Esthesioneuroblastoma (Olfactory Neuroblastoma), from the CureRays guide library.

Esthesioneuroblastoma is a rare cancer that starts in the smell nerves high in the nose and is treated with surgery and radiation — often together — with radiation playing a central, curative role because of the tumor's delicate location near the brain and eyes.

What it is.

Esthesioneuroblastoma, also called olfactory neuroblastoma, is a rare cancer that begins in the olfactory (smell) nerve tissue high in the nasal cavity, near the thin bone that separates the nose from the brain. Despite the name, it is unrelated to the childhood cancer neuroblastoma. It usually grows slowly and most often causes a blocked nose, nosebleeds, or a reduced sense of smell, which can delay diagnosis. Because it sits in a delicate area surrounded by the eyes, brain, and major nerves, treatment is carefully planned by a team and usually combines surgery to remove the tumor with radiation; chemotherapy is added for higher-grade or advanced disease. With modern surgery and radiation, many patients do well, though long-term follow-up is important because it can return years later.

How radiation treats it.

Radiation damages the DNA inside cancer cells so they can no longer divide. For esthesioneuroblastoma, radiation is one of the most important treatments because the tumor sits in a delicate spot surrounded by the eyes, optic nerves, and brain, where surgery alone may not safely remove every cell. After surgery, radiation cleans up microscopic disease and lowers the chance of return; when surgery is not possible, it can be the main treatment. Advanced techniques — intensity-modulated radiation and especially proton therapy — shape the dose tightly to the tumor while sparing vision and brain tissue. Radiation is painless during delivery, given over several weeks of daily sessions, and external-beam treatment leaves no radioactivity in the body.

The ways we can treat it.

Intensity-modulated radiation (IMRT). Beams are sculpted around the complex anatomy of the skull base to deliver a high dose to the tumor bed while limiting dose to the eyes, optic nerves, and brain.

Proton therapy. Proton beams stop at a set depth, depositing little dose beyond the target — especially valuable here for sparing the nearby brain, optic nerves, and eyes.

Stereotactic radiosurgery (selected). Highly focused radiation can treat a small residual or recurrent tumor in one or a few sessions when surgery is not ideal.

Questions we hear often.

Is this the same as neuroblastoma in children? No. Despite the similar name, esthesioneuroblastoma (olfactory neuroblastoma) is a different disease that starts in the smell-nerve tissue of the nose, usually in adults. It is not the childhood cancer neuroblastoma and is treated very differently.

Why is radiation so important here? The tumor grows in a narrow, delicate space next to the eyes, optic nerves, and brain, where surgery alone may not safely remove every cell. Radiation — especially precise techniques like proton therapy — clears microscopic disease and protects vision and brain function, which is why it is usually combined with surgery.

Will I lose my sense of smell? Because the cancer arises in the smell nerves and treatment involves that area, the sense of smell on the affected side is often reduced or lost. Your team will discuss what to expect and how treatment is planned to protect as much function as possible while removing the cancer.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.