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Nasal Cavity and Paranasal Sinuses Cancer: Staging & Treatment

TNM is the most commonly used system for staging nasal cavity and paranasal sinus cancers. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 1, 2, 3, 4a, and 4b), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these factors. Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of nasal cavity and paranasal sinus cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

STAGE TNM STAGE TREATMENT
I T1 N0 M0 The primary tumor is limited to maxillary sinus mucosa without any erosion or
destruction of bone. No spread to nearby lymph nodes or distant body parts.
For Stage I and II cancers, surgery is considered as the preferred treatment. Radiation therapy with or without chemotherapy may be employed after the primary treatment to kill any remaining cancer cells.
II T2 N0 M0 The primary tumor causing bone erosion or destruction or has invaded into
the hard palate and/or middle nasal meatus. No spread to nearby lymph nodes or distant body parts.
See Above
III T3 N0 M0 The primary tumor has invaded the bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, or ethmoid sinuses. No spread to nearby lymph nodes or distant body parts. For Stage III to IVA cancers, surgery is employed as the first-line treatment and involves the resection of the primary tumor along with any affected lymph nodes. This is generally followed by radiation therapy or radiotherapy + chemotherapy depending upon the presence of any adverse prognostic feature.
T1-3 N1 M0 The primary tumor with or without invasion into the bones, posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, or ethmoid sinuses. The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. No spread to distant body parts. See Above
IVA T1-3 N2 M0 The primary tumor with or without invasion into the bones, posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, or ethmoid sinuses. The disease has spread to a single ipsilateral lymph node measuring either </=3 cm with extranodal involvement or >3 cm but <6 cm without extranodal involvement; or to multiple ipsilateral or bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. No spread to distant body parts. See Above
T4a N0-2 M0 The primary tumor has invaded into the anterior orbital contents, the skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses. The disease might have spread to single, multiple, or bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. No spread to distant body parts. See Above
IVB Any T N3 M0 The primary tumor that might or might not have invaded the adjacent structures. The disease has spread to lymph nodes measuring >6 cm or significant extranodal involvement. No spread to distant body parts. For Stage IVB cancer, where surgical resection cannot remove all cancer cells, radiotherapy along with chemotherapy or targeted therapy is usually employed as the first-line treatment. Surgery may be employed if the tumor shrinks sufficiently that it can be removed with surgery.
T4b Any N M0 The primary tumor has invaded into the orbital apex, dura, brain, middle cranial fossa, cranial nerves, nasopharynx, or clivus. The disease might or might not have spread to nearby lymph nodes. No spread to distant body parts. See Above
IVC Any T Any N M1 The primary tumor that might or might not have invaded the adjacent structures. The disease might or might not have spread to nearby lymph nodes. The disease has spread to a distant body part, such as the lungs. For Stage IVC cancer, chemotherapy is usually employed as the first-line treatment. Radiation therapy may be employed as palliative treatment.

Palliative Treatment: It helps in improving the overall quality of life by providing relief from the symptoms and by reducing the suffering caused by HNC and its treatment. It is generally given as supportive care for advanced staged HNCs, along with other treatments. It may include but not limited to: using drugs or other interventions to reduce pain, bleeding, and other symptoms; surgical interventions like gastrostomy or tracheostomy to support nutrition or respiration; support and counselling for speech, swallowing, and oral hygiene-related problems; and radiation therapy to palliate pain, bleeding, obstructive problems, etc.

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes, patient’s choice and health condition are also important to make a treatment choice.

Following are the goals of Staging and Treatment of Nasal Cavity and Paranasal Sinuses Cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement of overall quality of life
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