Paranasal+Sinuses

NOT related to smoking [1] 2:1 male to female occurrence [1] Peak age incidence 10-20yrs of age and 50-60 yrs of age [1] Present at advanced stages [1] Sites of occurrence for nasal cavity and paranasal sinuses 30% to 40% occur in the maxillary sinus 40% to 50% in the nasal cavity 10% in the ethmoid sinuses 5% in the frontal and sphenoid sinuses 30% to 40% occur in the maxillary sinus 40% to 50% in the nasal cavity 10% in the ethmoid sinuses 5% in the frontal and sphenoid sinuses || Exposure to Mustard Gas [1,2] Exposure to Radium [2] History of Retinoblastoma – when treated with radiation therapy || IMAGING: CT/MRI of the primary site and neck. Chest X-ray, CT of thorax if adenoid cystic or neuroendocrine carcinoma. PET/CT may also be ordered. LABS: Complete blood count.[4] || Other types include malignant melanoma, lymphoma, inverted papilloma, sarcoma, and benign tumors [5,4] || Submandibular, Subdigastric (Jugulodigastric), Retropharyngeal, and Superior Cervical lymph nodes[5,4] || - The eye socket. - The base of the skull - The front of the eye - The skin of the cheek - Behind the jaw -The bone between the eyes || **Stage 0**: Carcinoma in situ. Cancer cells only in skin covering the ethmoid sinus. **Stage I**: Cancer cells have not spread to lymph nodes or other anatomical site. But may have grown into bones surrounding the nasal cavity. **Stage II**: Cancer has spread to one or more areas of the ethmoid sinus. **Stage III**: Cancer has grown into the bones of the eye socket, hard palate. Possible spread to one lymph node on the same side of the neck, however node is smaller than 3cm. **Stage IVA**: An invasive cancer (T4a) with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1), but no metastasis (M0). It is also used for any cancer (T) with more significant nodal involvement (N2), but no metastasis (M0). **Stage IVB**: An invasive cancer (any T) that has spread to lymph nodes (any N) but has no metastasis (M0). It is also used for any cancer (any T) that is found in lymph nodes and is larger than 6 cm (N3), but no metastasis (MO). **Stage IVC**: Any tumor (any T, any N) when there is evidence of distant spread (M1). [9,10]    || Late-xerostomia, chronic keratitis & iritis, optic pathway injury, soft tissue or osteoradionecrosis, cataracts[6] Long term complications of nasal vestibule irradiation have been minimal. Central nervous sytem damage, unilateral or bilateral vision loss, serous otitis media, and chronic sinusitis Radiation retinopathy is rare at 45Gy Some visual acuity changes after 60Gy: Decreased visual acuity after 65Gy, Visual acuity decreased 85-90% at 80Gy Optic nerve injury-the 15 year actuarial incidence reached 11% for doses above 60Gy [11] || Nasal Vestibule: The most common form of treatment is radiation therapy. Surgery may be performed if the tumor is relatively small in size and location is optimal. [4] Nasal Cavity: Surgery followed up with radiation therapy is the treatment option of choice. After surgery the radiation dose is 60 Gy when there are positive margins the dose range is 60-68 Gy which is less than the dose given when treating with radiation only to decrease the amount of radiation delivered to the optic nerve. When treating the nasal cavity with radiation only the dose is 74-79 Gy which is treated twice-daily (1.1 to 1.2 Gy/fraction) with a 6-hour interfraction interval. This fractionation scheme is used to decrease the amount of radiation damage to the optic nerve. Ethmoid Sinus: Optimal treatment is surgery and radiotherapy. [4] Maxillary Sinus: Treatment includes surgery and radiation therapy. Most often a radical maxillectomy is done. Craniofacial resection is done when the ethmoid roof is part of the tumor mass. When the patient has lesions that are inoperable they are treated with radiation. When a tumor is inoperable the physician may treat with radiation therapy initially then assess the patient for surgery. [4] Sphenoid Sinus: Most often is treated with radiation therapy. [4] Dose: 60-70 Gy If the patient has an increased risk for metastatic disease the treatment may include a dose of 50 Gy to the neck. [4] External radiation therapy for nasal cavity, ethmoid sinus, and maxillary sinus use analogous techniques. The treatment uses anterior portal with an additional one to two posterior titled lateral portals. The plan is then optimized using wedges. After the patient has received 45-50 Gy of the dose the fields may be reduced to a gross tumor volume with margin. The patient is instructed to look straight ahead with their eyes open. The anterior portal is 1.5 – 2 centimeters across the midline to ensure the nasal cavity and ethmoid-sphenoid complex and medial contra lateral orbit are included. The cribriform plate and the frontal sinus are included in the superior margin. The floor of the nose, maxillary antrum, and alveolar ridge give the basis for the inferior margin. To remove the mandible and tongue from the line of treatment a tongue blade and cork are utilized. The lateral portals are also similar for nasal cavity, ethmoid, and maxillary sinus tumors. The anterior portion of the lateral portal is located at the lateral bony canthus. The superior border is dependent upon the disease involvement. The inferior border is created to cover the floor of the antrium which is normally at the lip comissure. The posterior borders are designed to remove the spinal cord and brainstem from the fields. [4] ||
