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Stages of Nasal Cavity and Paranasal Sinus Cancers
If you’ve been diagnosed with a nasal cavity or paranasal sinus cancer, your doctors will try to figure out if it has spread, and if so, how far. This process is called staging.
The stage describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
How is the stage determined?
The staging system most often used for nasal cavity and paranasal sinus cancers is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:
- Extent of the main tumor (T): Where is the tumor? How far has it grown into nearby structures?
- Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how many are affected, are they on the same side where the cancer started, and how large are they?
- Spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body, such as the lungs or bones?
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.
Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.
Clinical stage vs. pathological stage
Nasal cavity and paranasal sinus cancers are typically given a clinical stage based on the results of any exams, biopsies, and imaging tests that have been done. The clinical stage is used to help determine the best treatment options.
If surgery has been done, the pathological stage, also called the surgical stage, can also be determined. It is based on the exams and tests used to determine the clinical stage, plus what was learned during surgery.
Sometimes the pathological stage might be different from the clinical stage. For example, it might become clear during surgery that the cancer has grown farther than what could be seen on imaging tests.
Explore the 3D interactive model to learn more about the nasal cavity and paranasal sinuses.
Stages of nasal cavity or ethmoid sinus cancer
Stage grouping: Tis, N0, M0
The tumor is only in the top layer of cells lining the inside of the nasal cavity or ethmoid sinus and has not grown any deeper (Tis).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T1, N0, M0
The tumor has grown into deeper layers, but it is only in one part of the nasal cavity or ethmoid sinus, although it might have grown into the bone (T1).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T2, N0, M0
The tumor has grown into more than one part of the nasal cavity or ethmoid sinus, or it is in both the nasal cavity and the ethmoid sinus. It may or may not have grown into the bone (T2).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T3, N0, M0
The 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 (T3).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
OR
T1-3, N1, M0
The tumor may or may not have grown outside of the nasal cavity or ethmoid sinus and into nearby structures (T1 to T3).
The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 cm across (N1).
The cancer has not spread to distant parts of the body (M0).
IVA
T4A, N0-1, M0
The tumor has grown into 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 (T4a).
The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 cm across (N1).
The cancer has not spread to distant parts of the body (M0).
OR
T1-4A, N2, M0
The tumor may or may not have grown into structures outside the nasal cavity or ethmoid sinus – as far as moderately advanced disease (T1 to T4a).
The cancer is N2 if:
- It has spread to a single lymph node on the same side of the neck as the tumor, which is 3 cm or smaller but is growing outside of the lymph node (extranodal extension), OR
- It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 cm but no larger than 6 cm across, OR
- It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
- It has spread to at least one lymph node on the other side of the neck, and no lymph nodes are larger than 6 cm across
The cancer has not spread to distant parts of the body (M0).
IVB
T4b, Any N, M0
The 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 cranial nerves, or the nasopharynx (throat behind the nasal cavity). This is also known as very advanced local disease (T4b).
The cancer may or may not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).
OR
Any T, N3, M0
The tumor may or may not have grown into structures outside the nasal cavity or ethmoid sinus (any T).
The cancer is N3 if:
- It has spread to at least one lymph node that is larger than 6 cm across, OR
- It has spread to a single lymph node on the same side as the tumor, which is larger than 3 cm and is growing outside of the lymph node (extranodal extension), OR
- It is growing in many lymph nodes (on the same side or the other side of the tumor), at least one of which is growing outside of the lymph node (extranodal extension), OR
- It has spread to at least one lymph node on the other side of the neck, which is 3 cm or smaller but is growing outside of the lymph node (extranodal extension)
It has not spread to distant parts of the body (M0).
IVC
Any T, Any N, M1
The tumor may or may not have grown into structures outside the nasal cavity or ethmoid sinus (any T). The cancer may or may not have spread to nearby lymph nodes (any N).
The cancer has spread to distant parts of the body (M1).
Stages of maxillary sinus cancer
Stage grouping: Tis, N0, M0
The tumor is only in the top layer of cells lining the inside of the nasal cavity or ethmoid sinus and has not grown any deeper (Tis).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T1, N0, M0
The tumor has grown into deeper layers, but it is only in one part of the nasal cavity or ethmoid sinus, although it might have grown into the bone (T1).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T2, N0, M0
The tumor has grown into more than one part of the nasal cavity or ethmoid sinus, or it is in both the nasal cavity and the ethmoid sinus. It may or may not have grown into the bone. (T2).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
T3, N0, M0
The 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 (T3).
The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).
OR
T1-3, N1, M0
The tumor may or may not have grown outside of the nasal cavity or ethmoid sinus and into nearby structures (T1 to T3).
The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 cm across (N1).
The cancer has not spread to distant parts of the body (M0).
IVA
T4A, N0-1, M0
The tumor is growing into 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 (T4a).
The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 cm across (N1).
The cancer has not spread to distant parts of the body (M0).
OR
T1-4A, N2, M0
The tumor may or may not have grown into structures outside the maxillary sinus (as far as moderately advanced disease) (T1 to T4a).
The cancer is N2:
- It has spread to a single lymph node on the same side of the neck as the tumor, which is 3 cm or smaller but is growing outside of the lymph node (extranodal extension), OR
- It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 cm but no larger than 6 cm across, OR
- It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
- It has spread to at least one lymph node on the other side of the neck, and no lymph nodes are larger than 6 cm across
The cancer has not spread to distant parts of the body (M0).
IVB
T4b, Any N, M0
The tumor is growing into the throat behind the nasal cavity (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 cranial nerves. This is also known as very advanced local disease (T4b).
The cancer may or may not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).
OR
Any T, N3, M0
The tumor may or may not have grown into structures outside the maxillary sinus (any T).
The cancer is N3 if:
- It has spread to at least one lymph node that is larger than 6 cm across, OR
- It has spread to a single lymph node on the same side as the tumor, which is larger than 3 cm and is growing outside of the lymph node (extranodal extension), OR
- It is growing in many lymph nodes (on the same side or the other side of the tumor), at least one of which is growing outside of the lymph node (extranodal extension), OR
- It has spread to at least one lymph node on the other side of the neck, which is 3 cm or smaller but is growing outside of the lymph node (extranodal extension)
It has not spread to distant parts of the body (M0).
IVC
Any T, Any N, M1
The tumor may or may not have grown into structures outside the maxillary sinus, and it may or may not have affected a vocal cord (any T).
The cancer may or may not have spread to nearby lymph nodes (any N).
The cancer has spread to distant parts of the body (M1).
*The following additional categories are not listed above:
- TX: Main tumor cannot be assessed due to lack of information.
- NX: Regional lymph nodes cannot be assessed due to lack of information.
**3 cm = just over 1 inch; 6 cm = just over 2 inches
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Nasal cavity and paranasal sinuses. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 137-147.
Last Revised: February 27, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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