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Health condition · Clinically reviewed

Nasal and paranasal sinus tumours, the sinusitis that isn't sinusitis.

Rare cancers of the nose and sinuses often masquerade as ordinary sinusitis. Knowing when one-sided symptoms deserve a closer look can shorten the road to diagnosis.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG12 and specialist head and neck oncology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on urgent referral, MDT staging and specialist commissioned treatment.

Key facts

Nasal and sinus tumours at a glance.

The essentials, in plain English - what these tumours are, who is at risk, and how they are managed in the UK today.

  • What it is

    Rare cancers arising in the nasal cavity or paranasal sinuses - the maxillary sinus is the most commonly affected site.

  • Most common type

    Squamous cell carcinoma accounts for the majority of cases, though other histologies do occur.

  • Occupational link

    Strongly associated with wood dust, nickel and leather work exposures - often over many years.

  • Why it is missed

    Symptoms mimic chronic sinusitis closely, which frequently leads to diagnostic delay.

  • Who assesses it

    Specialist commissioned ENT and head and neck oncology multidisciplinary teams.

  • Core treatment

    Surgery and radiotherapy, often combined, given the proximity of these sinuses to the orbit and skull base.

Why this guide matters

When "just sinusitis" needs a second look.

These tumours are rare, but the symptom overlap with chronic sinusitis is exactly what delays diagnosis. Three points shape everything else on this page.

  • One-sided symptoms are the clue

    Genuine sinusitis is usually bilateral. Persistent unilateral obstruction, discharge or bleeding is what should prompt reassessment.

  • Occupational history matters

    Wood dust, nickel and leather work exposures raise suspicion and are worth mentioning explicitly to your GP.

  • Specialist MDT care changes outcomes

    Because these cancers sit next to the orbit and skull base, treatment planning in a specialist head and neck oncology MDT is essential.

How the diagnosis is made

From persistent symptoms to a specialist plan.

The steps a UK GP and specialist team will normally follow, in order, per NICE NG12 - so you know what to expect and why.

  1. 01

    Assessing

    Persistent unilateral symptoms

    Unexplained one-sided nasal obstruction or discharge that has not settled with standard treatment prompts assessment.

  2. 02

    Assessing

    Urgent referral criteria

    NICE NG12 recommends urgent referral for unilateral nasal symptoms persisting beyond the expected course of sinusitis treatment.

  3. 03

    Assessing

    Nasendoscopy

    A thin flexible camera examines the nasal cavity directly, looking for a mass, ulceration or unusual bleeding point.

  4. 04

    Confirming

    CT imaging

    Cross-sectional imaging maps the extent of any lesion and its relationship to the sinuses, orbit and skull base.

  5. 05

    Confirming

    MRI for soft tissue and staging

    MRI adds detail on soft-tissue and perineural spread that CT can miss, and helps with formal staging.

  6. 06

    Confirming

    Biopsy for histology

    Tissue sampling confirms the diagnosis and histological subtype, which shapes the treatment plan.

  7. 07

    Planning

    Head and neck oncology MDT

    A specialist commissioned multidisciplinary team agrees the surgical, radiotherapy and chemotherapy plan together.

Typical timeline: urgent referral to a specialist MDT decision, usually within a few weeks.

Symptoms

What these tumours actually look like.

A cluster of one-sided symptoms that persist beyond ordinary sinusitis. And the features that mean it's time to escalate.

  • Unilateral nasal obstruction

    Persistent blockage on one side only - the single most characteristic early symptom, and easy to mistake for simple congestion.

  • Unilateral nasal discharge

    One-sided discharge, sometimes blood-stained, that does not respond to usual sinusitis treatment.

  • Nosebleeds

    Recurrent or unexplained bleeding from one nostril deserves a closer look, especially alongside other symptoms.

  • Facial pain or swelling

    Pain or a visible swelling over the cheek or around the sinuses, sometimes with tenderness.

  • Loosening of upper teeth

    A tumour extending from the maxillary sinus can loosen the upper molars or premolars - an easily overlooked clue.

  • Visual disturbance or diplopia

    Double vision or other visual changes suggest orbital involvement and need prompt specialist assessment.

  • Facial numbness

    Altered sensation over the cheek or upper lip can reflect nerve involvement as disease advances.

  • Red flag - symptoms mimicking chronic sinusitis

    When "sinusitis" will not settle despite proper treatment, this is exactly the pattern that leads to delayed diagnosis.

Treatment

How these tumours are treated in the UK.

Surgery and radiotherapy form the backbone of treatment, with chemotherapy, reconstruction and rehabilitation supporting the wider plan.

  • Surgical resection

    Often complex given proximity to the orbit and skull base - may require craniofacial resection performed jointly by ENT and neurosurgery.

  • Radiotherapy

    Frequently combined with surgery, either before or after, to improve local control given the challenging anatomy involved.

  • Chemotherapy

    Used for advanced or metastatic disease, sometimes alongside radiotherapy as a combined chemoradiotherapy approach.