 * Epidemiology: || Rare Tumors – approx. 3% of all upper respiratory tumors [1]
 * Sites of occurrence for nasal cavity and paranasal sinuses **
 * Etiology: || Industrial Exposure – dusts inhaled while working, such as wood, nickel, flour, fabric dusts [1,2]
 * Signs & Symptoms: || Signs and symptoms associated with nasal cavity carcinoma include: [3]
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Nasal obstruction
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Nasal discharge
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Nosebleeds
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Numbness or tingling
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Problems with vision
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Sinus congestion
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Mass in the nose
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Mass on the face or the roof of the mouth
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Pain in the ear and or upper teeth
 * <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Neck or face swelling ||
 * Diagnostic Procedures: || GENERAL: Complete history and physical. Fiberoptic endoscopic examination with biopsies. Patient should have a dental evaluation before the start of radiation. A baseline ophthalmologic exam, as well as a baseline speech and swallowing assessment if surgery is planned.
 * Histology: || Squamous cell most common type;
 * Lymph Node Drainage: || Drainage is mainly ipsilateral and few or no lymphatic vessels in paranasal sinuses; If lymph nodes are involved some common nodes include the
 * Metastatic Spread: || Lymph node metastasis from the nasal cavity and paranasal sinuses usually does not happen unless the tumor has expanded to areas that contain capillary lymphatics. According to Chao, “approximately 5% of patients have clinically positive lymph nodes on initial presentation; lymph node metastases develop in another 15% of patients after treatment has controlled the primary tumor. However, spread to the retropharyngeal and cervical lymphnodes are possible. According to Perez, Lymph node involvement and distant metastasis are infrequent at diagnosis (11% and 1% respectively).” [4,6]
 * Grading: || <span style="background-color: transparent; color: #0f63b8; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;">Primary tumor described by its grade, by histological examination. Histological grade describes how closely the cancer cells resemble normal tissue under a microscope. <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; margin-left: 0.25in; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0f63b8; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">Normal tissue contains many different types of cells grouped together, which is called differentiated. Tissue from a tumor usually has cells that look more alike each other (called poorly differentiated). Generally, the more differentiated the tissue, the better the prognosis. A tumor's grade is described using the letter "G" and a number. <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none; text-indent: 0.5in;"><span style="background-color: transparent; color: #0f63b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">GX: Indicates the grade cannot be evaluated.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none; text-indent: 0.5in;"><span style="background-color: transparent; color: #0f63b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">G1: Indicates the cells look more like normal tissue (well differentiated).  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none; text-indent: 0.5in;"><span style="background-color: transparent; color: #0f63b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">G2: The cells are only moderately differentiated.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none; text-indent: 0.5in;"><span style="background-color: transparent; color: #0f63b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">G3: The cells don’t resemble normal tissue (poorly differentiated).  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none; text-indent: 0.5in;"><span style="background-color: transparent; color: #0f63b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">Recurrent: Recurrent cancer is cancer that comes back after treatment.[7]  ||
