Nasal Cavity and Paranasal Sinuses Cancer Staging 

Nasal Cavity and Paranasal Sinuses Cancer Staging 

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The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications for cancers of the nasal cavity and paranasal sinuses are provided below, along with anatomic staging. [1]

Table 1. TNM classification (Open Table in a new window)

Primary tumor (T)

Maxillary sinus

TX

Primary tumor cannot be assessed

Tis

Carcinoma in situ

T1

Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone

T2

Tumor causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates

T3

Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses

T4a

Moderately advanced local disease

Tumor invades the anterior orbital contents, skin of the cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses

T4b

Very advanced local disease

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Nasal cavity and ethmoid sinus

TX

Primary tumor cannot be assessed

Tis

Carcinoma in situ

T1

Tumor restricted to any 1 subsite, with or without bony invasion

T2

Tumor invading 2 subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion

T3

Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate

T4a

Moderately advanced local disease

Tumor invades any of the following: anterior orbital contents, skin of the nose or cheek, minimal extension to the anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses

T4b

Very advanced local disease

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-])

N2

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2a

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2c

Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N3a

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-);

or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)

Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)

Distant metastasis (M)

cM0

No distant metastasis

cM1

Distant metastasis

Table 2. Histologic grade (Open Table in a new window)

Histologic grade (G)

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

Table 3. Anatomic stage/prognostic groups (Open Table in a new window)

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

T1

N1

M0

T2

N1

M0

T3

N1

M0

IVA

T4a

N0

M0

T4a

N1

M0

T1

N2

M0

T2

N2

M0

T3

N2

M0

T4a

N2

M0

IVB

T Any

N3

M0

T4b

N Any

M0

IVC

T Any

N Any

M1

Head and Neck. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 8th edition. Springer; 2016.

Primary tumor (T)

Maxillary sinus

TX

Primary tumor cannot be assessed

Tis

Carcinoma in situ

T1

Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone

T2

Tumor causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates

T3

Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses

T4a

Moderately advanced local disease

Tumor invades the anterior orbital contents, skin of the cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses

T4b

Very advanced local disease

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Nasal cavity and ethmoid sinus

TX

Primary tumor cannot be assessed

Tis

Carcinoma in situ

T1

Tumor restricted to any 1 subsite, with or without bony invasion

T2

Tumor invading 2 subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion

T3

Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate

T4a

Moderately advanced local disease

Tumor invades any of the following: anterior orbital contents, skin of the nose or cheek, minimal extension to the anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses

T4b

Very advanced local disease

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-])

N2

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2a

Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N2c

Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

N3a

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);

or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);

or  a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);

Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-);

or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)

Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);

or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);

or a single contralateral node of any size and ENE (+)

Distant metastasis (M)

cM0

No distant metastasis

cM1

Distant metastasis

Histologic grade (G)

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

T1

N1

M0

T2

N1

M0

T3

N1

M0

IVA

T4a

N0

M0

T4a

N1

M0

T1

N2

M0

T2

N2

M0

T3

N2

M0

T4a

N2

M0

IVB

T Any

N3

M0

T4b

N Any

M0

IVC

T Any

N Any

M1

Marvaretta M Stevenson, MD Assistant Professor, Division of Medical Oncology, Duke University Medical Center

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Guy J Petruzzelli, MD, PhD, MBA, FACS Physician-in-Chief and Vice President of Oncology Programs, Curtis and Elizabeth Anderson Cancer Institute at Memorial University Medical Center; Professor of Surgery-Head, Neck, and Endocrine Surgery, Mercer University School of Medicine-Savannah Campus

Guy J Petruzzelli, MD, PhD, MBA, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Association of Clinical Anatomists, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society of Clinical Oncology, Chicago Medical Society, Georgia Society of Otolaryngology-Head and Neck Surgery, International Academy of Oral Oncology, International Head and Neck Scientific Group, North American Skull Base Society, Society of Surgical Oncology, Society of University Otolaryngologists-Head and Neck Surgeons, SWOG

Disclosure: Nothing to disclose.

Nasal Cavity and Paranasal Sinuses Cancer Staging 

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