Esthesioneuroblastoma Treatment

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What started out as nose bleeds and a stuffed up nose turned out to be cancer. Having esthesioneuroblastoma is scary. But at UVA Health, you'll find a team of experts who have the skills to treat this type of cancer that often spreads to the brain.

Esthesioneuroblastoma is also known as an olfactory neuroblastoma (or ONB). It's a cancerous tumor of the small nerve cells along the roof the nose. These nerve cells provide our sense of smell. 

Esthesioneuroblastoma Treatment at UVA Health

At UVA Health, you'll find a team of experts to tailor treatment for esthesioneuroblastoma. Most nose tumors are types of skull base tumors. These are growths on or near the bones that support the brain. Learn more about UVA Health's expertise in treating skull base tumors.

Like with most cancers, treatment often requires a combined approach that includes:


Surgery is usually needed for a long-term cure. A team approach is often used, with head and neck surgeons working directly with neurosurgeons to remove all portions of the tumor.

At UVA Health, we use the craniofacial approach.This treatment includes making incisions on the face (next to the nose) to remove the portion of the tumor from the nose, as well as incisions along the top of the head that allow neurosurgeons to remove portions of the tumor from the brain. 

This treatment is often used in combination with radiation and chemotherapy.

A less invasive approach can also be used where small cameras (endoscopes) and small instruments are inserted through the nostril to avoid facial incisions. This technique is often combined with an incision across the top of the head to fully remove any portion of the tumor that is in the brain.

Radiation Therapy

Radiation therapy alone is used in some cases, but it usually isn't as successful without surgery. At UVA Health, radiation is often used before surgery to shrink the tumor.


We also use chemotherapy to treat esthesioneuroblastoma in patients with the most extensive disease.

Signs of Nose Cancer

The disease most often affects patients between 40 and 70 years of age. It affects slightly more men than women.

The most common symptoms include:

  • Nasal obstruction (difficulty breathing through the nose)
  • Nose bleeds

These symptoms often start gradually and are mistaken for other, more common causes.

This type of tumor is generally slow-growing. As a result, most patients with esthesioneuroblastoma already have a tumor extending beyond the nose (into the brain or other areas of the body) at the time of diagnosis.

Signs that the tumor has spread may include:

  • Loss of smell
  • Vision loss,
  • Eye pain or tearing
  • Ear pain and severe headaches

How We Diagnose & Stage Ethesioneuroblastoma  

If you're having these symptoms, you'll want to rule out ethesioneuroblastoma.

Diagnosis usually requires a biopsy. Doctors will take a small tissue sample and analyze it under a microscope. A biopsy is often performed at the doctor’s office by an otolaryngologist (ear, nose and throat specialist). 

Once you’ve been diagnosed, your doctor will also order CT (computed tomography) and MRI (magnetic resonance imaging). These tests help determine the location, size, and extent of the tumor.

Unlike many other tumors that are staged according to tumor size on a scale of 1-4, this condition is staged using the Kadish system:

  • Kadish A tumors are confined to the nasal cavity
  • Kadish B tumors extend into the nearby nasal sinuses
  • Kadish C tumors are more advanced and extend into the eye socket, skull base, brain, neck lymph nodes or other areas of the body

No matter what stage your cancer is found, you'll find treatment options at Virginia's first Comprehensive Cancer Center.