Stages of nasal cavity and ethmoid sinus cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for nasal cavity and ethmoid sinus cancer is the TNM system. For nasal cavity and ethmoid cancer there are 5 stages – stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

When describing the stage, doctors may use the words local, regional or distant. Local means that the cancer is only in the nasal cavity or ethmoid sinuses and has not spread to other parts of the body. Regional means the cancer has spread to the lymph nodes in the neck (cervical lymph nodes). Distant means in a part of the body farther from the nasal cavity and ethmoid sinuses.

The stage of cancer in the nasal cavity or ethmoid sinus depends on where the tumour develops in these structures. The different areas of the nasal cavity and ethmoid sinus are called subsites.

The nasal cavity subsites are the:

• wall that divides the nasal cavity (called the septum)
• floor of the nasal cavity
• side walls of the nasal cavity
• area covered by skin just inside the nostril (called the nasal vestibule)

The ethmoid sinus subsites are the left and right sides of the ethmoid sinus.

Find out more about staging cancer.

Cancer cells are only in the lining of the nasal cavity or ethmoid sinus.

The tumour is in 1 subsite of the nasal cavity or ethmoid sinus. It may have grown into the underlying bone.

The tumour is in 2 subsites of either the nasal cavity or ethmoid sinus or has grown into an area next to the sinuses. It may also have grown into the underlying bone.

The tumour has grown into any of the following:

• floor of the eye socket (orbit)
• maxillary sinus
• roof of the mouth (palate)
• the part of the ethmoid bone that separates the nasal cavity and the brain (called the cribriform plate)
• at least 1 subsite of the nasal cavity or ethmoid sinus

The cancer may also have grown into 1 lymph node in the neck on the same side as the tumour. The lymph node is no larger than 3 cm.

Stage 4 nasal cavity and ethmoid sinus cancer can be divided into stages 4A, 4B and 4C depending on:

• which nearby areas the tumour has grown into, such as the skin of the nose or cheek, other bones of the skull, other paranasal sinuses or the brain
• the number and size of the lymph nodes with cancer
• if the cancer has grown outside of lymph nodes (extranodal extension)
• whether the lymph nodes are on the same or opposite side of the neck as the tumour, or on both sides of the neck
• if the cancer has spread to other parts of the body, such as to the lungs or liver (called distant metastasis)

Recurrent nasal cavity and ethmoid sinus cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.