Esthesioneuroblastoma: Symptoms, Causes, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD. Last reviewed October 17, 2026. This content is for educational purposes and is not medical advice.
Quick Answer
Esthesioneuroblastoma, also called olfactory neuroblastoma, is a rare cancer that starts in the upper nasal cavity near the smell-detecting structures. It can cause loss of smell, frequent nosebleeds and difficulty breathing through the nose. The exact cause is unknown. Treatment is usually surgery to remove the tumor, often followed by radiation therapy; chemotherapy is used in some cases.
What the research says
Based on abstracts retrieved from PubMed:
Surgery plus radiotherapy gives the best survival for removable tumors. A review of large population-based studies, multicenter studies, and meta-analyses found that surgery followed by radiotherapy provides the best overall survival and recurrence-free survival for resectable disease. Exclusively endoscopic resection is indicated for modified Kadish A/B tumors without an increased risk of death or recurrence, and the review reports that chemotherapy has failed to show a benefit in survival or disease control (Ariizumi & Asakage, Jpn J Clin Oncol, 2024).
The neck lymph nodes matter even when they look clear at diagnosis. A systematic review and proportion meta-analysis of 18 articles found nodal metastasis at presentation in 11.5% of patients, and a similar 12.3% of patients with clinically negative necks who did not receive elective neck treatment developed nodal metastasis during follow-up, most of them with Kadish stage C tumors (Tomasoni et al., Head Neck, 2023).
Elective neck radiation lowered regional recurrence. A meta-analysis of 9 retrospective studies (489 patients with clinically node-negative disease) found that elective neck irradiation significantly reduced regional recurrence compared with no treatment, with no measured difference in overall survival or distant-metastasis-free survival (low-quality evidence) (De Virgilio et al., Rhinology, 2021).
Key Facts at a Glance
Fact | Detail |
Definition | Rare cancer starting in the upper nasal cavity (olfactory neuroblastoma) [1] |
Pronunciation | es-thee-zee-o-noo-row-blas-TOE-muh |
Who it affects | Usually adults, but can occur at any age [1] |
Early signs | Lost sense of smell, frequent nosebleeds, blocked nasal breathing [1] |
Main tests | Endoscopic exam, MRI/CT/PET imaging, biopsy [2] |
Main treatment | Surgery, usually with radiation; chemotherapy in some cases [2] |
Care team | Neurosurgeons, head and neck surgeons, radiation and medical oncologists [2] |
What Is Esthesioneuroblastoma?
Esthesioneuroblastoma is a rare type of cancer that starts in the upper part of the inside of the nose, known as the nasal cavity. It is also called olfactory neuroblastoma.
The cancer usually affects adults. But it can occur at any age. It generally begins as a growth of cells, called a tumor, inside the nose. From there, it might grow into the sinuses, eyes, and brain. It can also spread to other parts of the body.
Symptoms
Esthesioneuroblastoma symptoms include:
Loss of the sense of smell
Frequent nosebleeds
Difficulty breathing through the nose
As the cancer grows, it might cause:
Eye pain
Loss of vision
Ear pain
Headaches
When to See a Doctor
These symptoms are common and are far more likely to have everyday causes such as allergies, sinus infections, or nasal polyps. But the right move is simple: make an appointment with a healthcare professional if you have lasting symptoms that worry you. Persistent one-sided nosebleeds or a loss of smell that does not come back deserve a proper evaluation.
Causes
Experts have not found the exact cause of esthesioneuroblastoma. What is known follows the general pattern of how cancer develops.
In general, cancer happens when cells develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. These changes tell the cells to make many more cells quickly. The changes also give the cells the ability to keep living when healthy cells would naturally die. This produces too many cells.
The cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cells can break away and spread to other parts of the body.
Risk Factors
Healthcare professionals have not found many risk factors for esthesioneuroblastoma. This cancer can happen at any age, but it is more common in adults.
Complications
Complications of esthesioneuroblastoma may include:
Cancer that grows into nearby organs and tissues. Esthesioneuroblastoma can grow and get into the sinuses, eyes, and brain.
Spread of the cancer, known as metastasis. Esthesioneuroblastoma can spread to other parts of the body, such as the lymph nodes, bone marrow, lungs, liver, skin, and bones.
How Esthesioneuroblastoma Is Diagnosed
Diagnosing esthesioneuroblastoma can be hard. It is rare, and it can look like other cancers that occur in the head, neck, or nose. Testing shows whether the cancer is esthesioneuroblastoma and provides other information that helps shape a treatment plan.
An esthesioneuroblastoma diagnosis might involve:
Physical exam. A member of the healthcare team may take a history of symptoms and look at the eyes, nose, and head and neck.
Endoscopic exam. A healthcare professional may pass a thin, flexible tube with a camera, called an endoscope, into the nose. This lets them look at the cancer and see how large it is.
