|
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 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 do not include patients
dying of other diseases. 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. They may no
longer be accurate. Improvements in treatment may result in a more
favorable outlook for recently diagnosed patients.
For all nasal cavity or paranasal sinus cancers combined, the
relative 5-year survival is 54%. Survival tends to worsen as the stage
increases -- for stage 1 disease, the 5-year relative survival is 83%,
but for stage IV disease it is only 25%. For maxillary sinus cancer,
the relative 5-year survival ranged from about 60% for stage I to 30%
for stage IV.
Revised: 03/14/2008
|