TNM Classification for Cancer of Nasal Cavity and Paranasal Sinuses
The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications for cancers of the nasal cavity and paranasal sinuses are provided below, along with anatomic staging. [1]
Table 1. TNM classification (Open Table in a new window)
Primary tumor (T) |
|
Maxillary sinus |
|
TX |
Primary tumor cannot be assessed |
Tis |
Carcinoma in situ |
T1 |
Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone |
T2 |
Tumor causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates |
T3 |
Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses |
| T4 | Moderately advanced or very advanced local disease |
T4a |
Moderately advanced local disease Tumor invades the anterior orbital contents, skin of the cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses |
T4b |
Very advanced local disease Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus |
Nasal cavity and ethmoid sinus |
|
TX |
Primary tumor cannot be assessed |
Tis |
Carcinoma in situ |
T1 |
Tumor restricted to any 1 subsite, with or without bony invasion |
T2 |
Tumor invading 2 subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion |
T3 |
Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate |
| T4 | Moderately advanced or very advanced local disease |
T4a |
Moderately advanced local disease Tumor invades any of the following: anterior orbital contents, skin of the nose or cheek, minimal extension to the anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses |
T4b |
Very advanced local disease Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus |
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
NX |
Regional lymph nodes cannot be assessed |
N0 |
No regional lymph node metastasis |
N1 |
Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-]) |
N2 |
Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
N2a |
Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-) |
N2b |
Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
N2c |
Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N3 | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) with clinically overt ENE (+) |
N3a |
Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with clinically overt ENE (ENEc) |
| Pathological N (pN) | |
| Nx | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-) |
| N2 | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N2a | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); |
| N2b | Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N2c | Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-) |
| N3 | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+) |
Distant metastasis (M) |
|
cM0 |
No distant metastasis |
cM1 |
Distant metastasis |
| pM1 | Distant metastasis, microscopically confirmed |
Table 2. Histologic grade (Open Table in a new window)
Histologic grade (G) |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
Table 3. Anatomic stage/prognostic groups (Open Table in a new window)
Stage |
T |
N |
M |
0 |
Tis |
N0 |
M0 |
I |
T1 |
N0 |
M0 |
II |
T2 |
N0 |
M0 |
III |
T3 |
N0 |
M0 |
T1 |
N1 |
M0 |
|
T2 |
N1 |
M0 |
|
T3 |
N1 |
M0 |
|
IVA |
T4a |
N0 |
M0 |
T4a |
N1 |
M0 |
|
T1 |
N2 |
M0 |
|
T2 |
N2 |
M0 |
|
T3 |
N2 |
M0 |
|
T4a |
N2 |
M0 |
|
IVB |
T Any |
N3 |
M0 |
T4b |
N Any |
M0 |
|
IVC |
T Any |
N Any |
M1 |
Tables
Primary tumor (T) |
|
Maxillary sinus |
|
TX |
Primary tumor cannot be assessed |
Tis |
Carcinoma in situ |
T1 |
Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone |
T2 |
Tumor causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates |
T3 |
Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses |
| T4 | Moderately advanced or very advanced local disease |
T4a |
Moderately advanced local disease Tumor invades the anterior orbital contents, skin of the cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses |
T4b |
Very advanced local disease Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus |
Nasal cavity and ethmoid sinus |
|
TX |
Primary tumor cannot be assessed |
Tis |
Carcinoma in situ |
T1 |
Tumor restricted to any 1 subsite, with or without bony invasion |
T2 |
Tumor invading 2 subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion |
T3 |
Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate |
| T4 | Moderately advanced or very advanced local disease |
T4a |
Moderately advanced local disease Tumor invades any of the following: anterior orbital contents, skin of the nose or cheek, minimal extension to the anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses |
T4b |
Very advanced local disease Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus |
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
NX |
Regional lymph nodes cannot be assessed |
N0 |
No regional lymph node metastasis |
N1 |
Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-]) |
N2 |
Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
N2a |
Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-) |
N2b |
Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
N2c |
Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N3 | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) with clinically overt ENE (+) |
N3a |
Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with clinically overt ENE (ENEc) |
| Pathological N (pN) | |
| Nx | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-) |
| N2 | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N2a | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); |
| N2b | Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-) |
| N2c | Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-) |
| N3 | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+) |
Distant metastasis (M) |
|
cM0 |
No distant metastasis |
cM1 |
Distant metastasis |
| pM1 | Distant metastasis, microscopically confirmed |
Histologic grade (G) |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
Stage |
T |
N |
M |
0 |
Tis |
N0 |
M0 |
I |
T1 |
N0 |
M0 |
II |
T2 |
N0 |
M0 |
III |
T3 |
N0 |
M0 |
T1 |
N1 |
M0 |
|
T2 |
N1 |
M0 |
|
T3 |
N1 |
M0 |
|
IVA |
T4a |
N0 |
M0 |
T4a |
N1 |
M0 |
|
T1 |
N2 |
M0 |
|
T2 |
N2 |
M0 |
|
T3 |
N2 |
M0 |
|
T4a |
N2 |
M0 |
|
IVB |
T Any |
N3 |
M0 |
T4b |
N Any |
M0 |
|
IVC |
T Any |
N Any |
M1 |
