What is Ear Cancer?
Ear cancer is cancer which develops in the ear, the ear canal or middle ear and inner ear. Ear cancer is a rare cancer. Most of the cancers of the ear develop in the skin of the outer ear. Around 5 of 100 skin cancers occur on the ear. It is very rare for cancer to develop inside the ear. Majority of the ear cancers are squamous cell carcinomas. There are other types of ear cancers, which include basal cell cancer, adenoid cystic, melanoma and adenocarcinoma.
The Human Ear
A human ear consists of 3 parts: The outer ear, the middle ear and the inner ear. Bone is also an important part of the ear which surrounds and protects the ear.
The Outer Ear: This is the part which we can see, i.e. which is visible to us.
The Middle Ear: The middle ear consists of a small cavity comprising of 3 small bones. These bones help in transmission of the vibrations to the inner ear from the eardrum.
The Inner Ear: The inner ear contains fluid and a small spiral tube, which is known as cochlea. This cochlea contains many tiny hair-like nerves, which help in converting the vibrations transmitted from the middle ear into nerve impulses. These nerve impulses then travel to the brain. There are many fluid filled cavities in the inner ear, which help us in balancing.
The Bone: The temporal bone is the bone which surrounds the ear. The ear canal, inner ear and the middle ear all are present inside the temporal bone. The temporal bone belongs to a part of the skull and is present just above the ear.
Mastoid Bone is a part of the temporal bone. It is felt as a lumpy projection behind the ear. Externally, the mastoid bone is felt as hard and solid bone, however, internally, the bone is shaped like a honeycomb. Air is present inside the small cavities along with inner ear and nerves, which help control the movement of the tongue and face.
Causes of Ear Cancer
The exact cause of ear cancer is not known. Individuals with history of chronic ear infections (>10 years) are at a higher risk for developing ear cancer.
Signs & Symptoms of Ear Cancer
The symptoms of ear cancer depend on the location of the tumor. Swelling of cervical (neck) lymph nodes can be seen in some patients. The most common symptom of cancer in the middle ear is a discharge from the ear that can be stained with blood. Other symptoms of ear cancer include earache and hearing loss. Some patients are not able to move their face on the side where the ear cancer is. Symptoms of cancer in the inner ear include pain, hearing loss, headache, dizziness and tinnitus.
Diagnosis of Ear Cancer
Examination is done by the doctor and blood tests are done to check the general health of the patient. Biopsy is the only method of confirming the diagnosis of ear cancer or any cancer for that matter. Biopsy is a test where a small amount of tissue is taken from the affected region of the ear and sent to the lab for examination. A local anesthetic is given to numb the area so the patient does not feel pain during the biopsy. It is difficult to take biopsy of the middle ear and patient may need general anesthesia for it. If the biopsy reveals cancer, then imaging tests, such as CT scan or MRI scan are done to decide on the type of treatment, which is best for the patient. In some cases, patient may need to have these scans before performing a biopsy.
It is very difficult to take biopsy from the inner ear, as it is an extremely difficult place to reach without causing damage to the surrounding structures. Hence, in such cases, diagnosis is made with using CT scan and MRI scan.
Stages of Ear Cancer
Staging of a cancer is done depending on the size of the cancer and its extent, i.e. whether it has metastasized or spread to other part of the body. It is difficult to work out the staging system with rare cancers as there are lesser patients who have this type of cancer, which makes it difficult to develop a staging system. There are a number of different types of staging systems which are used for ear cancer.
Usually, an early stage ear cancer will be small and just localized to the area it has developed. A slightly advanced ear cancer is that has spread into the structures which are surrounding it. A secondary or metastatic ear cancer is that stage of the cancer which has metastasized or spread to another part of the body distant to the site where it started. Finding out the ear cancer stage helps the doctor to determine the type of treatment to be done.
The TNM staging system is used for cancers of the middle ear and ear canal. The “T” stands for tumor, the “N” refers to the presence of any cancer cells present in the lymph nodes. The “M” stands for metastasis, i.e. if there is spreading of the cancer to another area of the body.
The T staging for cancer in the ear canal and the middle ear comprises of:
T1: In this stage, the tumor is present only in the middle ear and patient does not have any facial numbness from the ear cancer and the cancer is not present in the adjacent bone.
T2: In this stage, the tumor has grown outside the region where it has originated and patient feels numbness or the cancer affects the nearby bone.
T3: In this stage, the growth of the tumor has extended or spread to the nearby salivary gland, which is the parotid gland or the ear cancer has spread to the jaw joint or the base of the skull.
