In the modified Kadish staging system for olfactory neuroblastoma (esthesioneuroblastoma), Stage D is defined as:

• A Tumour extending beyond sinonasal cavity to orbit, skull base, or intracranial compartment
• B Tumour limited to the nasal cavity and paranasal sinuses
• C Tumour with bilateral sinonasal involvement
• D Tumour with regional or distant metastases (cervical nodes or distant sites) ✓

Explanation

The modified Kadish staging (Morita/Dulguerov modification): Stage A = tumour confined to nasal cavity; Stage B = tumour extends to paranasal sinuses; Stage C = tumour extends beyond sinonasal cavity (orbit, skull base, intracranial extension); Stage D = regional (cervical node) or distant (systemic) metastases. Stage D was added to the original Kadish system (which had only A-C) to capture the important prognostic distinction of metastatic disease. Stage D carries the worst prognosis. Treatment for stages A-C typically involves combined modality: surgery + radiation ± chemotherapy. Stage C with intracranial extension requires anterior craniofacial resection.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.