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Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]
The staging systems are clinical estimates of the extent of disease. The assessment of the tumor is based on inspection, palpation, and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathological data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation. Computed tomographic and/or magnetic resonance imaging studies are generally required to adequately evaluate tumor extent prior to attempted surgical resection or definitive radiation therapy. If a patient relapses, complete restaging must be done to select the appropriate additional therapy.[1,2]
Definitions of TNM
Staging of nasal cavity and paranasal sinus carcinomas is not as well established as for other head and neck tumors. For cancer of the maxillary sinus, the nasal cavity, and the ethmoid sinus, the American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[3]
Table 1. Primary Tumor (T)a
| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | Carcinoma in situ. |
| Maxillary Sinus | |
| 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 maxillary sinus and pterygoid plates. |
| T3 | Tumor invades any of the following: bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, or ethmoid sinuses. |
| T4a | Moderately advanced local disease. |
| Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, or 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 | |
| T1 | Tumor restricted to any one subsite, with or without bony invasion. |
| T2 | Tumor invading two 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 nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, or 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 (V2), nasopharynx, or clivus. |
Table 2. Regional Lymph Nodes(N)a
| 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. |
| N2 | Metastasis in a single ipsilateral lymph node, >3 cm but =6 cm in greatest dimension, or metastases in multiple ipsilateral lymph nodes, =6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, =6 cm in greatest dimension. |
| N2a | Metastasis in a single ipsilateral lymph node, >3 cm but =6 cm in greatest dimension. |
| N2b | Metastases in multiple ipsilateral lymph nodes, =6 cm in greatest dimension. |
| N2c | Metastases in bilateral or contralateral lymph nodes, =6 cm in greatest dimension. |
| N3 | Metastasis in a lymph node, >6 cm in greatest dimension. |
Table 3. Distant Metastasis (M)a
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groupsa
| 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 | T4b | Any N | M0 |
| Any T | N3 | M0 | |
| IVC | Any T | Any N | M1 |
References:
- Mendenhall W, Werning J, Pfister D, et al.: Treatment of head and neck cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008, pp 809-77.
- Laramore GE, ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.
- Nasal cavity and paranasal sinuses. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 71-2.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of paranasal sinus and nasal cavity cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board. Board members review recently published articles each month to determine whether an article should:
- be discussed at a meeting,
- be cited with text, or
- replace or update an existing article that is already cited.
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Paranasal Sinus and Nasal Cavity Cancer Treatment are:
- James P. Neifeld, MD (Medical College of Virginia Hospital & Virginia Commonwealth University)
- Minh Tam Truong, MD (Boston University Medical Center)
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Paranasal Sinus and Nasal Cavity Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/paranasalsinus/HealthProfessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Disclaimer
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
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Last Revised: 2011-02-04
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