Radiation Oncology/Head & Neck/Sinonasal/Staging

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Nasal Cavity and Paranasal Sinuses Staging


Maxillary SinusEdit

AJCC 7th Edition (2009)
Tumor

  • T1 - Tumor limited to the maxillary sinus with no erosion or destruction of bone
  • T2 - Tumor causing bony erosion or destruction including extension into the hard palate, middle nasal meatus, except extension into posterior wall of maxillary sinus and pterygoid plates
  • T3 - Tumor invades any of the following: bone of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses
  • T4a - Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribiform plate, sphenoid or frontal sinuses
  • T4b - Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than CN V2, nasopharynx, or clivus


Nodes

  • NX - Cannot be assessed
  • N0 - No regional lymph nodes metastasis
  • N1 - Single ipsilateral lymph node, <= 3cm in greatest dimension
  • N2
    • N2a - Single ipsilateral lymph node, 3-6 cm in greatest dimension
    • N2b - Multiple ipsilateral lymph nodes, <= 6cm in greatest dimension
    • N2c - Bilateral or contralateral lymph nodes, <= 6cm in greatest dimension
  • N3 - Lymph node(s) >6 cm in greatest dimension


Metastasis

  • M0 - none
  • M1 - yes


Stage Grouping

  • Stage I - T1N0
  • Stage II - T2N0
  • Stage III - T3N0, T1-3N1
  • Stage IVA - T4a or N2
  • Stage IVB - T4b or N3
  • Stage IVC - M1

Nasal Cavity and Ethmoid SinusEdit

  • The nasal cavity and ethmoid sinuses share a common staging system
  • Four subsites: septum, floor, lateral wall, and vestible


AJCC 7th Edition (2009)
Tumor

  • T1 - Restricted to any one subsite, with or without bony invasion
  • T2 - Invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion
  • T3 - Invades the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate
  • T4a - Invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses
  • T4b - Invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx, or clivus


Nodes (same as for most H&N sites)

  • NX - Cannot be assessed
  • N0 - No regional lymph nodes metastasis
  • N1 - Single ipsilateral lymph node, <= 3cm in greatest dimension
  • N2
    • N2a - Single ipsilateral lymph node, 3-6 cm in greatest dimension
    • N2b - Multiple ipsilateral lymph nodes, <= 6cm in greatest dimension
    • N2c - Bilateral or contralateral lymph nodes, <= 6cm in greatest dimension
  • N3 - Lymph node(s) >6 cm in greatest dimension


Metastasis

  • M0 - none
  • M1 - yes


Stage Grouping

  • Stage I - T1N0
  • Stage II - T2N0
  • Stage III - T3N0, T1-3N1
  • Stage IVA - T4a or N2
  • Stage IVB - T4b or N3
  • Stage IVC - M1


Wang Classification (for carcinoma of the nasal vestibule)

  • T1 - Tumor confined to skin
  • T2 - Invades subcutaneous tissue and cartilage
  • T3 - Invades bone

Older staging systemsEdit

AJCC 6th Edition (2006)
No changes compared to 7th edition