 * Staging: || <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: 12pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;">**<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">//<span style="background-color: transparent; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;"> ﻿ ﻿ ﻿ ﻿   STAGING // **//<span style="background-color: transparent; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;"> See individual sinuses listed below. Maxillary, Ethmoid. ////<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">There is no standard staging system for cancer of the sphenoid and frontal sinuses //<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;"> **<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">//<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">Maxillary Sinus // ** <span style="background-color: transparent; color: #0063b8; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">Tumor Stage  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**Tx** Primary tumor cannot be evaluated. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T0** No evidence of primary tumor present. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**Tis** Carcinoma in-situ. Tumor is only in the innermost mucosal epithelium tissue lining the maxillary sinus. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T1** Tumor is only in the mucosal lining tissues of the maxillary sinus. Tumor does not invade any nearby bone. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T2** Tumor has begun to grow into the bone surrounding the maxillary sinus. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T3** Tumor has grown into the bone in the back posterior wall of the maxilla and or into the ethmoid sinuses, tissue under the skin or eye socket. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T4a** Tumor has grown into any other nearby structures such as the front of the eye socket, skin of the cheek, the tissues below the temple, the areaconnecting the back of the nose to the back of the mouth (nasopharynx), sphenoid sinus, frontal sinuses or up into the cribiform plate,pterygoid and the infratemporal fossa. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">**T4b** Tumor has grown into the area between the nasal cavity and the nasopharynx, back of the eye socket, brain, dura mater, middle cranial fossa,clivus and/or certain cranial nerves. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; text-align: left; text-decoration: none;">Nodal Stage <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N0 No lymph nodes containing cancer cells.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N1 Cancer cells in one lymph node on the same side of the neck as the tumor and the node measures 3cm across or less.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N2a Cancer in one lymph node, on the same side of the neck, that is more than 3cm across but no more than 6cm across.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N2b Cancer in more than one lymph node on the same side of the neck, but none of them is more than 6cm across.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N2c Cancer in lymph nodes on the other side of the neck (or on both sides) but none are more than 6cm across.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">N3 One or more nodes contain cancer and at least one node is more than 6cm across.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">Metastatic StageMx Distant metastases cannot be evaluated or determined.  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">M0 No cancer spread to other parts of the body. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">M1 Cancer has spread to other parts of the body, such as the lungs, brain or liver. <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 18px; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; font-weight: normal; line-height: 115%; text-align: left; text-decoration: none;">**Stage 0** Carcinoma in situ. Cancer cells only in skin covering the maxillary sinus.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 18px; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; font-weight: normal; line-height: 115%; text-align: left; text-decoration: none;">**Stage 1** Cancer cells have not spread to bone, lymph nodes or other anatomical site. Tumor in earliest invasive stage and confined to the mucosal lining of the maxillary sinus.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 18px; margin-left: 1in; text-align: left; text-decoration: none; text-indent: -1in;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; font-weight: normal; line-height: 115%; text-align: left; text-decoration: none;">**Stage 2** Cancer has grown into and destroyed some of the bones around the maxillary sinus. Cancer has spread to floor of maxillary sinus (hardpalate) and or nose, bony tissue that lies over the opening into the maxillary sinus (middle meatus).