Number stages for ethmoid sinus cancer
The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need. It can also give some idea of your outlook (prognosis).
The number staging system uses the TNM system to divide cancers into stages. There are 5 stages of ethmoid sinus cancer, numbered from 0 to 4.
Number stages
There are 5 number stages of ethmoid sinus cancer.
Stage 0 or carcinoma in situ (CIS)
If you have CIS or stage 0 cancer, you have a very early stage cancer. Some doctors prefer to call this preinvasive cancer because there are cancer cells only in the top layer of cells that line the inside of the ethmoid sinus, and it has not grown deeper. This means the cancer cells are contained there and cannot spread.
If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.
Stage 1
If you have stage 1 cancer of the ethmoid sinus, the tumour is only in one part of the ethmoid sinus, but it may have grown into the bones of the sinus.
The cancer has not spread to the lymph nodes or other parts of the body.
Stage 2
If you have stage 2 cancer of the ethmoid sinus, the tumour has grown into other parts of the ethmoid sinus, or into both the nasal cavity and ethmoid sinus. It may have grown into the bones of the nasal cavity or ethmoid sinus.
The cancer has not spread to the lymph nodes or other parts of the body.
Stage 3
Having stage 3 cancer of the ethmoid sinus can mean either:
- the tumour has spread into the side or bottom of the eye socket, the maxillary sinus, the roof of the mouth (palate) or the bone that separates the nose from the brain (cribriform plate). It has not spread to the lymph nodes or other parts of the body.
- the tumour is any size, except T4, and there are cancer cells in one lymph node on the same side of the neck as the tumour, but the node measures 3cm across or less. It has not spread to the lymph nodes or other parts of the body.
Stage 4
This means the cancer is advanced. All T4 tumours are stage 4 even if they have not spread to lymph nodes or other parts of the body. Stage 4 is split into A, B and C.
Stage 4a means either:
- the tumour has spread into the front part of the eye socket, the skin of the nose or cheek, the sphenoid or frontal sinuses, or bones in the face (pterygoid plates). There are no cancer cells in nearby lymph nodes, or there is cancer in one lymph node on the same side of the neck as the tumour, but the node measures 3cm across or less. It has not spread to other organs.
- the tumour is any size except 4b. There is cancer in one lymph node, on the same side of the neck, that is more than 3cm across but no more than 6cm or, there is cancer in more than one lymph node on the same side of the neck, but none of them is more than 6cm across or, there is cancer in at least one lymph node on the other side of the neck (or on both sides), but none are more than 6cm across. It has not spread to other organs.
Stage 4b means either:
- the tumour is any size. One or more nodes contain cancer, and at least one node is more than 6cm across, or it has spread to a lymph node and has grown outside of the lymph node. It has not spread to other organs.
- the tumour has spread into the back part of the eye socket, the brain, the layer of tissue covering the brain (dura), parts of the skull, some of the nerves that connect the brain to the body (cranial nerves), or the area connecting the back of the nose to the back of the mouth (nasopharynx). The lymph nodes can be affected or not. It has not spread to other organs.
Stage 4c:
- the tumour is any size. The lymph nodes can be affected or not. The cancer has spread to other parts of the body, such as the lungs, brain or liver.
Treatment
Ethmoid sinus cancer is difficult to treat as these sinuses are very close to your eye sockets and the base of your skull.
Your treatment is very individualised and will depend on many factors:
- the tumour type
- where the tumour is (its stage)
- your own choice
- how fit you are medically
Surgery
For squamous cell cancers, the most common type of ethmoid sinus cancer, you might have surgery if your team thinks that all of the tumour can be removed. Your surgeon will use organ preserving endoscopic surgery where possible. This type of surgery is less invasive and cause less damage to nearby structures.
For advanced cancers, you might need a bigger operation. How you might look after surgery (cosmetic result) and the possibility of reconstruction are important factors in the final treatment decision.
Radiotherapy and chemotherapy
You might have radiotherapy or chemotherapy with radiotherapy (chemoradiotherapy):
- instead of surgery if all of the tumour cannot be removed
- if surgery will be too damaging to healthy structures
- after successful surgery to reduce the chances of the cancer coming back
Occasionally, you might have chemotherapy alone to try to shrink the tumour. This might make it possible for the surgeon to do surgery. You might have radiotherapy after surgery and possibly more chemotherapy.
Proton beam therapy
You may be suitable for proton beam radiotherapy instead of standard radiotherapy. This might either be part of a trial or because the tumour is in a location that is difficult to treat. Talk to your doctor about this treatment option.
For other types of ethmoid sinus cancers, talk to your healthcare team to find out more about treatment by stage.
