Cancer of the ear
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There are 3 parts to the ear
Another important part of the ear is the bone that surrounds and protects the ear.
The outer ear is the part of the ear we can see. It protects the rest of the ear and helps us collect sound. There are 3 parts to the outer ear
- The ear flap or pinna
- The ear canal (meatus)
- The eardrum (tympanic membrane).
The eardrum vibrates when a sound is made.
The middle ear is a small cavity which contains three small bones. These pass on the vibrations from the eardrum to the inner ear.
The inner ear is filled with fluid. It also contains a small spiral tube called the cochlea. The cochlea has lots of tiny hair like nerves on it. It converts the vibrations from the middle ear into nerve impulses which then travel to the brain. The inner ear also has a number of fluid filled cavities which help us to balance.
The bone that surrounds the ear is called the temporal bone. The ear canal, middle ear and inner ear are all within the temporal bone. The temporal bone is part of the skull above the ear.
One part of the temporal bone is called the mastoid bone. It is the lumpy bit you can feel behind your ear. The outside of the mastoid bone is a hard solid bone but inside is bone that is shaped like honeycomb. There is air inside the small cavities. They also contain the inner ear and the nerves that control the movement of the face and tongue.
Cancer of the ear is a rare cancer. Most of these cancers start in the skin of the outer ear. About 5 out of 100 skin cancers develop on the ear. Those that develop inside the ear are very rare. Less than 1 in every million people in the UK will develop cancer in the middle ear each year.
Cancers of the outer ear usually develop in the skin of the ear. The cause of most skin cancers is long term exposure to the sun. Most cancers develop on the top part of the ear, called the helix.
The cause of cancers in the middle ear is unknown. People with a history of chronic ear infections have a higher risk of developing cancer in the ear. Chronic means for 10 years or more.
The symptoms of cancer of the ear depend on where the tumour is within the ear. Some people may also have swollen lymph nodes in their neck.
Outer ear – the main symptom is a spot or sore that doesn’t heal within 4 weeks. Most squamous cell cancers are pink lumps that have a hard scaly surface. They often bleed easily and ulcerate. If you have mole on your ear you should report any changes, such as the mole growing, itching or bleeding.
Middle ear – the most common symptom is a discharge from the ear which may be blood stained. Other symptoms include hearing loss and earache. Occasionally people cannot move their face on the side of the affected ear.
Inner ear – pain including a headache, hearing loss, tinnitus and dizziness.
Most cancers of the ear are squamous cell carcinomas. Other types include
- Basal cell cancer
- Adenoid cystic
Your doctor will examine you and you may have blood tests to check your general health.
The only way to confirm a diagnosis of cancer is to take a small amount of tissue from the abnormal area of the ear and examine it under a microscope. Doctors call this a biopsy. Before your doctor takes the biopsy they give you a local anaesthetic to numb the area so you don’t have any pain. Biopsies of the middle ear can be difficult to take and you may need to have a general anaesthetic.
If the biopsy shows a cancer, you may also have an MRI scan or a CT scan to help your doctor decide which treatment you need. There is more information about these scans in the cancer tests section. Occasionally people have scans before a biopsy.
Doctors do not take biopsies of the inner ear. This is because it is very difficult to reach without causing problems to other structures around it. Your doctor will make a diagnosis using MRI scans and CT scans.
The staging of a cancer looks at the size of the cancer and whether it has spread. Working out the staging system can be difficult with rare cancers because there are not many people with the cancer. So it is hard to develop the staging system. Doctors use a number of different staging systems for cancer of the ear.
Generally an early stage cancer is small and just within the area it started in. One that is slightly more advanced has grown into the surrounding structures. A secondary or metastatic cancer has spread to another part of the body from where it started. Working out the stage of the cancer helps your doctor to decide about treatment.
The staging system for cancers of the outer ear is the same as for skin cancer you can read more about this on our stages of skin cancer page in the skin cancer section. If you have a melanoma the staging system is the same as for melanomas that develop elsewhere on the body. You can read more about this staging system on the stages of melanoma page.
For cancers of the ear canal and middle ear doctors can use the TMN staging system. The T part refers to the tumour, the N whether the lymph nodes have any cancer cells in them and M tells us if it has spread to another organ in the body.
The staging for the ear canal and the middle ear is
T1 – the tumour is just in the middle ear and is not causing any numbness of the face and is not in the nearby bone
T2 – the tumour has grown outside the area and is causing numbness or is affecting the bone
T3 – the tumour has grown into the nearby salivary gland (parotid gland) or the base of the skull or the joint of the jaw
We have separate question and answers about the treatment of cancer of the ear depending on where it started
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