CANCER OF THE EAR

This information booklet has been written to help you and your family to understand more about cancer of the ear. It has been written and updated by Head and Neck Specialist Oncology doctors and surgeons, specialist nurses and other relevant healthcare professionals as well as patients. We hope it will help answer some of the questions you may have about tour diagnosis and treatment. At the end of the booklet are details of other publications that may help you address some of the feelings you may have, and also provide more details about cancer itself. What is cancer of the ear? Cancers of the ear are uncommon and most develop in the skin of the outer ear. Cancers can develop in the structures inside the ear but these cancers are very rare. Most ear cancers are know as squamous cell carcinoma. Basal cell carcinoma and malignant melanoma are mainly skin cancers that can also arise in the ear. CANCER OF THE EXTERNAL EAR What are the symptoms? This usually shows as a slowly progressing ulcer or as a persistent area of crusting, usually on the upper edge of the outer part of the ear (see picture 1). It can be present for many years. A swelling or lump in the neck may also be present. What caused it? People who have experienced long periods of exposure to the sun in their daily life can have an increased risk of cancer of the skin of the external ear, especially pale-skinned people. Can it spread? If the cancer were to spread, it would normally be to nearby lymph glands - in the case of the ear this would be glands in the neck. You may notice an enlargement of one of these glands - this is the lump in the neck mentioned earlier. How is it treated? If the cancer is confined to the outer edge of the ear, it is usually treated by surgery. A wedge-type incision is used and then sutured or stitched to give

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a good cosmetic result. Many small cancers of the skin of the ear can be treated this way, with no further treatment necessary except for regular follow-up in clinic. Occasionally the whole of the external ear will have to be removed. This operation is known as a total pinnectomy, and it is followed by reconstructive surgery or a prosthesis (artificial replacement). If the lymph nodes in the neck are involved an operation will be required to remove the lymph glands on one or both sides of the neck, even if they are not swollen. This procedure is called a neck dissection (see separate patient information leaflet for more details). CANCER OF THE EAR CANAL These cancers are rare, but where they do occur they are most likely to be a squamous cell carcinoma. Cancers of the glands of the ear can occur, but these are also extremely rare, and are likely to be of a type known as adenoid cystic carcinoma. What are the symptoms? The most frequently symptoms are: Discharge from the ear canal, often tinged with blood Hearing loss Sometimes facial paralysis on the side of the affected ear Earache. Where is it? In the outer portion of the ear canal or in the deeper ear canal. What has caused it? The cause is not known. It would appear to be more common in older people who have a long history of outer ear infection called otitis externa. Can it spread? This type of cancer can spread to the middle ear. It is also possible for the cancer to spread into the parotid gland - (the salivary gland located beneath the ear and around the angle of the jaw), or backwards into the middle ear. It can also spread to the lymph nodes that are present in front of an behind the ear as well as the neck although this is rare. This can be diagnosed by regular examinations and CT scanning. How is it treated? It can be treated surgically by means of a combination of a common middle ear operation called a mastiodectomy, often with removal of the parotid gland. Removal of the tempero-mandibular joint (jaw joint) is a possibility but is almost never done. This would be followed by neck dissection (see separate information leaflet).

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Some patients have radiotherapy as the first treatment for cancer of the ear; however, radiotherapy is usually given post operatively to destroy any small areas of cancer cells that cannot be removed surgically. CANCER OF THE MIDDLE EAR This is very rarely encountered, and is mainly of the type known as squamous cell carcinoma. What are the symptoms? Long-term discharging ear More recent blood-stained ear discharge Hearing loss Sometimes, facial paralysis Where is it? It is often first noticed by deafness and then ulceration to the entrance of the ear canal, coming from the middle ear. What has caused it? This is not always known. It mostly affects older people with a history of a discharging ear occurring over many years. Can it spread? It commonly spreads to the surrounding close structures such as bone, and can damage the facial nerve, causing facial paralysis. It can also spread to the lymph nodes although this is rare. This will be checked by regular examination of your neck and a CT Scan. How is it treated? It is diagnosed by biopsy. CT or MRI scanning (see individual patient information leaflets) which will show the extent of the tumour. You will be seen by a team of specialists who will explain the best course of action and why. They will discuss the alternatives with you as well as the side effects of any treatment. It is most often treated surgically followed by post operative radiotherapy in order to destroy small areas of cancer cells not able to be removed at time of operation. The surgery may be relatively limited but more likely to be quite expensive with removal of bone. Your team will talk to you about the effects of the operation, which will include deafness on that side. Glomus tumour Glomus tumours are benign, rarely malignant tumours of the ear that arise from the outer layers of the blood vessels in the middle ear.

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Where is it? It is usually noticed as a polyp in the middle ear. What are the symptoms? Hearing loss Pulsating tinnitus (ringing in the ear) Blood-stained ear discharge Dizziness/vertigo Facial paralysis Earache What caused it? This is not really known. The symptoms are very slow to progress, so in many cases the patient has not consulted his of her GP until later symptoms such as pain appear. The doctor will notice an obvious middle ear polyp upon examination of the ear or a red or blue-tinged swelling. Can it spread? It can spread to surrounding structures such as bone and nerves. It can occasionally spread to the brain if left untreated. How is it treated? The details of the treatment are specific to the place from which the tumour started, depends upon how large it has become. It can often be removed surgically, depending on the likelihood of nerve damage radiotherapy can slow the growth and keep the disease in check for many years. Please refer to CancerBACUPs booklet - Understanding cancer of the head and neck for further details of some of the tests you may undergo, radiotherapy, and side effects of radiotherapy and surgery. There is also a useful section about your feelings at this time and details of other useful publications and other organisations and sources of support.
Malleus

Pinna (ear) Ear canal (external auditory canal) Ear drum (tympanic membrane)

Cochlea

Eustachian tube Outer Ear Middle Ear Inner Ear

WPR27200 Nov 2007

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