# Radiation Oncology/Head & Neck/Sinonasal/Staging

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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
* 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 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)
* 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 systems

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