Imaging tests. Imaging tests take pictures of the inside of the body. They show the size of the cancer, exactly where it is, and whether it has spread. Tests might include magnetic resonance imaging (MRI) scans, computerized tomography (CT) scans, and positron emission tomography (PET) scans.
Biopsy. A biopsy removes a sample of tissue for testing in a lab. For esthesioneuroblastoma, a special tool is passed into the nose to remove a small piece of the cancer. This procedure can often be done in a healthcare professional's office.
Treatment
Esthesioneuroblastoma treatment usually involves surgery to remove the cancer. Other treatments include radiation therapy and chemotherapy.
Because the tumor sits near critical structures, treatment usually involves a team of experts with different specialties. The team might include neurosurgeons (surgeons who operate on the nervous system), head and neck surgeons, radiation oncologists (doctors who use radiation to treat cancer), and medical oncologists (doctors who use medicines to treat cancer). If the person is a child, the team might also include specialists in pediatric surgery and oncology.
Surgery
The type of surgery depends on where the tumor is and how large it is. Surgery might involve:
Removing the part of the tumor that is in the nose. This is usually done with an endoscope. The tube has a camera that lets the surgeon see the cancer, and special surgical tools passed through the endoscope help remove the cancer and nearby tissue.
Opening the skull to reach the tumor, known as a craniotomy. This procedure involves removing a small piece of skull, which allows the surgeon to remove the tumor from near the brain.
Surgery complications might include spinal fluid leaking into the nose, infection, and vision problems.
Radiation Therapy
Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons, or other sources. People with esthesioneuroblastoma often have radiation therapy after surgery to kill any cancer cells that might remain in the head and neck.
If surgery is not possible, radiation therapy can be used alone or with chemotherapy.
Chemotherapy
Chemotherapy uses strong medicines to kill cancer cells. In people with esthesioneuroblastoma, chemotherapy might be used with radiation therapy after surgery to kill cancer cells that remain.
Clinical Trials
New treatments, interventions, and tests are continually being studied. Clinical trials may offer access to these options, and a care team can help identify trials that fit a person's situation.
Coping, Support, and Complementary Therapies
No alternative medicine treatments can cure esthesioneuroblastoma. Complementary therapies, however, may help manage the side effects of treatment. Options that might help during cancer treatment include acupuncture, aromatherapy, hypnosis, massage, music therapy, relaxation techniques, tai chi, and yoga. Always talk with the healthcare team before starting any of these.
An esthesioneuroblastoma diagnosis can feel scary, and coping often improves with time. Practical steps include learning enough about the cancer, such as its type and grade, to make decisions about care; talking with others who have cancer through support groups; talking to someone trusted about feelings, whether a friend, family member, clergy, or counselor; and keeping friends and family close, deciding in advance what kind of help is most welcome, such as rides to treatment or meals.
Preparing for Your Appointment
Start by making an appointment with a doctor or other healthcare professional if symptoms worry you. You might be referred to an ear, nose, and throat specialist.
What you can do:
Ask ahead of time whether anything needs to be done before the visit, such as restricting your diet.
Write down symptoms, including any that may not seem related to the reason for the appointment.
Write down important personal information, including major stresses or recent life changes.
Make a list of all medicines, vitamins, and supplements, along with doses.
Bring a family member or friend along; someone else may remember information you miss.
Write down questions to ask the healthcare team.
Useful questions for esthesioneuroblastoma include: What is likely causing my symptoms? What are other possible causes? What tests do I need? Is my condition likely to go away or be long lasting? What is the best course of action? I have other health conditions; how can they be managed together? What printed material or websites do you recommend?
What to expect from your doctor: questions about whether symptoms come and go or stay steady, how severe they are, and what seems to make them better or worse.
Conclusion
Esthesioneuroblastoma is a rare cancer of the upper nasal cavity, and its defining feature is location: it sits near the smell-detecting structures, close to the sinuses, eyes, and brain. That location shapes everything about it: the quiet early symptoms of a lost sense of smell and repeated nosebleeds, the difficulty of diagnosis, and the need for a coordinated team of surgeons and oncologists.
The encouraging news is that this cancer has an established treatment path. Surgery, whether through the nose with an endoscope or through a craniotomy, removes the tumor, and radiation, sometimes with chemotherapy, treats what remains. Anyone with persistent, one-sided nose symptoms or an unexplained loss of smell should get it checked; early evaluation is the single most useful step, and no lasting nose symptom is too small to mention to a healthcare professional.
Take Action: What to Do Next
If you have lasting nose symptoms that worry you, especially loss of smell, frequent nosebleeds, or blocked breathing on one side, schedule an appointment with a healthcare professional, who may refer you to an ear, nose, and throat specialist.
When you go, bring a written symptom list, your medicines and doses, a friend or family member, and your questions.
Frequently Asked Questions
What is esthesioneuroblastoma?
Esthesioneuroblastoma is a rare cancer that starts in the upper part of the inside of the nose (the nasal cavity), near the smell-detecting structures. It is also called olfactory neuroblastoma. It usually affects adults but can occur at any age, and it can grow into the sinuses, eyes, and brain or spread elsewhere in the body.
