The different number stages of maxillary sinus cancer and the treatment you might have.
What staging is
The stage of a cancer means how big it is and whether it has spread. It is important because the stage often decides the treatment. The tests and scans you have to diagnose cancer give some information about the stage. But your doctor may not be able to tell you the exact stage until you have surgery.
There are 4 main stages in this system - stages 1 to 4. Some doctors also refer to stage 0.
Stage 0 or carcinoma in situ (CIS)
If you have CIS or stage 0 cancer of the maxillary sinus, you have a very early stage cancer. Some doctors prefer to call this pre cancer because there are cancer cells only in the skin like tissue covering your maxillary sinus. This means the cancer cells are contained there and cannot spread.
As the cells cannot spread, this is not yet a true cancer. If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.
This is the earliest stage of invasive cancer. It means that cancer is contained within the lining of the sinus. It has not spread to any bones of the maxillary sinus or anywhere else.
If you have stage 2 maxillary sinus cancer it means the cancer has grown into and destroyed some of the bones in the maxillary sinus. So the cancer is in:
- the floor of the maxillary sinus (hard palate)
- the bony tissue that lies over the opening into the maxillary sinus (middle meatus of the nasal cavity)
- both of the above
Stage 2 means the cancer has not grown into the bone in the back part of the sinus or anywhere else not mentioned above.
Having stage 3 maxillary sinus cancer can mean 2 things:
- it has begun to grow into the sinus bones. If this happens, it may reach the tissues under the skin, the skin of the cheek, the eye socket or the ethmoid sinus in front of the maxillary sinus. It has not spread to the lymph nodes or other organs
- the tumour is any size, except T4, and has spread to one lymph node on the same side of the neck. The lymph node is no more than 3cm across
This means the cancer is advanced. All T4 tumours are considered to be stage 4 even if they have not spread to lymph nodes or other parts of the body. Stage 4 could mean one of 3 things:
- the tumour has grown into nearby structures such as the eye, the skull, the back of the nose, or into the sphenoid or frontal sinuses. It may also have spread to one lymph node on the same side of the neck, but the node is less than 3cm across
- The cancer is any size, has spread to more than one lymph node on the same side of the neck and at least one node is bigger than 3cm, there are several cancerous lymph nodes of any size, or there are lymph nodes of any size on the other side of the neck
- the cancer has spread to other parts of the body such as the lungs, liver or brain
Treatment by stage
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 have radiotherapy 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
- could not remove a large enough margin of healthy tissue from around the tumour
If you have stage 2 maxillary sinus cancer, you are most likely to have either:
- surgery alone (maxillectomy)
- 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.
Treatment for stage 3 maxillary sinus cancer is surgery (radical or extended maxillectomy) and radiotherapy. 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 neo adjuvant treatment.
If the cancer has spread to the lymph nodes, you will need an operation called a neck dissection or radiotherapy to get rid of any cancer cells in this area.
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. This will not completely remove your cancer.