Nasal Cavity and Paranasal Sinuses Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How are nasal cavity and paranasal sinus cancers staged?

Staging is a process that tells the doctor how widespread a cancer may be. It will show if the cancer has spread and how far. The stage (extent) of the cancer is a main factor in determining the treatment and prognosis (outlook) for people with nasal cavity or paranasal sinus cancers. Other important factors include the type of cancer and a person's general health.

Cancers of the nasal cavity and paranasal sinuses first grow and spread into nearby areas and then may spread to nearby lymph nodes. Lymph nodes are bean-sized collections of immune cells scattered throughout the head and neck (and the rest of the body). Cancers that continue to grow may then spread to other parts of the body, such as the lungs.

The most common system used to describe the stages of cancers is the American Joint Committee on Cancer (AJCC) TNM system. For nasal and paranasal sinus cancers, the TNM system is based on 3 key pieces of information:

  • T stands for tumor (how far it has grown into nearby skull bones or other structures).
  • N stands for spread to nearby lymph nodes in the head and neck.
  • M is for metastasis (spread to distant organs). The most common site of spread for these cancers is to the lungs, although they may also spread to distant bones.

T categories

The T group of nasal cavity and paranasal sinus cancers is based on the results of head and neck exams and on any imaging tests of the area, such as CT or MRI scans. Higher T group numbers indicate more growth within the nasal cavity or paranasal sinuses or spread to other nearby areas. The T groups for cancers that start in the maxillary sinuses differ from those for cancers that start in the nasal cavity or ethmoid sinuses.

T categories for maxillary sinus cancer

TX: Primary (main) tumor cannot be assessed.

T0: No evidence of primary tumor.

Tis: Cancer cells are limited to the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.

T1: Tumor is only in the tissue lining the sinus (the mucosa) and does not invade bone.

T2: Tumor has begun to grow into some of the bones of the sinus, other than into the bone of the back part of the sinus.

T3: Tumor has begun to grow into the bone at the back of the sinus (called the posterior wall) or the tumor has grown into the ethmoid sinus, the tissues under the skin, or the side or bottom of the eye socket.

T4a: Tumor is growing into other structures such as the skin of the cheek, the front part of the eye socket, the bone at the top of the nose (cribriform plate), the sphenoid sinus, the frontal sinus, or certain parts of the face (the pterygoid plates or the infratemporal fossa). This is also known as moderately advanced local disease.

T4b: Tumor has grown into the throat behind the nasal cavity (called the nasopharynx), the back of the eye socket, the brain, the tissue covering the brain (the dura), some parts of the base of the skull (middle cranial fossa or clivus), or certain nerves. This is also known as very advanced local disease.

T categories for nasal cavity and ethmoid sinus cancer

TX: Primary (main) tumor cannot be assessed.

T0: No evidence of primary tumor.

Tis: Cancer cells are only in the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ.

T1: Tumor is only in the nasal cavity or one of the ethmoid sinuses, although it may have grown into the bones of the sinus.

T2: Tumor has grown into other nasal or paranasal cavities, and may or may not have grown into nearby bones.

T3: Tumor has grown into the side or bottom of the eye socket, the roof of the mouth (palate), the cribriform plate (the bone that separates the nose from the brain), and/or the maxillary sinus.

T4a: Tumor has grown into other structures such as the front part of the eye socket, the skin of the nose or cheek, the sphenoid sinus, the frontal sinus, or certain bones in the face (pterygoid plates). This is also known as moderately advanced local disease. Cancers that are T4a are usually resectable (meaning they can be removed with surgery).

T4b: Tumor is growing into the back of the eye socket, the brain, the dura (the tissue covering the brain), some parts of the skull (the clivus or the middle cranial fossa), certain nerves, or the nasopharynx (throat behind the nasal cavity). This is also known as very advanced local disease. These tumors are not resectable (they cannot be removed with surgery).

N categories

The N groups are based on spread of the cancer to nearby (regional) lymph nodes and on the size of the nodes. These groups are the same for all nasal cavity and paranasal sinus cancers:

NX: Nearby (regional) lymph nodes cannot be assessed.

N0: Cancer has not spread into the lymph nodes.

N1: Cancer has spread to a single lymph node that is on the same side as the tumor and is no larger than 3 centimeters (cm) across (slightly larger than 1 inch).

N2: Cancer has spread to a single lymph node on the same side as the tumor that is larger than 3 cm but no larger than 6 cm (slightly larger than 2 inches) across; or cancer has spread to more than one lymph node on the same side as the tumor, all of which are no larger than 6 cm across; or cancer is in at least one lymph node that is not on the same side as the tumor (but none are larger than 6 cm across).

N3: Cancer has spread to at least one nearby lymph node that is larger than 6 cm across.

M categories

The M groups for all nasal cavity and paranasal sinus cancers are the same:

M0: No cancer spread (metastasis) distant organs or tissues

M1: The cancer has spread to distant organs such as the lung or distant bones.

Stage groupings

Once the T, N, and M groups have been assigned, this information is combined to assign an overall stage for the cancer. This process is called stage grouping. Stage grouping rules are the same for all cancers of the nasal cavity and paranasal sinuses.

    Stage

    T

    N

    M

 

    Stage 0

    Tis

    N0

    M0

    Stage I

    T1

    N0

    M0

    Stage II

    T2

    N0

    M0

    Stage III

    T3

    N0

    M0

    T1, T2, or T3

    N1

    M0

    Stage IVA

    T1, T2, or T3

    N2

    M0

    T4a

    N0, N1, or N2

    M0

    Stage IVB

    Any T

    N3

    M0

    T4b

    Any N

    M0

    Stage IVC

    Any T

    Any N

    M1

In general, patients with lower stage cancers tend to have a better outlook for a cure or long-term survival.


Last Medical Review: 01/10/2013
Last Revised: 01/10/2013