Nasal Cavity and Paranasal Sinus Cancer Staging

After someone is diagnosed with a nasal cavity or paranasal sinus cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer 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.

The earliest stage of nasal cavity and paranasal sinus cancers is stage 0, also known as carcinoma in situ (CIS). The other stages range from I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

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:

  • The extent of the main tumor (T): Where is the tumor? How far has it grown into nearby structures?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how many are affected, and how large are they?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The lungs are the most common site of spread, although it can also spread to other organs, such as the 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 of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described here is the most recent AJCC system, effectiveJanuary 2018. 

Nasal cavity and paranasal sinus cancers are typically given a clinical stage based on the results of any exams, biopsies, and imaging tests that might have been done (as described in How Are Nasal Cavity and Paranasal Sinus Cancers Diagnosed?). If surgery has been done, the pathologic stage (also called the surgical stage) can be determined.

The stages of nasal cavity and paranasal sinus cancers are slightly different, based on where the cancer starts. They are grouped together as:

  • Cancers that start in the nasal cavity or ethmoid sinus
  • Cancers that start in the maxillary sinus

Nasal cavity and paranasal sinus cancer staging can be complex. If you have questions about the stage of your cancer and what it might mean for you, ask your doctor to explain it to you in a way you understand.

Stages of nasal cavity or ethmoid sinus cancer

AJCC stage

Stage grouping

Stage description*

0
 

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).

I

T1
N0
M0

The tumor has grown deeper, 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).

II

T2
N0
M0

The tumor has grown into more than one part of the nasal cavity or ethmoid sinus, or it is in both nasal cavity and the ethmoid sinus (T2).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

 

 

III

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 to T3
N1
M0

The tumor might or might 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 centimeters (cm) across (N1).

The cancer has not spread to distant parts of the body (M0).

 

 

IVA

T4a
N0 or N1
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 centimeters (cm) across (N1).

The cancer has not spread to distant parts of the body (M0).

OR

 

T1-T4a
N2
M0

The tumor might or might 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:

  • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (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, none of which is 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 might or might 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 might or might not have grown into structures outside the nasal cavity or ethmoid sinus (any T). The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3).

It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor might or might not have grown into structures outside the nasal cavity or ethmoid sinus (any T). The cancer might or might 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 in the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

 

Stages of maxillary sinus cancer

AJCC stage

Stage grouping

Stage description*

0
 

Tis
N0
M0

The tumor is only in the top layer of cells lining the inside of the maxillary 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).

I

T1
N0
M0

The tumor has grown deeper, but it is only in the tissue lining the sinus (the mucosa) and does not grow into the bone. (T1).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

II

T2
N0
M0

The 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 (T2).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

 

 

III

T3
N0
M0

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

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

T1 to T3
N1
M0

The tumor might or might not have grown into structures just outside the maxillary sinus (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 centimeters (cm) across (N1).

The cancer has not spread to distant parts of the body (M0).

 

 

IVA

T4a
N0 or N1
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 centimeters (cm) across (N1).

The cancer has not spread to distant parts of the body (M0).

OR

 

T1-T4a
N2
M0

The tumor might or might 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 larger than 3 centimeters (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, none of which is 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 might or might 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 might or might not have grown into structures outside the maxillary sinus (any T).

The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3).

It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor might or might not have grown into structures outside the maxillary sinus, and it might or might not have affected a vocal cord (any T).

The cancer might or might 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 in the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 20, 2017 Last Revised: December 20, 2017

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