The trachea is the tube that connects your mouth and nose to your lungs. It divides into two tubes, called the right and the left bronchus, where it joins to each lung. Air passes through the trachea to go in and out of the lungs as you breathe.
The trachea is in front of your esophagus (gullet), which is the tube that food goes down. The trachea is about 10–16cm (5–7in) long. It is made up of rings of tough, fibrous tissue (cartilage). You can feel these if you touch the front of your neck.
Causes of tracheal cancer
We don’t know exactly what causes tracheal cancer. The most common type of tracheal cancer is called squamous cell cancer. Squamous cell cancer is linked to smoking cigarettes. However, other types of tracheal cancer don’t seem to be caused by smoking.
Symptoms of tracheal cancer
The most common symptoms of tracheal cancer are:
• a dry cough
• a hoarse voice
• difficulty in swallowing
• fevers, chills and chest infections that keep coming back
• coughing up blood
•w heezing or noisy breathing.
These symptoms can be caused by other conditions, but it’s important to have them checked by your doctor.
Diagnosing tracheal cancer
You usually start by seeing your PCP. If they are unsure what the problem is, or think your symptoms could be caused by cancer, they will refer you to a hospital specialist. At the hospital, the specialist doctor will examine you and ask you about your symptoms and general health. They will arrange any tests you need. Several tests may be used to help diagnose tracheal cancer and to check whether it has spread:
X-rays use high-energy rays to take a picture of the inside of your body. Your doctor can use an x-ray of your chest to look at your lungs and trachea.
Lung function tests
These simple tests measure how well your lungs are working. You wear a nose clip and breathe through a mouth piece into a machine. The doctor or nurse will tell you when and how hard to breathe. You usually sit down while you’re having lung function tests. They can take 30–60 minutes.
CT (computerized tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and won’t harm anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan. You may be given a drink or injection of a dye, which allows particular areas in the body to be seen more clearly on the scan. For a few minutes, this may make you feel hot all over. If you’re allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan, you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan. Before the scan you’ll be asked to remove any metal belongings, including jewelry. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan show up more clearly. During the test, you’ll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
The doctor examines your trachea using a thin, flexible tube with a light and camera at the end (bronchoscope). The doctor passes the bronchoscope into your nose or mouth and down into the trachea. Using the bronchoscope, they can take photographs and small samples of tissue (biopsies) from any areas that don’t look normal. A doctor who specializes in analyzing cells (pathologist) examines the biopsy under a microscope to look for signs of cancer. You will be asked not to eat or drink anything for a few hours before the bronchoscopy. Just before the test, you may be given a mild sedative to make you feel sleepy and relaxed. Once you’re comfortable, the doctor sprays a local anesthetic on to the back of your throat to make it numb. The test can be uncomfortable, but it only takes a few minutes. You should not eat or drink for at least an hour afterwards, or until your throat has stopped feeling numb. You will be able to go home when the sedative wears off, but you shouldn’t drive for 24 hours after the test. If possible, ask someone to pick you up from the hospital, as you may feel sleepy.
Instead of a flexible bronchoscope, the doctor may use a straight, firm bronchoscope to keep the trachea steady while they examine it and take biopsies. You usually have a general anesthetic for this and you may have to stay in hospital overnight.
This is similar to a flexible bronchoscopy, but uses sound waves to build up a picture on a computer screen. The doctor passes an ultrasound probe on the end of the bronchoscope into the trachea to examine areas nearby. This test takes less than an hour and you can usually go home on the same day.
Staging and grading of tracheal cancer
Staging of tracheal cancer
The stage of a cancer describes its size and whether it has spread. Knowing the stage helps doctors decide on the best treatment for you. Different types of staging systems are used for different cancers. But because tracheal cancer is rare, there isn’t a standard system for it.
Your doctor can give you more information. They might describe the stage of the cancer as:
• earlyor local to describe cancer that is only in the trachea
• locallyadvanced to describe cancer that has spread into nearby areas of the body
• metastaticor advanced to describe cancer that has spread to distant organs, such as the lungs, liver or bones.
Grading of tracheal cancer
The grade of a cancer gives the doctor an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.
• Low-grademeans that the cancer cells look similar to normal cells.
• High-grademeans the cells look more abnormal.
A low-grade tumor will usually grow more slowly and be less likely to spread than a high-grade tumor.
Treatment for tracheal cancer
Your treatment will depend on the stage and grade of the cancer and your general health. The main treatments for tracheal cancer are surgery and radiotherapy. If possible, the cancer will be removed completely with surgery. Radiotherapy is often given after this to reduce the risk of cancer coming back. Radiotherapy may also be used if the tumor is in a difficult place to operate on, or for people who are not able to have an operation. Chemotherapy is sometimes given after surgery or radiotherapy to reduce the risk of cancer coming back. Radiotherapy or chemotherapy may also be given to relieve symptoms if the cancer has spread to other parts of the body. If the tumor is blocking your airway or making it hard to breathe, several other treatments can help.
The surgeon may be able to remove an early, local cancer completely. They do this by removing the section of trachea where the cancer is, and then joining the cut ends back together. This is specialized surgery, so it’s only available at some hospitals. You may have to travel to a hospital where a team of specialist surgeons with experience of this type of surgery can look after you. The thought of having any type of surgery can be frightening. Your surgeon or specialist nurse will explain what to expect, and answer any questions before your operation.
