Ear


 * **Epidemiolgy:** || * Other than skin cancer, tumors arising in the ear are rare1
 * Glomus Jugulare, or carotid body tumor1
 * A highly vascular tumor
 * Can grow along the course of the tympanic nerve
 * External ear tumors most commonly occur in patients 50 to 80 years old and are more common in men while tumors of the middle ear and mastoid are more common in patients 40 to 60 years old with more women having middle ear tumors than men.2 ||
 * **Etiology:** || * Tumors of the external ear are often cutaneous malignancies that could be related to sun exposure.2
 * Otorrhea, chronic exzema, chronic dermatologic conditions, and chronic ulcerations from trauma are all conditions that are suspected to have possible etiologic components for ear tumors.2

||
 * **Signs & Symptoms:** || * Presentation generally consists of small ulcerations most commonly located in the helix.2
 * For lesions in the external auditory canal (EAC), pain and pruritus are common symptoms.2 ||
 * **Diagnostic Procedures:** || Diagnostic workup includes:
 * Complete history and physical
 * Computed Tomography (CT)
 * Magnetic Resonance Imaging (MRI)
 * Biopsy ||
 * **Histology:** || Tumors of the ear including areas such as the mastoid region, middle ear, and auditory canal, are approximately 85% squamous cell carcinoma.3 ||
 * **Lymph node drainage:** || The following possible lymph node involvement was noted for each site:
 * External ear: superficial parotid, retroauricular, superficial cervical
 * Middle ear: parotid, deep cervical nodes
 * Inner ear: no lymph nodes.4 ||
 * **Metastatic spread:** || ** Cancer of the External Ear **
 * Nearby lymph glands/ glands of the neck 5


 * Cancer of the Ear Canal **
 * This type of cancer can spread to the middle ear. It is also possible for the cancer to spread into the parotid gland. It can also spread to the lymph nodes that are present around the ear as well as the neck although this is rare. 5

> to the lymph nodes although this is rare. 5
 * Cancer of the Middle Ear **
 * It commonly spreads to surrounding structures such as bone, and can damage the facial nerve, causing facial paralysis. It can also spread


 * Glomus Tumor **
 * It can spread to surrounding structures such as bone and nerves. It can occasionally spread to the brain if left untreated. 5 ||
 * **Grading:** || The majority of cancers of the ear are skin carcinomas and are graded as follows: 6


 * Hisologic Grade (G) **

GX - Grade cannot be assessed G1 - Well differentiated G2 - Moderately differentiated G3 - Poorly differentiated G4 - Undifferentiated ||
 * **Staging:** || The majority of cancers of the ear are skin carcinomas are staged as follows: 6

**Primary Tumor (T)**

TX - Primary tumor cannot be assessed T0 - No evidence of primary tumor Tis - Carcinoma in situ T1 - Tumor 2 cm or less in greatest dimension T2 - Tumor more than 2 cm, but not more than 5 cm, in greatest dimension T3 - Tumor more than 5 cm in greatest dimension T4 - Tumor invades deep extradermal structures (i.e., cartilage, skeletal muscle, or bone)


 * Regional Lymph Nodes (N) **

NX - Regional lymph nodes cannot be assessedN0 - No regional lymph node metastasis N1 - Regional lymph node metastatis


 * Distant Metastasis (M) **

MX - Distant metastasis cannot be assessed M0 - No distant metastasis M1 - Distant metastasis

Stage 0 - Tis N0 M0
 * Stage Grouping **

Stage I - T1 N0 M0

Stage II - T2 N0 M0 T3 N0 M0

Stage III - T4 N0 M0 Any T N1 M0

Stage IV - Any T Any N M1 || Radiation alone or a combination of radiation and surgery for large lesions of the EAC, for these tumors the field should include the ipsilateral preauricular, postauricular, and subdigastric lymph nodes. Advanced tumors that cannot be resected should be treated with high energy electrons or a high energy electron low energy photon mix with doses of 65-70Gy. ||
 * **Radiation side effects:** || Side effects could include skin changes, hair loss, and partial or complete loss of hearing. ||
 * **Prognosis:** || Tumors involving the middle ear and tumors with extension into the temporal bone are the most difficult to treat.2 Size of the tumor can affect the prognosis, as well as any bone or nerve involvement.2 ||
 * **Treatments:** || For tumors involving the auricle electrons are used, small superficial lesions do not need much margin but as the tumors increase in size and depth, the field margins increase. A dose of 65Gy over six and a half weeks is required.
 * **TD 5/5:** || Ear TD 5/5 -50Gy ||
 * **References:** || # Bentel GC. //Radiation Therapy Planning.// 2nd ed. The McGraw-Hill Companies; 1996: 313-314.
 * 1) Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd edition. Philadelphia,PA: Lippincott, Williams & Watkins. 2011:203-208.
 * 2) Chao KSC, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002: 183-187.
 * 3) Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, Missouri; Mosby Inc; 2004: 640-641.
 * 4) Doncaster and Basetlaw Hospitals. //Cancer of the ear//. Available at: [] Accessed on May 29, 2012.
 * 5) American Joint Committee on Cancer. //AJCC Cancer Staging Manual//. 6th ed. New York, NY: Springer; 2002. ||

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