**Stage 3** Cancer has begun to grow into the back of the maxillary sinus or other sinus bones and/or into the base of the skull. Possible reaching into the underlying skin, the skin of the cheek, the eye socket or the ethmoid sinus. It has not spread to the lymph nodes or other organs. <span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">Lymph node involved on the same side of the neck no greater than 3cm across.  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; font-weight: normal; line-height: 115%; text-align: left; text-decoration: none;">Stage 4 has 3 groupings 4a, 4b and 4c <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: 12pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">**Stage 4a** Cancer in one lymph node, on the same side of the neck, that is more than 3cm across but no more than 6cm across or Cancer in more than one lymph node anywhere in the neck, but none of them are more than 6cm across.  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; text-align: left; text-decoration: none;">And cancer has spread to lining of the maxillary sinus, bone around the maxillary sinus, behind the mandible, tissue under the skin and/orcheek, eye and/or eye socket, base of skull, and/or other sinuses. <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: 12pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">**Stage 4b** Cancer in one or more lymph nodes anywhere and any size in the neck. At least one lymph node is larger than 6 cm. Tumor has spread to the bone of the skull, brain, cranial nerves, back of the eye, and/or nasopharynx.  <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: 12pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: 'Times New Roman','serif'; font-size: 16px; text-align: left; text-decoration: none;">**Stage 4c** Tumor has spread to a distance beyond the maxillary sinus to other anatomical site(s).  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;">**<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">//<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">Ethmoid Sinus // ** <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;">Tumor Stage <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">T1 Tumor is only in the ethmoid sinus, but it may have grown into the bones of the sinus. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">T2 Tumor has begun to grow into other paranasal sinuses or into the nasal cavity and may have started to grow into bone. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">T3 Tumor has spread into the bone of the eye socket, roof of the mouth or maxillary sinus. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">T4 Tumor has spread into other nearby structures such as the eye, skull, brain, sphenoid, or frontal sinuses or the skin of the nose or cheek, or the nasopharynx. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;">Nodal Stage <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N0 No lymph nodes contain cancer cells <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N1 Cancer cells in one lymph node on the same side of the neck as the tumor, but the node measures 3cm or less across. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N2 Cancer in one lymph node, on the same side of the neck, that is larger than 3cm but smaller than 6 cm across. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N2b Cancer in more than one lymph node on the same side of the neck, all of which are smaller than 6cm across. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N2c Cancer in lymph nodes on bilateral or contralateral side of the neck with the size being than 6cm or greater across. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">N3 One or more nodes contain cancer and at least one node is more than 6cm across. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman'; font-size: 16px; line-height: 12pt; margin-bottom: 7.5pt; margin-left: 0in; margin-right: 0in; margin-top: 2.25pt; text-align: left; text-decoration: none;">Metastatic Stage <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">M0 No cancer spread to other parts of the body. <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: normal; margin-bottom: 0pt; margin-left: -12pt; margin-right: 0in; margin-top: 0in; text-align: left; text-decoration: none; text-indent: 48pt;">M1 Cancer has spread to other parts of the body, such as the lungs, brain or liver.[8]
 * Radiation Side Effects: || Acute-mucositis, skin erythema, nasal dryness, xerostomia