After the operation
You will be looked after in a high-dependency unit or intensive care for a few days. You will have a wound in your neck or chest. To start with, you’ll have drainage tubes to remove any extra fluid or blood from the area. Until you can drink properly, you will have fluids given through a drip (infusion). A physiotherapist will help you do breathing exercises and to cough up any phlegm (sputum). You may have a stitch under your chin or a neck brace. This keeps your head safely in a position that protects the trachea as it heals. About a week after the operation, the doctor or nurse will remove the stitches or neck brace. Your trachea will be slightly shorter, so you still need to be careful about moving your head for a while. Your surgeon will give you advice about this.
Radiotherapy uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells. Radiotherapy can be given after surgery to reduce the risk of the cancer coming back, or if some of the cancer couldn’t be removed. If you can’t have surgery, radiotherapy may be used as the first treatment. It can also be given to relieve the symptoms of cancer that has spread outside the trachea. You have treatment in small doses (called fractions) over 3–7 weeks. It is given by a radiotherapy machine, which is similar to a large x-ray machine. The length of time it’s given for depends on the type of tumor you have and its size. Radiotherapy only treats the area of the body that the rays are aimed at. It doesn’t make you radioactive. If you are having radiotherapy to control symptoms, such as pain, you might only need a few days of treatment or even just a single dose.
Side effects of radiotherapy
You may have side effects during radiotherapy. These usually disappear gradually over a few weeks or months after treatment finishes. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help. After 2–3 weeks of treatment, the main problem you’re likely to notice is difficulty swallowing. This happens because the radiotherapy can make your throat sore and dry inside. You may also have heartburn or indigestion. If you find it hard to eat and drink, let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy and/or protein to your diet. Some can be used to replace meals, while others are used in addition to your normal diet. A few of these products are available directly from your chemist or the supermarket, but your doctor, nurse or dietitian can also prescribe them for you.
Radiotherapy can also make your trachea and lungs sore and swollen. This may make you feel breathless or give you a dry cough or chest pain. It can start in the weeks after treatment and usually improves with time. If you notice these side effects, tell your doctor. They can give you drugs and treatment to help.
Your radiotherapy team will give you advice about skincare during treatment. It’s common to have a skin reaction in the area of your chest and neck being treated. The skin can become sore and red. This usually starts about 2–3 weeks after treatment starts and may last for 3–4 weeks after treatment ends. Let your radiotherapy team know if your skin becomes sore. They can give you painkillers and advice about caring for your skin until it heals.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. Chemotherapy is sometimes given with radiotherapy if tracheal cancer can’t be removed with surgery. Chemotherapy may also be given to help control the symptoms of cancer that has spread.
Side effects of chemotherapy
The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain any treatment you are offered and what to expect. Let them know about any side effects during treatment. They can often prescribe drugs to reduce them. Chemotherapy can reduce the number of white blood cells in your blood during treatment. This will make you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens. Chemotherapy can also cause other side effects, such as feeling tired, a sore mouth, feeling sick (nausea) or being sick (vomiting), diarrhea and hair loss. Let your doctor or nurse know about any side effects, as they can often give you advice and help to reduce these.
Other treatments for tracheal cancer
If the tumor is making it difficult for you to breathe, you may need other types of treatment to clear your trachea. You might need this to control breathing symptoms caused by advanced cancer. But these treatments may also be used before you start treatment for much earlier stages of cancer. These treatments are usually done using rigid bronchoscopy while you are under a general anesthetic. Your doctor will explain what to expect and any side effects that are likely with your treatment.
The doctor uses surgical instruments through the bronchoscope to remove the part of the tumor blocking your trachea.
Internal radiotherapy (brachytherapy)
This type of radiotherapy can be used to shrink the tumor in the trachea. A thin tube is put inside your trachea, close to the tumor. A solid radioactive material is then put inside this tube and left in place for a few minutes.
This treatment destroys the tumor inside the trachea with a laser light. The doctor aims a laser light at the tumor to remove as much of it as possible.
Cryotherapy uses liquid nitrogen, which is very cold, to freeze and destroy cancer cells. The doctor puts a thin tube close to the tumor and runs liquid nitrogen inside the tube to make it freeze. They move the probe around until enough of the tumor has been removed to open up your airway.
Diathermy is also known as electrocautery. The doctor uses a tube heated by an electrical current to destroy the tumor blocking the trachea.
Argon beam coagulation
This treatment also uses heat to destroy areas of the tumor. The doctor puts a thin tube close to the tumor and uses argon gas and an electric current to heat up the area.
Photodynamic therapy (PDT)
This treatment uses laser or other light sources, and a light-sensitive drug to destroy cancer cells. The doctor gives you the drug as an injection into your vein. This makes cells in your body more sensitive to light. The doctor then aims a light at the tumor in the trachea. This starts the drug working to destroy the cancer cells.
Sometimes a small device called a stent is put inside the trachea to hold it open where the tumor is starting to block it. The most common type of stent is a small wire frame. The doctor uses a bronchoscope to put the folded-up stent into the trachea. As it comes out of the end of the bronchoscope, the stent opens up like an umbrella. This pushes and holds the airway open. Afterwards, you won’t usually feel the stent and you’ll be able to breathe more easily. It can stay in your trachea permanently.