Ear cancer is a malignant tumor of the auricle, ear canal or middle ear. It is manifested by the presence of a node, ulcers or bleeding granulations, discharge from the ear, pain, noise and itching in the ear. Unilateral hearing impairment is possible. With the spread of ear cancer, symptoms of damage to the cranial nerves occur. With lymphogenic metastasis, an increase in regional lymph nodes is detected. The diagnosis is made taking into account complaints, otoscopy, radiography, CT, MRI, biopsy and other studies. Treatment – classical surgical interventions, electrosurgical techniques, radiotherapy, chemotherapy.
Meaning
Ear cancer is a rare malignant neoplasm that usually develops from epithelial cells, in some cases from the underlying soft tissues. It makes up about 1% of the total number of oncological diseases. As a rule, it affects people over 40 years old. Men and women are equally likely to suffer from ear cancer. The first place in prevalence is occupied by tumors of the auricle (80%), the second – neoplasms of the external auditory canal (15%), the third – lesions of the middle ear (5%).
Malignant tumors of the ear often occur against the background of traumatic injuries and chronic inflammatory processes. Disease sprouts nearby tissues, can penetrate into the structures of the inner ear, affect the cranial nerves, cause carcinomatosis of the meninges and massive bleeding caused by the destruction of the internal carotid artery. In the later stages, pathology metastasizes to regional lymph nodes. Distant metastases are rarely detected. Treatment is carried out by specialists in the field of oncology and otolaryngology.
Causes
The causes of the development of this pathology are not precisely established, but experts identify a number of factors contributing to its occurrence. Among such factors are inflammatory and precancerous ear diseases. The precursor of ear cancer can be a polyp, borderline nevus or a chronic ulcer. The probability of a malignant lesion also increases in the presence of chronic otitis and laryngitis, scars after burns, frostbite and ear injuries.
In addition, psoriasis, chronic eczema and SLE are among the diseases that provoke the development of oncological processes in the ear area. Exogenous factors play a certain role in the development of ear cancer, including excessive insolation (in cancer of the auricle) and ionizing radiation. Less significant are high humidity and low temperature, which contribute to the occurrence of inflammatory diseases of the ear and nasopharynx. Some experts point to the presence of a hereditary predisposition to oncological diseases.
Classification
Taking into account the localization, there are two types of ear cancer: tumors of the outer ear and middle ear. Tumors of the outer ear, in turn, are divided into two subtypes: neoplasms of the auricle and the external auditory canal. Taking into account the causes of development, primary and secondary ear cancer are distinguished. The primary focus occurs when the cells of the ear tissues are malignated, the secondary one is usually the result of the germination of malignant tumors from nearby organs (for example, from the nasopharynx, paranasal sinus, etc.).
There are exophytic and endophytic types of tumor growth. Endophytic tumors grow mainly deep, exophytic – into the lumen of the organ. Taking into account the microscopic structure, three types of neoplasms are distinguished: ulcerative, infiltrative and solitary vegetative. Taking into account the features of the histological structure , there are three types of oncological lesions of the ear:
- Spinocellular epithelioma. Develops from epithelial cells. This type is characterized by rapid growth. When located in the area of the auricle, it is an easily bleeding warty outgrowth with a wide base, when localized in the area of the auditory canal, it resembles erosion or a kidney-shaped outgrowth in appearance. Sometimes it spreads to the entire ear canal.
- Basal cell carcinoma. It originates from epithelial cells. This type is characterized by slower growth and late metastasis. It is an ulcer or a flat tumor-like formation resembling scar tissue.
- Sarcoma. It originates from the underlying connective tissue. It is very rare. Slow growth is characteristic when located in the auricle area and fast – when localized in the auditory canal.
Sometimes melanomas occur in the ear area, proceeding similarly to other melanomas of the skin.
In clinical practice, a four-stage classification is used, reflecting the prevalence of ear cancer:
- Stage 1 – the tumor affects the skin of the outer ear or the mucous membrane of the middle ear, the underlying cartilage and bone structures are intact.
- Stage 2 – the neoplasm penetrates into the cartilage of the outer ear or the bone tissue of the middle ear, but does not go beyond the compact bone layer.
- Stage 3 – ear cancer spreads beyond the compact layer and affects regional lymph nodes.
