Cancer of Nasal Cavity Staging Chart

TNM Classification for Cancer of Nasal Cavity and Paranasal Sinuses

The TNM classification for cancers of the head and neck in the nasal cavity and paranasal sinuses is provided below, along with anatomic staging.

Table. TNM classification 

Primary tumor (T)
Maxillary sinus:
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
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 and/or middle nasal meatus, except extension to posterior wall of the maxillary sinus and pterygoid plates
T3	Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor or medial wall of the orbit, pterygoid fossa, ethmoid sinuses
T4a	Moderately advanced local disease Tumor invades the anterior orbital contents, skin of the 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 cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus
Nasal cavity and ethmoid sinus:
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
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 the nose or cheek, minimal extension to the 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 maxillary division of trigeminal nerve (V2), nasopharynx, or clivus
Regional lymph nodes (N)
NX	Regional nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node ≤3cm in greatest dimension
N2	Metastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension; or in multiple ipsilateral lymph nodes, none >6cm in greatest dimension; or in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N2a	Metastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension
N2b	Metastasis in multiple ipsilateral lymph nodes, none >6cm in greatest dimension
N2c	Metastasis in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N3	Metastasis in a lymph node >6cm in greatest dimension
Distant metastasis (M)
M0	No distant metastasis
M1	Distant metastasis

Euthanasia When is it Time? The decision regarding the euthanasia of a beloved pet may be the most difficult decision one makes in one’s entire life; obviously, the consequences are irrevocable. Whatever the decision is, it should be one that you can always look back upon and know that the best decision was made and that you would make the same decision over  again in the same situation. So how do you know if it is time? There are several criteria used in evaluating life quality and you should consider them carefully. Is your pet eating? Basically, quality life involves eating or at least interest in food. An animal that is hungry has vitality that must be considered, though this is not the only consideration. Is your pet comfortable? The pet should be free of debilitating pains, cramps, aches or even the psychological pain that comes from the development of incontinence in an animal who has been housebroken for an entire life.  Does the pet still enjoy favorite activities? The elderly pet does not necessarily need to continue chasing balls or jumping after discs but he should enjoy sleeping comfortably, favorite resting spots, the company of family, etc. You know your pet better than any one and only you can truly answer these questions.  Dr. Alice Villalobos, the veterinarian who started Pawspice, a quality of life program for terminal pets, has published a scoring system for life quality called The HHHHHMM scale.  The letters stand for: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More Good Days than Bad. Quality of Life Scale: The HHHHHMM Scale Pet caregivers can use this Quality of Life Scale to determine the success of pawspice care. Score patients using a scale of 1 to 10. Score Criterion 1-10 HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary? 1-10 HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube? 1-10 HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake. 1-10 HYGIENE - The patient should be brushed and cleaned, particularly after elimination. Avoid pressure sores and keep all wounds clean. 1-10 HAPPINESS - Does the pet express joy and interest? Is the pet responsive to  things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated? 1-10 MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g., a cart)? Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.) 1-10 MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay. *TOTAL *A total over 35 points represents acceptable life quality  Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 09/2004, for Canine and Feline Geriatric Oncology Honoring the Human-Animal Bond, by Blackwell Publishing, Table 10.1, released 2006. If you are considering euthanasia, discuss the pet’s condition with your veterinarian prior to making a decision or even coming in for an appointment. Every veterinarian has a story or two about the pet that was brought in for euthanasia but turned out to have a relatively simple problem and ultimately achieved a complete recovery.