Treatment of Ear Cancer
The main type of treatment done for ear cancer, which has originated in the ear canal or middle ear, consists of surgery and radiation therapy. Depending on the cancer stage, the doctor may also decide on giving the patient chemotherapy. Treatment of the ear cancer depends on the following factors:
- The site of the cancer in the ear.
- The type of ear cancer.
- The ear tumor size.
- If the cancer has spread to the surrounding areas or structures.
- Patient’s general health.
Patients having cancers which develop in the neck and head will commonly consult a team of specialists and other health professionals which include:
- Oncologists, which are specialists in cancer drugs and radiation therapy.
- Cancer surgeon including head and neck surgeons that consist of ear, nose and throat (ENT) surgeons, plastic surgeons and facial and mouth bone surgeons.
- Specialist nurses, dieticians and physiotherapists.
Surgery for Ear Cancer
The type of surgery and the amount of surgery which the patient needs depends on the location of the cancer in the patient’s ear. Surgical procedure also depends on the how much and where the cancer has spread to the surrounding tissues or to the adjacent structures. During surgery the surgeon will remove the entire tumor along with the surrounding tissue, so that the patient is completely free from cancer cells. This is known getting clear margins of the tissue and it needs to be a minimum 5 mm surrounding the tumor/cancer. Getting clear margins will decrease the risk of cancer recurrence.
Surgery for ear cancer involves having to remove a part or all of the following:
- The ear canal.
- The middle ear.
- A part or the entire temporal bone.
- The inner ear.
Mastoidectomy: The temporal bone is a bone that is present near the ear, at the side of the skull. Temporal bone resection or mastoidectomy is the surgical procedure where the temporal bone is removed.
Removal of facial nerve and lymph nodes: In rare cases, the facial nerve may need to be removed by the surgeon. The facial nerve travels down the side of the face and passes through the salivary gland. The surgeon may also need to remove the adjacent lymph nodes, which are present near the patient’s neck and the salivary gland that is present on the side of the patient’s head.
Post Surgery: The condition of the patient and how he/she feels after the surgery depends on the type of surgery which the patient has had. This surgical wound is often present behind the ear and after the surgery the patient will have stitches and may also have a dressing covering the wound. Patient will also have one or two small tubes close to the wound for draining of any fluid from the region. This will help in reducing the swelling. A couple of days will be needed before the fluid stops draining from these tubes, after which they are taken out. Patient is started on an I.V. drip for fluids, for preventing dehydration. Painkillers are given to alleviate the pain.
Hospital Stay & Hearing Loss: The length of the hospital stay depends on the type of surgery done. Also how much hearing ability the patient has will be dependent on the type of surgery that patient has. If the middle and inner ear is surgically removed, then the patient may not be able to hear from that side. The balance of the patient is also affected and the patient can also feel dizzy. In some cases, the surgeon is able to reconstruct some part of the ear so that the patient’s hearing is restored.
Patient’s Appearance: The change in the appearance of the patient will not be much, as the surgeon will try to use techniques for removal of tumor and will try to reconstruct the area as much as possible so that the patient does not look that different afterwards. The scar line is often present behind the ear or in the natural crease on the patient’s face. It is important that the patient and the surgeon communicate with each other and talk about the surgery and the aftermath of the surgery in that how it will affect the patient’s hearing, appearance and eating.
Radiation Therapy for Ear Cancer
This is a cancer treatment which utilizes high energy beams that are focused on the region of the cancer to kill or destroy the cancer cells. Radiation therapy may be done as the primary ear cancer treatment or it may be used when the surgeon has not been able to have clear margin of tissue surrounding the tumor. In such cases radiation therapy decreases the risk of recurrence of cancer. Patient is given radiation therapy usually every day for around 4 and 7 weeks.
Chemotherapy for Ear Cancer
Chemotherapy is the cancer treatment which utilizes drugs for killing the cancer cells. These drugs are known as cytotoxic drugs. Chemotherapy alone will not be able to cure ear cancer; however, it can help relieve symptoms if there is recurrence of ear cancer or if the patient cannot have other treatments. Chemotherapy can also be used in conjunction with radiation therapy before or after the surgery is done. Research is still being carried out to find out the best possible course of treatment which will cure ear cancer. Some of the chemotherapy drugs for ear cancer include cisplatin and fluorouracil .
Follow Up for Ear Cancer/Ear Tumor
Patient needs to have regular checkups after the treatment of ear cancer is completed. During these checkups, the doctor asks about the patient’s general health and examines the patient’s ear. During these checkups, the patient can ask the doctor if he/she has any concern. The frequency of the checkups will depend on the patient’s situation. The follow up checkups will be every 2 or 3 months and the frequency will reduce as time passes.