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The prognosis (outlook) for people with cancers of the nasal
cavity and paranasal sinuses depends on many factors. These include the
type of cancer, the size and location of the cancer, whether the cancer
has spread to other areas of the body, and the general health of the
patient. Cancers of the nasal cavity and paranasal sinuses first grow
or spread locally (to nearby areas) and then spread to the lymph nodes.
Lymph nodes are bean-sized glands scattered throughout the head and
neck (and the rest of the body) which fight infection and remove cell
waste.
Staging is a process that tells the doctor how widespread a
cancer may be. It will show whether the cancer has spread and how far.
The treatment and outlook for nasal cavity or paranasal sinus cancers
depend, to a large extent, on their stage. For early cancer, surgery
may be all that is needed. For more advanced cancer, other treatments
such as chemotherapy or radiation therapy may be required. Be sure to
ask your doctor to explain the stage of your cancer so that you can
make the best choice for yourself about your treatment.
Nasal cavity and paranasal sinus cancers are staged using a
system that is agreed upon by the American Joint Committee on Cancer
(AJCC).The AJCC/TNM System describes the extent of the primary tumor
(T), the absence or presence of metastasis to nearby lymph nodes (N),
and the absence or presence of distant metastasis (M). Information
about the T, N, and M categories is then combined by a process called
stage grouping to determine the patient’s stage. This stage
is described in Roman numerals from 0 to IV.
T categories for maxillary sinus cancer
TX: Primary 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 begins to grow
into some of the bones of the sinus. (Note: If the cancer grows into
the bone of the back part of the sinus, it is classified as T3).
T3: Tumor begins 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 eye socket.
T4a: Tumor grows into other
structures such as the skin of the cheek, the eye, the bone at the top
of the nose (cribiform plate), the sphenoid sinus, the frontal sinus,
or certain parts of the face (the pterygoid plates and the
infratemporal fossa).
T4b: Tumor has grown into
the area between the nasal cavity and the throat (called the
nasopharynx), the brain, the tissue covering the brain (the dura), some
parts of the skull (middle cranial fossa, the clivus), or certain
nerves.
T categories for nasal cavity and ethmoid
sinus cancer
TX: Primary 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
T3: Tumor has grown into
bone of the eye socket, the roof of the mouth (palate), the cribiform
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 eye, the skin of the nose, the skin of the
cheek, the sphenoid sinus, the frontal sinus, or certain bones in the
face (pterygoid plates). Cancers that areT4a are 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, the middle cranial
fossa), certain nerves, or the nasopharynx (the area between the nasal
cavity and the throat). Tumors are called T4b when they are not
resectable (they cannot be removed with surgery)
N categories
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 cm (slightly larger than 1 inch)
N2: Cancer has spread to a
lymph node that is larger than 3 cm (slightly larger than one inch) but
smaller than 6 centimeters (slightly larger than 2 inches); or cancer
has spread to more than one lymph node which are smaller than 6 cm; or
cancer is in a lymph node that is not on the same side as the tumor
(and the lymph node is smaller than 6 cm).
N3: Cancer has spread to at
least one nearby lymph node that is larger than 6 cm (slightly larger
than 2 inches)
M categories
MX: Metastasis cannot be
assessed
M0: No distant metastasis
M1: Metastasis present to
distant organs such as the lung, brain, or liver.
Stage groupings
| Stage |
T |
N |
M |
| Stage 0 |
Tis |
N0 |
M0 |
| Stage I |
T1 |
N0 |
M0 |
| Stage II |
T2 |
N0 |
M0 |
| Stage III |
T1 or T2 |
N1 |
M0 |
| |
T3 |
N0 or 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 |
Survival by stage
The 5-year survival rate refers to the percentage of patients
who live at least 5 years after their cancer is diagnosed. Many of
these patients live much longer than 5 years after diagnosis, and
5-year rates are used to produce a standard way of discussing
prognosis. Five-year relative survival rates assume that some people
will die of other causes and compare the observed survival with that
expected for people without the cancer. These are considered to be a
more accurate way to describe the outlook for patients with a
particular type and stage of cancer. Of course, 5-year survival rates
are based on patients diagnosed and initially treated more than 5 years
ago. Improvements in treatment since then may result in a more
favorable outlook for recently diagnosed patients.
The following statistics come from the National Cancer
Institute's SEER database and are based on cancers diagnosed between
1988 and 2001. This database does not list these cancers by AJCC stage,
but instead groups them into local, regional and distant stages. Local
stage means that there is no sign that the cancer has spread outside of
the nose or sinus (where it started). This corresponds to AJCC stages I
and II. Regional means that the cancer has started growing into nearby
structure or lymph nodes. This corresponds to stages III, IVA, and IVB.
Distant means that the cancer has spread to distant sites, such as the
lung or liver. This corresponds to stage IVC.
For all nasal cavity and paranasal sinus cancers combined, the
relative 5-year survival is 54%. Survival tends to worsen as the stage
increases:
| Stage |
5-year
relative survival |
| Localized |
83% |
| Regional |
47% |
| Distant |
25% |
For nasal cavity cancers, survival is slightly better:
| Stage |
5-year
relative survival |
| Localized |
86% |
| Regional |
57% |
| Distant |
38% |
Last Medical Review: 08/13/2009 Last Revised: 08/13/2009
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