  • Craniofacial resection

    A joint ENT and neurosurgical procedure when the tumour approaches or involves the skull base.

  • Reconstructive surgery

    Reconstructs the nasal, sinus or facial structures removed during resection, sometimes with the help of prosthetics.

  • Facial prosthetics

    Where reconstruction alone cannot restore appearance or function, a maxillofacial prosthetist can fit a bespoke prosthesis.

  • Speech and language therapy

    Supports speech, swallowing and voice where surgery or radiotherapy affects these functions.

  • Dietetic support

    Helps maintain nutrition through treatment, particularly where eating or swallowing is affected.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12).

  • National Cancer Institute. Paranasal sinus and nasal cavity cancer treatment.

  • British Association of Head and Neck Oncologists. Standards for head and neck cancer care.

  • Public Health England. Occupational cancer - nasal and sinus cancer risk factors.

Red flags

When nasal symptoms need urgent attention.

Most nasal symptoms are ordinary sinusitis or allergy. These are the situations that aren't - and where urgent referral is needed.

  • Persistent unilateral nasal obstruction

    One-sided blockage that does not resolve after appropriate treatment is the classic warning sign and warrants urgent referral.

  • Unilateral blood-stained discharge

    Blood-stained or persistent one-sided discharge is not typical of simple sinusitis and needs specialist assessment.

  • Visual disturbance or diplopia

    Double vision or other visual change points to possible orbital involvement and needs urgent specialist review.

  • Loosening of upper teeth

    Unexplained loosening of the upper teeth, without dental disease to explain it, can signal maxillary sinus involvement.

  • Non-healing facial swelling

    A firm, non-tender or enlarging facial swelling that does not settle deserves imaging rather than watchful waiting.

  • Occupational exposure history

    Long-term exposure to wood dust, nickel or leather work raises the index of suspicion for any of the above symptoms.

  • Symptoms outlasting sinusitis treatment

    Any "sinusitis" that fails to improve on standard treatment should prompt reassessment rather than a repeat course.

  • Cranial nerve symptoms

    Facial numbness, weakness or other cranial nerve signs suggest possible skull base or perineural spread.

  • Unexplained weight loss with nasal symptoms

    Systemic features alongside persistent nasal symptoms should always be flagged for urgent specialist assessment.

Living with it

A rare cancer, with a specialist team behind you.

Four things that make the biggest difference through treatment and beyond - specialist care, planned rehabilitation, restored function and long-term follow-up.

A quiet reminder

You are not managing this alone.

A dedicated head and neck oncology MDT, speech and language therapists and dietitians work alongside you from diagnosis through recovery.

  1. 01 Team

    You are cared for by a specialist team

    Treatment happens in a specialist commissioned head and neck cancer centre with a dedicated multidisciplinary team around you.

  2. 02 Recovery

    Rehabilitation is part of the plan

    Speech and language therapy and dietetic support help you recover function, not just treat the tumour.

  3. 03 Function

    Appearance and function can be restored

    Reconstructive surgery and, where needed, facial prosthetics aim to restore how you look and how you breathe, eat and speak.

  4. 04 Follow-up

    Long-term follow-up matters

    Regular specialist review after treatment helps catch recurrence early and manage any lasting effects.

Frequently asked

Everything we get asked about nasal and sinus tumours.

Quick answers on symptoms, referral criteria, diagnosis and treatment.

  • What are nasal and paranasal sinus tumours?

    Rare cancers arising in the nasal cavity or the paranasal sinuses, with the maxillary sinus being the most commonly affected site. Squamous cell carcinoma is the most common type. They are strongly associated with occupational exposures such as wood dust, nickel and leather work.

  • Why are they often diagnosed late?

    Early symptoms - unilateral nasal obstruction, discharge or facial pain - closely mimic chronic sinusitis. This overlap frequently leads to diagnostic delay, which is why NICE NG12 sets a low threshold for urgent referral when unilateral symptoms persist.

  • When does NICE recommend urgent referral?

    NICE NG12 recommends urgent referral for unexplained unilateral nasal symptoms that persist beyond the expected course of sinusitis treatment, particularly with bleeding, facial pain, visual change or loosening of the upper teeth.

  • How is the diagnosis confirmed?

    Nasendoscopy allows direct examination of the nasal cavity, followed by CT and MRI imaging to assess the extent of disease and biopsy to confirm the histological diagnosis. A specialist commissioned ENT and head and neck oncology MDT then agrees the treatment plan.

  • What does treatment involve?

    Surgery is often complex because of the proximity to the orbit and skull base, and may require craniofacial resection. Radiotherapy is frequently combined with surgery, and chemotherapy is used for more advanced disease. Reconstructive surgery, prosthetics and MDT rehabilitation support recovery afterwards.

  • Who am I likely to be treated by?

    Care is delivered in a specialist commissioned head and neck cancer centre by an ENT and head and neck oncology multidisciplinary team, with input from speech and language therapy and dietetics as part of rehabilitation.

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