Radiation Oncology/Head & Neck/Sinonasal/Staging

Nasal Cavity and Paranasal Sinuses Staging

Maxillary Sinus
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

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 Sinus

 * 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)

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