Stages of Paranasal Sinus and Nasal Cavity Cancer

After paranasal sinus and nasal cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the paranasal sinuses and nasal cavity or to other parts of the body.

The process used to find out if cancer has spread within the paranasal sinuses and nasal cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an opening in the body, such as the nose or mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. Sometimes a substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if nasal cavity cancer spreads to the lung, the cancer cells in the lung are actually nasal cavity cancer cells. The disease is metastatic nasal cavity cancer, not lung cancer.

There is no standard staging system for cancer of the sphenoid and frontal sinuses.

The staging described below for the maxillary and ethmoid sinuses and the nasal cavity is only used for patients who have not had lymph nodes in the neck removed and checked for signs of cancer.

The following stages are used for maxillary sinus cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the mucous membranes lining the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the mucous membranes of the maxillary sinus.

Stage II

In stage II, cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the part of the sphenoid bone behind the upper jaw.

Stage III

In stage III, cancer has spread to any of the following:

• The bone at the back of the maxillary sinus.
• The tissues under the skin.
• The part of the eye socket near the nose or the bottom of the eye socket.
• The area behind the cheek bone.
• The ethmoid sinus.

or

Cancer is found in the maxillary sinus and may have spread to any of the following:

• The bones around the maxillary sinus, including the roof of the mouth and the nose.
• The tissues under the skin.
• The part of the eye socket near the nose or the bottom of the eye socket.
• The area behind the cheek bone.
• The ethmoid sinus.

Cancer has also spread to one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC.

Stage IVA

In stage IVA, cancer has spread to any of the following:

• The eye.
• The skin of the cheek.
• The part of the sphenoid bone behind the upper jaw.
• The area behind the upper jaw.
• The bone between the eyes.
• The sphenoid or frontal sinuses.

Cancer may have also spread to one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller.

or

Cancer is found in the maxillary sinus and may have spread to any of the following:

• The bones around the maxillary sinus, including the roof of the mouth and the nose.
• The bone between the eyes.
• The tissues under the skin.
• The skin of the cheek.
• The eye, the part of the eye socket near the nose, or the bottom of the eye socket.
• The area behind the cheek bone.
• The part of the sphenoid bone behind the upper jaw.
• The area behind the upper jaw.
• The ethmoid, sphenoid, or frontal sinuses.

Cancer has also spread to one of the following:

• one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
• more than one lymph node on the same side of the neck as the cancer and the lymph nodes are not larger than 6 centimeters; or
• lymph nodes on the opposite side of the neck as the cancer or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.

Stage IVB

In stage IVB, cancer has spread to any of the following:

• The area behind the eye.
• The brain.
• The middle parts of the skull.
• The nerves that begin in the brain and go to the face, neck, and other parts of the brain (cranial nerves).
• The upper part of the throat behind the nose.
• The base of the skull near the spinal cord.

Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.

or

Cancer may be found anywhere in or near the maxillary sinus. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue.

Stage IVC

In stage IVC, cancer may be found anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.

The following stages are used for nasal cavity and ethmoid sinus cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the mucous membranes lining the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and is found in only one area of either the nasal cavity or the ethmoid sinus and may have spread into bone.

Stage II

In stage II, cancer is found in two areas of either the nasal cavity or the ethmoid sinus that are near each other, or cancer has spread to an area next to the sinuses. Cancer may also have spread into bone.

Stage III

In stage III, cancer has spread to any of the following:

• The part of the eye socket near the nose or the bottom of the eye socket.
• The maxillary sinus.
• The roof of the mouth.
• The bone between the eyes.

or

Cancer is found in the nasal cavity or ethmoid sinus and may have spread to any of the following:

• The part of the eye socket near the nose or the bottom of the eye socket.
• The maxillary sinus.
• The roof of the mouth.
• The bone between the eyes.

Cancer has also spread to one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC.

Stage IVA

In stage IVA, cancer has spread to any of the following:

• The eye.
• The skin of the nose or cheek.
• The front parts of the skull.
• The part of the sphenoid bone behind the upper jaw.
• The sphenoid or frontal sinuses.

Cancer may have also spread to one lymph node on the same side of the neck as the cancer, and the lymph node is 3 centimeters or smaller.

or

Cancer is found in the nasal cavity or ethmoid sinus and may have spread to any of the following:

• The eye, the part of the eye socket near the nose, or the bottom of the eye socket.
• The skin of the nose or cheek.
• The front parts of the skull.
• The part of the sphenoid bone behind the upper jaw.
• The sphenoid or frontal sinuses.

Cancer has also spread to one of the following:

• one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
• more than one lymph node on the same side of the neck as the cancer and the lymph nodes are not larger than 6 centimeters; or
• lymph nodes on the opposite side of the neck as the cancer or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.

Stage IVB

In stage IVB, cancer has spread to any of the following:

• The area behind the eye.
• The brain.
• The middle parts of the skull.
• The nerves that begin in the brain and go to the face, neck, and other parts of the brain (cranial nerves).
• The upper part of the throat behind the nose.
• The base of the skull near the spinal cord.

Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.

or

Cancer may be found anywhere in or near the nasal cavity and ethmoid sinus. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue.

Stage IVC

In stage IVC, cancer may be found anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.

After surgery, the stage of the cancer may change and more treatment may be needed.

If the cancer is removed by surgery, a pathologist will examine a sample of the cancer tissue under a microscope. Sometimes, the pathologist’s review results in a change to the stage of the cancer and more treatment is needed after surgery.

Paranasal sinus and nasal cavity cancer can recur (come back) after it has been treated.

The cancer may come back in the paranasal sinuses and nasal cavity or in other parts of the body.