- Stage 4 – a large disintegrating neoplasm is detected, affecting neighboring anatomical structures and penetrating into the deep lymph nodes of the neck with the formation of conglomerates. Sometimes ear cancer gives hematogenous metastases.
Outer ear cancer
In the initial stages, ear cancer may be asymptomatic. Subsequently, patients complain of itching, noise in the ear and increasing pain in the affected area. In the area of the auricle or the external auditory canal, a node, ulcer or granulation is detected. Ear cancer located in the area of the auditory canal bleeds more often compared to tumors of the auricle. Serous, mucous or purulent discharge is possible. When ear cancer metastasizes to regional lymph nodes, their increase is detected.
With the germination of the internal parts of the ear and nearby anatomical structures, hearing disorders occur, pronounced pain syndrome, paralysis of facial muscles caused by facial nerve damage, and intracranial complications. The diagnosis of “ear cancer” is made on the basis of otoscopy, cytological and histological examination data. To determine the prevalence of the process, patients are referred for MRI, CT and X-ray of the skull. Differential diagnosis of ear cancer is carried out with inflammatory diseases of the ear, weeping eczema, tuberculosis, lupus erythematosus and benign neoplasms of the outer ear.
Patients with stage 1 ear cancer are prescribed radiotherapy. If the remnants of the neoplasm remain after a course of radiation therapy, electroexcision is performed. Patients with stage 2 ear cancer undergo combination therapy – classical surgical removal or electrosection of the node in combination with preoperative radiotherapy. During the processes in the area of the external auditory canal, the complete removal of the auricle is carried out. At stage 3 of ear cancer, radiation therapy is used in combination with subsequent extended surgical intervention. The affected lymph nodes are excised together with the fiber, with multiple metastasis, the Krail operation is performed. The prognosis for ear cancer depends on the localization and stage of the process. The earlier the neoplasm is diagnosed and the more distally the neoplasm is located, the higher the probability of a favorable outcome.
Middle ear cancer
In the initial stages, the symptoms resemble manifestations of chronic otitis media. The most common early signs of ear cancer are hearing loss and suppuration. Granulations may appear in the area of the auditory canal. With the germination of the underlying tissues, the intensity of the pain syndrome increases, patients with ear cancer note the irradiation of pain in the temple and neck. The growth of granulations becomes more violent, granulations bleed easily. Dizziness and rapid progressive hearing loss are observed.
Subsequently, the clinical picture of ear cancer is supplemented with symptoms indicating the defeat of various anatomical structures. When the facial and trigeminal nerves are involved, sharp pains and paralysis of the facial muscles occur. With the germination of the pharynx and parotid salivary gland, swallowing disorders and difficulties with movements of the lower jaw are noted. When ear cancer spreads to the meninges, carcinomatous meningitis develops. If the internal carotid artery is affected, heavy bleeding is possible. Regional lymph nodes increase in size, gradually lose mobility, form conglomerates with surrounding tissues, possibly with foci of decay.
The diagnosis is established on the basis of otoscopy, X-ray of the skull and biopsy followed by histological examination. During otoscopy, extensive, easily bleeding growths are detected. Radiographs of common processes reveal foci of destruction. To clarify the extent of the lesion, patients with ear cancer are referred to a neurologist for consultation, an MRI of the brain and other studies are prescribed. Differential diagnosis is carried out with chronic purulent otitis, osteomyelitis of the temporal bone, syphilis, tuberculosis and carotid chemodectomy.
For ear cancer limited to the limits of the tympanic cavity, combined therapy is performed – subtotal resection of the temporal bone or extended mastoidectomy in combination with pre- and postoperative telegammotherapy. With lymphogenic metastasis of ear cancer, excision of regional lymph nodes or (in the presence of multiple metastases) Krail surgery is performed simultaneously with the removal of the primary focus. In the later stages, palliative radiotherapy is prescribed. Chemotherapy is less effective. In ear cancer, it is sometimes used in combination with radiotherapy in the process of palliative conservative treatment. This method is not used for ear sarcomas.
The prognosis depends on the prevalence of the malignant process. After radical operations for ear cancer limited by the walls of the tympanic cavity, a cure often occurs. When adjacent anatomical structures are affected, especially the middle cranial fossa, zygomatic and basal bones, meningeal membranes and internal carotid artery, the prognosis is unfavorable. Patients with advanced stages of ear cancer die from purulent processes and intracranial complications.