Workup/Staging Flashcards
What are some presenting Sx of sinonasal/PNS tumors?
Facial pain, nasal obstruction, nasal discharge, epistaxis, sinus obstruction, trismus (pterygoid involvement), ocular deficits (diplopia, blurry vision), facial pain d/t trigeminal neuralgia, midfacial hypesthesia from impingement of the infraorbital branch of CN V2, palatal mass/erosion, and otalgia.
What is the basic workup for sinonasal/PNS tumors?
PNS tumor workup: H&P w/ nasal endoscopy and Bx, labs, CT/MRI head/neck, CT chest, PET if stage III/IV, dental consult if required (per NCCN, 2018).
Describe the T staging of maxillary and nasal cavity/ethmoid tumors per the latest AJCC (8th edition, 2017) classification.
Maxillary
T1: confined to sinus, no bone erosion
T2: bone erosion w/o involvement of post wall of max sinus or pterygoid plates
T3: invades post wall of max sinus, SQ tissues, pterygoid fossa, floor/medial wall of orbit, or ethmoid sinus
T4a: invades ant orbital structures, skin of cheek, pterygoid plate, infratemporal fossa, cribriform plate, sphenoid or frontal sinus
T4b: invades orbital apex, NPX, clivus, intracranial extension, CN involvement (except V2), dura, brain
Nasal Cavity/Ethmoid
T1: confined to 1 subsite, w/ or w/o bone invasion
T2: invades 2 subsites in a single region or extending to involve an adjacent region w/ in the nasoethmoidal complex, w/ or w/o bone invasion
T3: invades medial wall or floor of orbit, maxillary sinus, palate, or cribriform plate
T4a: invades ant orbital contents, skin of nose or cheek, min extension to ant cranial fossa, pterygoid plates, sphenoid, or frontal sinuses
T4b: invades orbital apex, dura, brain, middle cranial fossa, cranial nerves other than V2, NPX, or clivus
There is no formal T staging for frontal or sphenoid tumors
How are the nodes staged for sinonasal/PNS tumors?
N1: single ipsi ≤3 cm and ENE–
N2a: single ipsi >3 and ≤6 cm and ENE– or single ipsi/contralat node ≤3 cm and ECE+
N2b: multiple ipsi nodes ≤6 cm and ENE–
N2c: bilat or contralat ≤6 cm and ENE–
N3a: node >6 cm and ENE–
N3b: single ipsi node >3 cm and ENE+ or multiple ipsi/contra/bilat nodes, any with ENE+
How are the overall sinonasal/PNS stage groups broken down (based on TNM)?
Stage I: T1N0
Stage II: T2N0
Stage III: T3N0 or T1–3N1
Stage IVA: T4aN0–1 or T1–4aN2
Stage IVB: T4b or N3
Stage IVC: M1
What is Ohngren line, and why is it important?
The Ohngren line is a theoretic plane that extends from the medial canthus of the eye to the angle of the mandible. Tumors superoposterior to this line have deeper invasion, with many being unresectable (d/t invasion of the orbit, ethmoids, and pterygopalatine fossa). The relationship of a tumor to Ohngren line was an important prognostic factor, but with CT, MRI, and PET for imaging tumors, the significance of this line is principally historic.
For sinonasal/PNS tumors, what factors predict for nodal mets?
Neck nodal involvement is uncommon at Dx except when tumors have progressed to involve the mucosal surfaces (i.e., oral cavity, maxillary gingiva, or gingivobuccal sulcus). Histology is also predictive; squamous and undifferentiated tumors most commonly present with nodes, while nodal Dz is very uncommon with adenoid cystic and adenocarcinomas.
What neck node groups are generally involved with sinonasal/PNS tumors?
Retropharyngeal (1st echelon), Level Ib, II, and periparotid nodes are most commonly involved.
What subsite of PNS tumors has the highest rate of nodal mets?
Maxillary sinus tumors have the highest rate of nodal mets (10%–15%) of all PNS tumors.
What is the 5-yr OS rate for maxillary/ethmoid sinus tumors (all stages)?
∼45%
What is the 5-yr OS rate for N+ maxillary and ethmoid sinus tumors?
Maxillary: ∼15%, Ethmoid: 0%
What is the overall LC rate for sinonasal/PNS tumors?
50%–60%
