Nasal Cavity and Paranasal Sinuses

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification applies only to carcinomas. There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories:

T categories. Physical examination and imaging
N categories. Physical examination and imaging
M categories. Physical examination and imaging

2. Anatomical Sites and Subsites

Nasal Cavity (C30.0)

• Septum
• Floor
• Lateral wall
• Vagina

Maxillary sinus (C31.0)

Ethmoid sinus (C31.1)

• Left
• Right

3. Regional Lymph Nodes

The regional lymph nodes are the cervical nodes.

4. TNM Clinical Classification

4.1. T - Primary Tumour

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ

4.1.1. Maxillary Sinus

T1. Tumour limited to the mucosa with no erosion or destruction of bone
T2. Tumour causing bone erosion or destruction, including extension into hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates
T3. Tumour 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. Tumour invades any of the following: anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses
T4b. Tumour invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve V2, nasopharynx. clivus

4.1.2. Nasal Cavity and Ethmoid Sinus

T1. Tumour restricted to one subsite of nasal cavity or ethmoid sinus, with or without bony invasion
T2. Tumour involves two subsites in a single site or extends to involve an adjacent site within the nasoethmoidal complex, with or without bony invasion
T3. Tumour extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate
T4a. Tumour 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. Tumour invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx. clivus

4.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2. Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
     N2a. Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
     N2b. Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
     N2c. Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N3. Metastasis in a lymph node more than 6 cm in greatest dimension

Note: Midline nodes are considered ipsilateral nodes.

4.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of a selective neck dissection specimen will ordinarily include 6 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. When size is a criterion for pN classification, measurement is made of the metastasis, not of the entire lymph node.

6. G Histopathological Grading

See definitions here

7. Stage Grouping

Stage 0 Tis N0 M0 Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T1. T2 N1 M0 T3 N0. N1 M0 Stage IVA T1. T2. T3 N2 M0 T4a N0. N1. N2 M0 Stage IVB T4b Any N M0 Any T N3 M0 Stage IVC Any T Any N M1

8. Summary

Nasal Cavity and Paranasal Sinuses Maxillary Sinus T1 Mucosa T2 Bone erosion/destruction, hard palate, middle nasal meatus T3 Posterior bony wall maxillary sinus, subcutaneous tissues, floor/medial wall of orbit, pterygoid fossa, ethmoid sinus T4a Anterior orbit, cheek skin, pterygoid plates, infra-temporal fossa, cribriform plate, sphenoid/frontal sinus T4b Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx. clivus Nasal Cavity and Ethmoid Sinus T1 One subsite T2 Two subsites or adjacent nasoethmoidal site T3 Medial wall/floor orbit, maxillary sinus, palate, cribriform plate T4a Anterior orbit, skin of nose/cheek, anterior cranial fossa (minimal), pterygoid plates, sphenoid/frontal sinuses T4b Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, nasopharynx. clivus All Sites N1 Ipsilateral single ≤3 cm N2 (a) Ipsilateral single >3 to 6 cm (b) Ipsilateral multiple ≤6 cm (c) Bilateral, contralateral ≤6 cm >6 cm N3