The following stages are used for maxillary sinus cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells

are found in the innermost lining of the maxillary sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I In stage I, cancer has formed in the mucous membranes of the maxillary sinus. Stage II In stage II, cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull. Stage III In stage III, cancer has spread to any of the following: Bone at the back of the maxillary sinus. Tissues under the skin. The eye socket. The base of the skull. The ethmoid sinuses. or Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following: The lining of the maxillary sinus. Bones around the maxillary sinus, including the roof of the mouth and the nose. Tissues under the skin. The eye socket. The base of the skull. The ethmoid sinuses. Stage IV Stage IV is divided into stage IVA, IVB, and IVC. Stage IVA In stage IVA, cancer has spread either: to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3centimeters but not larger than 6 centimeters; or to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters. and cancer has spread to any of the following: The lining of the maxillary sinus. Bones around the maxillary sinus, including the roof of the mouth and the nose. Tissues under the skin. The eye socket. The base of the skull. The ethmoid sinuses. or Cancer has spread to any of the following: The front of the eye.

The skin of the cheek. The base of the skull. Behind the jaw. The bone between the eyes. The sphenoid or frontal sinuses. and cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck. Stage IVB In stage IVB, cancer has spread to any of the following: The back of the eye. The brain. The middle parts of the skull. The nerves in the head that go to the brain. The upper part of the throat behind the nose. The base of the skull. and cancer may be found in one or more lymph nodes of any size, anywhere in the neck. or Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus. Stage IVC In stage IVC, cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs. The following stages are used for nasal cavity and ethmoid sinus cancer: Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also calledcarcinoma in situ. Stage I In stage I, cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone. Stage II In stage II, cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone. Stage III In stage III, cancer has spread to any of the following: The eye socket. The maxillary sinus. The roof of the mouth. The bone between the eyes. or Cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following: The nasal cavity. The ethmoid sinus. The eye socket.

The maxillary sinus. The roof of the mouth. The bone between the eyes. Stage IV Stage IV is divided into stage IVA, IVB, and IVC. Stage IVA In stage IVA, cancer has spread either: to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3centimeters but not larger than 6 centimeters; or to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters. and cancer has spread to any of the following: The nasal cavity. The ethmoid sinus. The eye socket. The maxillary sinus. The roof of the mouth. The bone between the eyes. or Cancer has spread to any of the following: The front of the eye. The skin of the nose or cheek. Front parts of the skull. The base of the skull. The sphenoid or frontal sinuses. and cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck. Stage IVB In stage IVB, cancer has spread to any of the following: The back of the eye. The brain. The middle parts of the skull. The nerves in the head that go to the brain. The upper part of the throat behind the nose. The base of the skull. and cancer may be found in one or more lymph nodes of any size, anywhere in the neck. or Cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus. Stage IVC In stage IVC, cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.

