Sinonasal cancer TNM

TNM Classification of Malignant Tumours (8^th Edition, UICC, 2017)

Primary Tumour (T) – Maxillary Sinus

Tx        Primary tumour cannot be assessed

T0        No evidence of primary tumour

Tis        Carcinoma in situ

T1        Tumour limited to the mucosa with no erosion or destruction of bone

T2        Tumour causing bone erosion or destruction, including extension into the 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, or 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, or clivus

 

Primary Tumour (T) – Nasal Cavity and Ethmoid Sinus

Tx        Primary tumour cannot be assessed

T0        No evidence of primary tumour

Tis        Carcinoma in situ

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, or clivus

 

Regional Lymph Nodes (N)

Nx        Regional lymph nodes cannot be assessed

N0        No regional lymph node metastasis

N1        Metastasis in a single ipsilateral lymph node, ≤3 cm and no extranodal extension (ENE

N2a      Metastasis in a single ipsilateral lymph node, >3cm but ≤6cm, no ENE

N2b      Metastasis in multiple ipsilateral lymph nodes, all ≤6cm and no ENE

N2c      Metastasis in bilateral or contralateral lymph nodes, ≤6cm and no ENE

N3a      Metastasis in any lymph node >6cm with no ENE

N3b      Metastasis in any lymph node(s) with clinical ENE *

 

Notes: * The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal extension. Midline nodes are considered ipsilateral nodes.

The clinical and pathological T classifications are identical. The pathological (pN) classification is listed below for completeness.

           

Pathological classification of Regional Lymph Nodes (pN)

Histological examination of a selective neck dissection specimen will ordinarily include 10 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 15 or more lymph nodes.

pNx      Regional lymph nodes cannot be assessed

pN0      No regional lymph node metastasis

pN1      Metastasis in a single ipsilateral lymph node, ≤3cm, no ENE

pN2a    Metastasis in a single ipsilateral lymph node, ≤3cm With ENE+; OR single lymph node >3cm but ≤6cm and no ENE

pN2b    Metastasis in multiple ipsilateral lymph nodes, ≤6cm, no ENE

pN2c    Metastasis in bilateral or contralateral lymph nodes, ≤6cm, no ENE

pN3a    Metastasis in any lymph node >6cm, no ENE

pN3b    Metastasis in a single ipsilateral lymph node >3cm with ENE+; OR single contralateral node, any size with ENE+; OR multiple nodes, any size with ENE+

Midline nodes are considered ipsilateral nodes.

         

Distant Metastasis (M)

M0       No distant metastasis

M1       Distant metastasis