Σταδιοποίηση σε Ca Ρινικής Κοιλότητας & Παραρίνιων Κόλπων

 

Ca Ρινικής κοιλότητας & Παραρίνιων κόλπων

AJCC Stages/Prognostic Groups

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

T4b

Any N

M0

Any T

N3

M0

IVC

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

Ιγμόρειο

 

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 &/or the middle nasal meatus, except extension to posterior wall of maxillary sinus and pterygoid plates

T3

Tumor invades any of the following: Bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses

T4a

Moderately advanced local disease: Tumor invades anterior orbital contents, skin of 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 crania fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Ρινική κοιλότητα

& Ηθμοειδείς

 

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

T4a

Moderately advanced local disease: Tumor 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

Very advanced local disease: Tumor invades any of the following: Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than (V2), nasopharynx, or clivus

(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 in greatest dimension

N2

Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

N2a

Metastasis in a single ipsilateral lymph node > 3 cm but ≤ 6 cm in greatest dimension

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

N2c

Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

N3

Metastasis in a lymph node > 6 cm in greatest dimension

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Sinonasal carcinoma

  • Direct extension (most common)
  • Lymphatic (lymphatic metastases to regional nodes are uncommon)
  • Hematogenous
    • May involve bone, lung, liver, CNS
    • Organ metastases are uncommon

Esthesioneuroblastoma

  • Direct extension
  • Metastases
    • 20-40% of ENBs metastasize to regional lymph nodes, lungs, bone

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

Primary malignant tumors (WHO classification)

  • Malignant epithelial tumors
    • Squamous cell carcinomas
      • Verrucous carcinoma
      • Papillary squamous cell carcinoma
      • Basaloid squamous cell carcinoma
      • Spindle cell carcinoma
      • Adenosquamous carcinoma
      • Acantholytic squamous cell carcinoma
    • Lymphoepithelial carcinoma
    • Sinonasal undifferentiated carcinoma
    • Adenocarcinoma
      • Intestinal-type adenocarcinoma
      • Non-intestinal-type adenocarcinoma
    • Neuroendocrine tumors
      • Typical carcinoid
      • Atypical carcinoid
      • Small cell Ca, neuroendocrine type
  • Soft tissue tumors
    • Malignant tumors
      • Fibrosarcoma
      • Malignant fibrous histiocytoma
      • Leiomyosarcoma
      • Rhabdomyosarcoma
      • Angiosarcoma
      • Malignant peripheral nerve sheath
    • Tumors with low malignant potential/borderline tumors
      • Desmoid-type fibromatosis
      • Inflammatory myofibroblastic tumor
      • Glomangiopericytoma (sinonasal-type hemangiopericytoma)
      • Extrapleural solitary fibrous tumor
  • Tumors of bone and cartilage (malignant subtype)
    • Chondrosarcoma
    • Mesenchymal chondrosarcoma
    • Osteosarcoma
    • Chordoma
  • Hematolymphoid tumors
    • Extranodal NK-/T-cell lymphoma
    • Diffuse large B-cell lymphoma
    • Extramedullary plasmacytoma
    • Extramedullary myeloid sarcoma
    • Histiocytic sarcoma
    • Langerhans cell histiocytosis
  • Neuroectodermal tumors
    • Ewing sarcoma
    • Primitive neuroectodermal tumor
    • Olfactory neuroblastoma (esthesioneuroblastoma)
    • Melanotic neuroectodermal tumor of infancy
    • Mucosal malignant melanoma
  • Germ cell tumors
    • Immature teratoma
    • Teratoma with malignant transformation
    • Sinonasal yolk sac tumor (endodermal sinus tumor)
    • Sinonasal teratocarcinosarcoma
    • Mature teratoma
    • Dermoid cyst
  • Secondary tumors

Kadish Staging System for Esthesioneuroblastoma

Group A

Tumor localized to nasal cavity

Group B

Tumor localized to nasal cavity and sinuses

Group C

Tumor extends beyond nasal cavity and sinuses to skull base, anterior cranial fossa, orbit, or neck nodes, with or without distant metastases