T categories for maxillary sinus cancer TX: Primary (main) tumor cannot be assessed. T0: No evidence of primary tumor. Tis: Cancer cells are limited to the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ. T1: Tumor is only in the tissue lining the sinus (the mucosa) and does not invade bone. T2: Tumor begins to grow into some of the bones of the sinus, other than into the bone of the back part of the sinus. T3: Tumor begins to grow into the bone at the back of the sinus (called the posterior wall) or the tumor has grown into the ethmoid sinus, the tissues under the skin, or the side or bottom of the eye socket. T4a: Tumor grows into other structures such as the skin of the cheek, the front part of the eye socket, the bone at the top of the nose (cribriform plate), the sphenoid sinus, the frontal sinus, or certain parts of the face (the pterygoid plates or the infratemporal fossa). This is also known as moderately advanced local disease. T4b: Tumor has grown into the throat behind the nasal cavity (called the nasopharynx), the back of the eye socket, the brain, the tissue covering the brain (the dura), some parts of the base of the skull (middle cranial fossa or clivus), or certain nerves. This is also known as very advanced local disease. T categories for nasal cavity and ethmoid sinus cancer TX: Primary (main) tumor cannot be assessed. T0: No evidence of primary tumor. Tis: Cancer cells are only in the innermost layer of the mucosa (epithelium). These cancers are known as carcinoma in situ. T1: Tumor is only in the nasal cavity or one of the ethmoid sinuses, although it may have grown into the bones of the sinus. T2: Tumor has grown into other nasal or paranasal cavities, and may or may not have grown into nearby bones. T3: Tumor has grown into the side or bottom of the eye socket, the roof of the mouth (palate), the cribriform plate (the bone that separates the nose from the brain), and/or the maxillary sinus. T4a: Tumor has grown into other structures such as the front part of the eye socket, the skin of the nose or cheek, the sphenoid sinus, the frontal sinus, or certain bones in the face (pterygoid plates). This is also known as moderately advanced local disease. Cancers that are T4a are usually resectable (meaning they can be removed with surgery). T4b: Tumor is growing into the back of the eye socket, the brain, the dura (the tissue covering the brain), some parts of the skull (the clivus or the middle cranial fossa), certain nerves, or the nasopharynx (throat behind the nasal cavity). This is also known as very advanced local disease. These tumors are not resectable (they cannot be removed with surgery). N categories The N groups are based on spread of the cancer to nearby (regional) lymph nodes and on the size of the nodes. These groups are the same for all nasal cavity and paranasal sinus cancers: NX: Nearby (regional) lymph nodes cannot be assessed. N0: Cancer has not spread into the lymph nodes. N1: Cancer has spread to a single lymph node that is on the same side as the tumor and is no larger than 3 centimeters (cm) across (slightly larger than 1 inch).

N2: Cancer has spread to a single lymph node on the same side as the tumor that is larger than 3 cm but no larger than 6 cm (slightly larger than 2 inches) across; or cancer has spread to more than one lymph node on the same side as the tumor, all of which are no larger than 6 cm across; or cancer is in at least one lymph node that is not on the same side as the tumor (but none are larger than 6 cm across). N3: Cancer has spread to at least one nearby lymph node that is larger than 6 cm across. M categories The M groups for all nasal cavity and paranasal sinus cancers are the same: M0: No cancer spread (metastasis) distant organs or tissues M1: The cancer has spread to distant organs such as the lung or distant bones. Stage groupings Once the T, N, and M groups have been assigned, this information is combined to assign an overall stage for the cancer. This process is called stage grouping. Stage grouping rules are the same for all cancers of the nasal cavity and paranasal sinuses. Stage Stage 0 Stage I Stage II Stage III T Tis T1 T2 T3 T1, T2, or T3 Stage IVA T1, T2, or T3 T4a Stage IVB Any T T4b Stage IVC Any T N N0 N0 N0 N0 N1 N2 N0, N1, or N2 N3 Any N Any N M M0 M0 M0 M0 M0 M0 M0 M0 M0 M1

Treatment by stage for maxillary sinus cancer Stage1 If you have stage 1 maxillary sinus cancer, you are most likely to have surgery. The operation, called a maxillectomy involves removing the bone and tissue from the maxillary sinus. You may need to haveradiotherapy after your operation to destroy any cancer cells that may still be there. You may need this if the surgeon Could not remove all the tumour or Could not remove a large enough safety margin of healthy tissue from around the tumour Stage 2 If you have stage 2 maxillary sinus cancer, you are most likely to have either Surgery alone (maxillectomy) or Radiotherapy before or after surgery If you have either stage 1 or 2 maxillary sinus cancer and you are not fit enough to have surgery, you will probably have radiotherapy alone. Stage 3 Treatment for stage 3 maxillary sinus cancer is surgery (radical or extended maxillectomy) andradiotherapy. You may have the radiotherapy before or after surgery. Some people have radiotherapy or chemotherapy to shrink the cancer before surgery. This makes it easier for your surgeon to remove the cancer. You may hear this called neoadjuvant treatment. If the cancer has spread to the lymph nodes, you will need an operation called a neck dissection orradiotherapy to get rid of any cancer cells in this area. Stage 4 Radiotherapy is usually the treatment for stage 4 maxillary sinus cancer. If your sinuses are very blocked you may have surgery to relieve this before your radiotherapy. But this will not completely remove your cancer. Treatment by stage for ethmoid sinus cancer Using surgery to treat ethmoid sinus cancer is sometimes difficult. This is because these sinuses are very close to your eye sockets and the base of your skull. Operations tend to be more extensive than those for maxillary sinus cancer. Stage 1 and 2 If you have a small stage 1 or 2 ethmoid sinus cancer, your doctor may be able to completely remove it with an operation called an ethmoidectomy. But you are more likely to have radiotherapy for these early stage cancers. This works just as well as surgery. Stage 3 and 4 If you have these stages of ethmoid sinus cancer, you will have a combination of craniofacial surgeryand radiotherapy. You will have the radiotherapy either before or after your surgery. Treating sphenoid sinus cancer Because of where these sinuses are, they are very difficult to get to during surgery. Doctors will usually use radiotherapy to treat these cancers. Treating nasal cavity cancer If you have cancer of the nasal cavity your treatment will depend on where the tumour is and itsstage. If the cancer is in the tissue separating the two sides of the nose (your nasal septum) you will most likely have surgery.

