Cancer of the ear is a rare cancer. Most of these cancers start in the skin of the outer ear. Between 5 and 10 out of 100 skin cancers (5 - 10%) 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.
There are 3 parts to the ear:
- the outer ear
- the middle ear
- the inner ear
Another important part is the bone that surrounds and protects the ear (the temporal bone).
The ear canal
The ear canal is the passage running from the outer ear to the middle ear. It is also called the meatus.
The ear canal is actually part of the outer ear. But it is included in this section about middle and inner ear cancer. This is because the stages, symptoms, and treatment of ear canal cancer are different to cancer of the outer ear.
The middle ear
The middle ear is a small cavity which contains 3 small bones. These pass on the vibrations from the eardrum to the inner ear.
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.
Causes of ear cancer
The cause of ear cancer is largely unknown.
People with a history of chronic ear infections have a higher risk of developing cancer in the middle ear. Chronic means for 10 years or more.
The symptoms of ear cancer depend on where the tumour is within the ear.
Symptoms can include:
- discharge from the ear
- loss of hearing
- a lump in the ear canal
- weakness in your face
The most common symptom is a discharge from the ear which may be blood stained. Other symptoms include:
- hearing loss
- you cannot move your face on the side of the affected ear
- hearing loss
- tinnitus (noises, such a ringing, heard in the ear)
Some people with ear cancer might also have swollen lymph nodes in their neck.
Tests to diagnose
Your doctor will examine you and you might 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 (biopsy) from the abnormal area of the ear. A specialist doctor (pathologist) then examines this under a microscope.
Before your doctor takes the biopsy, you usually have a local anaesthetic to numb the area so you don’t have any pain. Biopsies of the middle ear can be difficult to take. So in this situation, you might have a general anaesthetic instead.
You might have an MRI scan or a CT scan if the biopsy shows you have cancer. This helps your doctor decide which treatment you need. 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 most common type of ear cancer is squamous cell cancer. Other types of cancer of the ear canal, middle or inner ear include:
- basal cell cancer
- adenoid cystic
The stage tells you how big the cancer is and whether it has spread. Developing a staging system is difficult when there are not many people with the cancer. There are different staging systems for cancer of the ear. Working out the stage of the cancer helps your doctor to decide about treatment.
Generally an early stage cancer is small and 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.
For cancers of the ear canal and middle ear doctors can use the TNM staging system.
- T describes the size of the tumour
- N describes whether there are any cancer cells in the lymph nodes
- M describes whether the cancer has spread to a different part of the body
The T 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
Treatment includes surgery, radiotherapy and sometimes chemotherapy