until there is skull base or nerve involvement 1
- Symptoms can be unilateral and frequently overlooked due to similarity with common benign conditions 1
Red Flags Requiring Immediate Evaluation
- Unilateral persistent symptoms
- Symptoms not responding to standard treatments
- Cranial neuropathies
- Facial numbness, swelling, or asymmetry
- Orbital symptoms (proptosis, diplopia, visual changes)
- Epistaxis that is severe or recurrent
Diagnostic Approach
For suspected sinus cancer, imaging is essential:
- CT scan is the first-line study to evaluate bone involvement and extent
- MRI with contrast helps differentiate tumor from inflammatory changes and assess soft tissue/intracranial extension
- Biopsy is required for definitive diagnosis
Early detection is critical as sinonasal tumors are commonly large at presentation due to the nonspecific nature of early symptoms and the absence of pain until advanced stages 1.