Treatment for cancer of the ear canal and middle ear

• How your doctor decides on treatment for ear cancer
• Surgery
• Radiotherapy
• Chemotherapy
• Follow up
• Coping with cancer of the ear

The main treatments for cancers that start in the ear canal or middle ear are surgery and radiotherapy. Depending on the stage of your cancer you may also have chemotherapy. The treatment you will have depends on

• Where in the ear the cancer is
• The type of cancer
• The size of the tumour
• Whether it has spread outside the area it started in (the cancer stage)
• Your general health

We have a separate page with general information about cancer of the ear. It tells you about the different types of ear cancer and the tests used to diagnose it and find out how far it may have grown and spread.

People who have cancers that start in the head and neck usually see a team of specialist doctors and other health professionals. They include

• Head and neck surgeons – including ear, nose and throat surgeons, mouth and facial bone surgeons, and plastic surgeons
• Specialists in cancer drugs and radiotherapy – oncologists
• Dentists
• Specialist nurses, physiotherapists and dieticians

The type and amount of surgery you need depends on where the cancer is in your ear. And whether it has spread into any of the surrounding tissues, or into nearby structures, such as the bone.

Your surgeon will remove the tumour together with an area of tissue surrounding it that is completely free of cancer cells. This is called a clear margin of tissue. It needs to be at least 5mm all round the cancer. Doing this helps to lower the risk of the cancer coming back.

Surgery may involve having some or all of the following removed

• The ear canal
• Part or all of the temporal bone
• The middle ear
• The inner ear

The temporal bone is the bone at the side of your skull, by the ear. The operation to remove the temporal bone is called a mastoidectomy or temporal bone resection.

Rarely, your surgeon may need to remove the facial nerve. This runs down the side of the face and through the salivary gland. They may also need to remove the lymph nodes nearby in your neck and the salivary gland on that side of your head.

Obviously how you are after surgery will depend on the operation you had. But for this operation, the wound is usually behind the ear. Immediately after the operation you will have stitches and may have a dressing over your wound. You will also have one or two small tubes near your wound to drain any fluid from the area. This helps to reduce swelling. It usually takes a couple of days for these tubes to stop draining fluid. Then your nurse or doctor will take them out.

You will have a drip for fluids, to stop you getting dehydrated. You will have painkillers to control any pain you have. How long you need to spend in hospital depends on your particular operation. Before your operation, your doctor will tell you what to expect.

Whether you can hear or not after the operation depends on the surgery you have. If you have to have your middle and inner ear removed it is unlikely that you will be able to hear on that side. You may also find that your balance is affected and you feel dizzy. Sometimes it is possible for the surgeon to rebuild (reconstruct) some of the ear so that you can hear.

Many people worry about how their appearance will change. With this operation, appearance won’t change for most people. Even with major surgery, the techniques used to remove the tumour and rebuild the area mean that you won’t look any different afterwards. Your scar line is likely to be behind your ear or in a natural crease on your face. You can talk to your specialist about this if you are worried.

Radiotherapy uses high energy waves to treat cancer. You may have radiotherapy as your main treatment. Or you may have it if your surgeon hasn’t been able to remove a clear margin of tissue from around the tumour. Then radiotherapy can lower the risk of the cancer coming back.

You usually have radiotherapy every week for 4 weeks (from Monday to Friday). At your first appointment your radiotherapist plans your treatment. This planning appointment takes a couple of hours but after that each treatment only takes a few minutes. You can find out more about radiotherapy in the about cancer section.

Chemotherapy uses anti cancer (cytoxic) drugs to destroy cancer cells. Chemotherapy on its own won’t cure cancer of the ear but doctors may use it to relieve symptoms if your cancer comes back or you can’t have other treatments.

To help cure ear cancer, researchers have been looking into giving chemotherapy with radiotherapy before or after surgery. We need more research to find out how well this works and when it is best to have chemotherapy.

The chemotherapy drugs you may have include fluorouracil and cisplatin. The cancer drug section of CancerHelp UK has detailed information about these drugs, including their common side effects.

You will have regular check ups once your treatment has finished. Your doctor will examine your ear and ask about your general health. This is your chance to ask any questions you have and to tell your doctor if anything is worrying you. How often you have check ups will vary, depending on your situation. They usually start off every 2 or 3 months and become less often as time goes on.

Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

It can also help to talk to other people who have the same thing. But it can be hard to find people who have had a rare type of cancer. Check out Cancer Chat – Cancer Research UK’s discussion forum. It is a place for anyone affected by cancer to share experiences, stories and information with other people who know what you are going through.

You may also find it helpful to contact the Rare Cancer Alliance or the Rarer Cancers Foundation who offer support and information to people who have rare cancers.