What are the symptoms of esthesioneuroblastoma?
The main symptoms are loss of the sense of smell, frequent nosebleeds, and difficulty breathing through the nose. As the cancer grows, it may also cause eye pain, loss of vision, ear pain, and headaches.
What causes esthesioneuroblastoma?
Experts have not found the exact cause. Like most cancers, it begins when cells develop changes in their DNA that make them multiply quickly and survive when healthy cells would naturally die, forming a tumor that can invade nearby tissue and spread.
How is esthesioneuroblastoma treated?
Treatment usually involves surgery to remove the cancer, either endoscopic removal through the nose or a craniotomy to reach tumors near the brain, often followed by radiation therapy and chemotherapy. If surgery is not possible, radiation alone or with chemotherapy may be used. Care typically involves neurosurgeons, head and neck surgeons, and oncologists.
What are the complications of esthesioneuroblastoma?
The cancer can grow into nearby organs and tissues such as the sinuses, eyes, and brain. It can also spread (metastasize) to other parts of the body, including the lymph nodes, bone marrow, lungs, liver, skin, and bones.
How is esthesioneuroblastoma diagnosed?
A specialist looks inside the nose with a thin camera called an endoscope and takes a small tissue sample, or biopsy. CT and MRI scans show the tumor's size and spread, and other scans may be used to check other parts of the body.
Who gets esthesioneuroblastoma?
It can happen at any age, from teens to older adults, and it affects both men and women. Because it is rare, it is best treated at a center with experience in nose and skull base tumors.
Can esthesioneuroblastoma be cured?
Many people can be cured or have long-term control of the cancer, especially when it is found early and treated with surgery and radiation. Your care team can explain what to expect based on the tumor's stage and grade.
Can esthesioneuroblastoma come back after treatment?
Yes, it can come back, sometimes many years later. Long-term follow-up with nose exams and MRI scans helps find any return early.
Will my sense of smell come back after treatment?
It depends on the tumor and the surgery. Smell loss is often permanent when surgery removes the area of the nose that senses smell, so ask your surgeon what to expect before treatment.
Trusted External Resources
National Cancer Institute: Olfactory Neuroblastoma
MedlinePlus: Nasal Cancer
National Cancer Institute: Understanding Cancer: Coping with Cancer
Related Reading
Nasal and Paranasal Tumors: Symptoms, Causes, Diagnosis, and Treatment explains other tumors of the nose and sinuses and their treatment.
Anosmia (Loss of Sense of Smell): What It Is, Causes, Symptoms, and Treatment explains loss of smell, its many causes and how it is checked.
Nosebleed (Epistaxis): Causes, Types, and Management explains common nosebleed causes and when bleeding needs medical care.
Nasal Endoscopy: Why It's Done, What to Expect, Recovery and Results explains the camera exam used to look inside the nose and sinuses.
References
Mayo Clinic Staff. Esthesioneuroblastoma - Symptoms and causes. Mayo Clinic. March 7, 2025. https://www.mayoclinic.org/diseases-conditions/esthesioneuroblastoma/symptoms-causes/syc-20351075
Mayo Clinic Staff. Esthesioneuroblastoma - Diagnosis and treatment. Mayo Clinic. March 7, 2025. https://www.mayoclinic.org/diseases-conditions/esthesioneuroblastoma/diagnosis-treatment/drc-20446400
National Cancer Institute. Olfactory Neuroblastoma. National Cancer Institute. Accessed October 14, 2026. https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/other-rare-tumors/olfactory-neuroblastoma
National Cancer Institute. Coping with Cancer. National Cancer Institute. Accessed October 14, 2026. https://www.cancer.gov/about-cancer/coping
National Library of Medicine. Nasal Cancer. MedlinePlus. Last updated December 11, 2024. https://medlineplus.gov/nasalcancer.html
Ariizumi Y, Asakage T. Development of an evaluation and treatment strategy for olfactory neuroblastoma: a review of evidence from large-scale studies, including population-based and multicenter studies, and meta-analyses. Jpn J Clin Oncol. 2024;54(8):847-862. PMID 38762332. https://doi.org/10.1093/jjco/hyae062
Tomasoni M, Marazzi E, Rampinelli V, et al. Lymph node metastasis from olfactory neuroblastoma at presentation and as disease relapse: A systematic review and proportion meta-analysis of prevalence data and variables influencing regional control. Head Neck. 2023;45(6):1486-1496. PMID 36995898. https://doi.org/10.1002/hed.27361
De Virgilio A, Costantino A, Sebastiani D, et al. Elective neck irradiation in the management of esthesioneuroblastoma: a systematic review and meta-analysis. Rhinology. 2021;59(5):433-440. PMID 34254061. https://doi.org/10.4193/Rhin21.139
Medical disclaimer
The information provided in this article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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