For cancers elsewhere in the nasal cavity, radiotherapy works just as well as surgery. It is often the preferred treatment because it does not change the appearance of the nose as much as surgery. If the cancer is very advanced, your doctor may suggest both treatments, with radiotherapy before or after surgery. Treating other types of nasal cavity and paranasal sinus cancer This includes lymphomas, sarcomas and melanomas. Treatment for lymphomas of the nasal cavity and paranasal sinuses is the same as for other types of lymphoma. Look in the treating non Hodgkins lymphoma section of CancerHelp UK for information about radiotherapy and chemotherapyto treat this type of cancer. If you have a melanoma or sarcoma of the nasal cavity or paranasal sinuses, you will most likely have surgery. Click on the links below to find out about Surgery for sarcoma Surgery for melanoma Note - the above links will take you to different cancer sections on CancerHelp UK. If you want to return to this nasal and sinus cancer section, use the back button at the top left of your screen. Treatment if your cancer comes back Your treatment depends on where the cancer has come back and the treatment you had first time round. Your doctors may choose a different treatment from what you had before. Unfortunately, once a nasal or sinus cancer has come back, it isnt usually possible to cure it. But treatment can help to relieve symptoms. If you had radiotherapy to treat maxillary or ethmoid sinus cancer or nasal cavity cancer the first time round, then this time you may have craniofacial surgery. If you previously had surgery, this time you will have radiotherapy. If radiotherapy or surgery dont help, you may then have chemotherapy alone or combined with biological therapy If your cancer has come back in the sphenoid sinuses you can have chemotherapy.

Stage I Paranasal Sinus and Nasal Cavity Cancer Treatment depends on where cancer is found in theparanasal sinuses and nasal cavity: If cancer is in the maxillary sinus, treatment is usually surgery with or without radiation therapy. If cancer is in the ethmoid sinus, treatment is usually radiation therapy and/or surgery. If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.) If cancer is in the nasal cavity, treatment is usually surgery and/or radiation therapy. If cancer is in the nasal vestibule, treatment is usually surgery or radiation therapy. For inverting papilloma, treatment is usually surgery with or without radiation therapy. For melanoma and sarcoma, treatment is usually surgery with or without radiation therapy andchemotherapy. For midline granuloma, treatment is usually radiation therapy. Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage I paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site. Stage II Paranasal Sinus and Nasal Cavity Cancer Treatment depends on where cancer is found in theparanasal sinuses and nasal cavity: If cancer is in the maxillary sinus, treatment is usually high-dose radiation therapy before or aftersurgery. If cancer is in the ethmoid sinus, treatment is usually radiation therapy and/or surgery. If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.) If cancer is in the nasal cavity, treatment is usually surgery and/or radiation therapy. If cancer is in the nasal vestibule, treatment is usually surgery or radiation therapy. For inverting papilloma, treatment is usually surgery with or without radiation therapy. For melanoma and sarcoma, treatment is usually surgery with or without radiation therapy and chemotherapy. For midline granuloma, treatment is usually radiation therapy. Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage II paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site. Stage III Paranasal Sinus and Nasal Cavity Cancer Treatment of stage III paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity. If cancer is in the maxillary sinus, treatment may include the following: High-dose radiation therapy before or after surgery. A clinical trial of fractionated radiation therapy before or after surgery. If cancer is in the ethmoid sinus, treatment may include the following: Surgery followed by radiation therapy.

