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

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.