Diagnosis and Staging of Nasal/Paranasal Cancer


The initial physical examination will determine the patient’s health history, exposure to environmental carcinogens, history of smoking, and exposure to radiation. Then the physician will perform a physical examination to locate the lesion or tumour and order follow-up tests for a definite diagnosis. These may include:

  • Complete Blood Count (CBC), used to determine a baseline of blood cells before during and after treatment.
  • Blood Chemistry tests to determine how important organs are functioning, such as the liver and kidneys.
  • Nasal endoscopy, which allows the specialist to see inside the nose, nasopharynx and throat and locate the lesion if visible.
  • Panendoscopy combines endoscopy of the nose pharynx and larynx. It can even involve the esophagus and the bronchus. It is performed to locate and identify the lesion as well as to look for spread to the surrounding tissues.
  • Biopsy is a small sample of the tumour taken for pathological diagnosis during the endoscopic procedure.
  • CT scan is used to locate lesions in the paranasal sinuses that are beyond the reach of the endoscopic procedure. This diagnostic technique presents a 3D cross-sectional image of the bones of the nose and head to determine if the tumour has spread and how large it is.
  • X rays of the sinuses are used to search for blockages or signs of infection.
  • MRI (Magnetic Resonance Imaging) presents a very clear picture of the tissues and in some cases can be used to distinguish benign from malignant tumours.
  • Bone scan uses radioactive materials to seek bone formation or destruction in the area affected by the tumour. (Canadian Cancer Society)


Staging refers to a cancer classification system that tells the physician how far along the disease is. The TNM system of the American Joint Committee on Cancer is widely accepted and used across the world. T stands for size of the tumour; N refers to the spread to the lymph nodes; and M means metastasis or spread to distant organs.

T  :  Size of the tumour

T0: No evidence of primary tumour.
Tis: Carcinoma in situ: the cancer has affected the epithelial cells lining the oral cavity but the tumour is not deep.
T1: Tumour is 2 cm (1 cm equals 0.39 inches) or smaller.
T2: Tumour is larger than 2 cm but smaller than 4 cm.
T3: Tumour is larger than 4 cm.
T4: The tumour is any size and has invaded adjacent structures, such as the larynx, bone, connective tissues, or muscles.

N: Lymph node involvement

N0: No metastasis in the regional lymph nodes.
N1: Metastasis in one lymph node on the same side of the primary tumour and smaller than 3 cm.
N2: Divided into 3 subgroups. N2a is metastasis in one lymph node larger than 3 cm and smaller than 6cm. N2b is metastasis in multiple lymph nodes on the same side of the tumour, none larger than 6cm. N2c denotes one or more lymph nodes, which may or may not be on the side of the primary tumour, none larger than 6cm.
N3: Metastasis in lymph node larger than 6cm

M  : Distant metastasis

M0: No distant metastasis.
M1: Distant metastasis present.


Santhanam, Kausalya, and Rebecca J. Frey. “Oral Cancers.” The Gale Encyclopedia of Cancer: A Guide to Cancer and Its Treatments, edited by Kristin Fust, 4th ed., vol. 2, Gale, 2015, pp. 1295-1303. Gale Virtual Reference Library.