 * Prognosis: || <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;">Prognotic factors for survival include age and performance status and for tumor control include tumor location, histology and extention of the disease.[9]**Maxillary Sinus**Each year, about 2,000 people are diagnosed with nasal cavity or paranasal sinus cancer in the United States. Tend to occur between ages 45 and 85 and twice as likely in males. <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;"><span style="background-color: transparent; color: #0063b8; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">The overall live-year relative survival rate of people with nasal cavity and/or paranasal sinus cancer is 54%. (cancer.net)[9] <span style="background-color: transparent; color: #000000; display: block; font-family: 'Times New Roman'; font-size: 16px; text-align: left; text-decoration: none;"> **<span style="background-color: transparent; font-family: Times New Roman; font-size: 16px; text-align: left; text-decoration: none;">Ethmoid Sinus **  <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">Stage 5 year survival <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">I 63% <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">II 61% <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">III 50% <span style="background-color: transparent; color: #0063b8; display: block; font-family: 'Times New Roman',serif; font-size: 16px; line-height: 115%; text-align: left; text-decoration: none;">IV 35% [8] ||
 * Treatments: || <span style="color: #ff00b2; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Treatment:
 * TD5/5: || The 5 % risk of complication within 5 years (TD5/5) are listed below for volumes within the irradiated field. [12] ||


 * ** Organ ** || ** 1/3 Volume ** || ** 2/3 Volume ** || ** 3/3 Volume ** || ** Complications ** ||
 * Brain Stem || 6000 cGy || 5300 cGy || 5000 cGy || Necrosis Infarction ||
 * Ear mid/external || 3000 cGy || 3000 cGy || 3000 cGy || acute serous otitis ||
 * Ear mid/external || 5500 cGy || 5500 cGy || 5500 cGy || chronic serous otitis ||
 * Parotid ||  || 3200 cGy || 3200 cGy || xerostomia ||
 * Optic Chiasma & Optic Nerve || No Partial Volume || No Partial Volume || 5000 cGy || Blindness ||

__**<span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Green Group **__ <span style="color: #ff00a5; font-family: 'Times New Roman',Times,serif; font-size: 16px; line-height: 24px;">Lisa - Signs and Symptoms and Treatment <span style="color: #632423; font-family: 'Times New Roman',Times,serif; font-size: 15px;">Eric - Etiology and Epidemiology <span style="color: #ad14ad; font-family: 'Times New Roman',Times,serif; font-size: 16px;">Kim A - Diagnostic procedures <span style="color: #0a3771; font-family: 'Times New Roman',Times,serif; font-size: 16px;">LaDonna - Staging, Grading and Prognosis <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 16px;">Curtis - Histology and Lymphatic Drainage <span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Shun - TD5/5 and Metastatic Spread

<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">References <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[1]National Cancer Institute. //Factsheet//. Available at: __ [] __ Accessed on May 26, 2011 <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[2]National Cancer Institute. Available at: [|http://www.cancer.org/Cancer/NasalCavityandParanasalSinusCancer/DetailedGuide/index] Accessed on May 26, 2011. Last Medical Review: 08/16/2010, Last Revised: 08/16/2010 <span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> [3] Available at National Cancer Institute [] Accessed May 27, 2011. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[4] Chaos KS, Perez CA, Brady LW. //Radiation Oncology-Management Decisions//. 2nd edition. Philadelphia:Lippincott, Williams & Wilkins. 2002 <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[5] Washington, Charles, and Dennis Leaver. Principles and Practices of Radiation Therapy. St. Louis,Missouri: Mosby Elsevier, 2010. Print <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[6] Perez CA, Brady LW, Halperin EC; //Principles and Practice of Radiation Oncology.// 5th Edition; Philadelphia PA; Lippincott Williams and Wilkins; 2008; 859-861 <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[7] Cancer Research UK. //Cancerhelp//. Available at: __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> [] Accessed on May 19, 2011 __ <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[8] American Cancer Society. //Nasal cavity and paranasal sinuses cancer//. Available at:__ [] __ <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Accessed May 18, 2011. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[9] Cancer.net. (n.d.). //Nasopharangeal Cancer//. Available at: http://www.cancer.net/patient/Cancer+Types/Nasopharyngeal+Cancer?sectionTitle=Patient Information Resources Accessed May 19, 2011. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[10] MedlinePlus. //Trusted health information for you. Nasal cancer.// Available at: __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;"> [] __<span style="font-family: 'Times New Roman',serif; font-size: 12pt;">Accessed on May 19, 2011. <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[11] Hansen E, Roach M. //Handbook of Evidence-based Radiation Oncology//. New York:Springer. 2007 <span style="font-family: 'Times New Roman',serif; font-size: 12pt;">[12] Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. //Int J Radiat Oncol Biol Phys//.1991;21(1):109-122