A clinical trial of combination chemotherapy before surgery or radiation therapy. A clinical trial of combination chemotherapy after surgery or other cancer treatment. If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.) If cancer is in the nasal cavity, treatment may include the following: Surgery and/or radiation therapy. Chemotherapy and radiation therapy. A clinical trial of combination chemotherapy before surgery or radiation therapy. A clinical trial of combination chemotherapy after surgery or other cancer treatment. For inverting papilloma, treatment is usually surgery with or without radiation therapy. For melanoma and sarcoma, treatment may include the following: Surgery. Radiation therapy. Surgery, radiation therapy, and chemotherapy. For midline granuloma, treatment is usually radiation therapy. If cancer is in the nasal vestibule, treatment may include the following: External radiation therapy and/or internal radiation therapy with or without surgery. A clinical trial of combination chemotherapy before surgery or radiation therapy. A clinical trial of combination chemotherapy after surgery or other cancer treatment. Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage III paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site. Stage IV Paranasal Sinus and Nasal Cavity Cancer Treatment of stage IV paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity. If cancer is in the maxillary sinus, treatment may include the following: High-dose radiation therapy with or without surgery. A clinical trial of fractionated radiation therapy. A clinical trial of chemotherapy before surgery or radiation therapy. A clinical trial of chemotherapy after surgery or other cancer treatment. A clinical trial of chemotherapy and radiation therapy. If cancer is in the ethmoid sinus, treatment may include the following: Radiation therapy before or after surgery. Chemotherapy and radiation therapy. A clinical trial of chemotherapy before surgery or radiation therapy. A clinical trial of chemotherapy after surgery or other cancer treatment. A clinical trial of chemotherapy and radiation therapy. If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer, usually radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.) If cancer is in the nasal cavity, treatment may include the following: Surgery and/or radiation therapy. Chemotherapy and radiation therapy.

A clinical trial of chemotherapy before surgery or radiation therapy. A clinical trial of chemotherapy after surgery or other cancer treatment. A clinical trial of chemotherapy and radiation therapy. For inverting papilloma, treatment is usually surgery with or without radiation therapy. For melanoma and sarcoma, treatment may include the following: Surgery, Radiation therapy, Chemotherapy. For midline granuloma, treatment is usually radiation therapy. If cancer is in the nasal vestibule, treatment may include the following: External radiation therapy and/or internal radiation therapy with or without surgery. A clinical trial of chemotherapy before surgery or radiation therapy. A clinical trial of chemotherapy after surgery or other cancer treatment. A clinical trial of chemotherapy and radiation therapy. Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients withstage IV paranasal sinus and nasal cavity cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site. Treatment Options for Recurrent Paranasal Sinus and Nasal Cavity Cancer Treatment of recurrent paranasal sinus and nasal cavity cancer depends on where cancer is found in the paranasal sinuses and nasal cavity. If cancer is in the maxillary sinus, treatment may include the following: Surgery followed by radiation therapy. Radiation therapy followed by surgery. Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life. A clinical trial of chemotherapy. If cancer is in the ethmoid sinus, treatment may include the following: Surgery and/or radiation therapy. Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life. A clinical trial of chemotherapy. If cancer is in the sphenoid sinus, treatment is the same as for nasopharyngeal cancer and may include radiation therapy with or without chemotherapy. (See the PDQ summary on Nasopharyngeal Cancer Treatment for more information.) If cancer is in the nasal cavity, treatment may include the following: Surgery and/or radiation therapy. Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life. A clinical trial of chemotherapy. For inverting papilloma, treatment is usually surgery with or without radiation therapy. For melanoma and sarcoma, treatment may include the following: Surgery. Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life. For midline granuloma, treatment is usually radiation therapy. If cancer is in the nasal vestibule, treatment may include the following: Surgery and/or radiation therapy. Chemotherapy as palliative therapy to relieve symptoms and improve the quality of life. A clinical trial of chemotherapy.