Tracheal Cancer

Overview

Cancer of the trachea is rare and only makes up about 0.1% (1 in 1,000) of all cancers. The most common types of tracheal cancer are squamous cell carcinoma and adenoid cystic carcinoma. Squamous cell cancers start in the cells that line different parts of the body, such as the airways, the mouth and the gullet. Adenoid cystic cancers are rarer and develop from glandular tissue. They can develop in different parts of the body but more commonly in the head and neck area.

Symptoms

The most common symptoms of tracheal cancer are:

  • a dry cough
  • breathlessness
  • a hoarse voice
  • difficulty in swallowing
  • fevers, chills and chest infections that keep coming back
  • coughing up blood
  • wheezing or noisy breathing.

These symptoms are common in conditions other than cancer. However, it is important to tell your doctor if you have any of these symptoms.

Causes

For most people the cause is unknown.

However, smoking is linked with squamous cell cancer of the trachea. This type of tracheal cancer is also more common in men over 60.

There isn’t any evidence linking adenoid cystic carcinoma of the trachea to smoking. Like many cancers, the cause is unknown. However, it seems to affect men and women equally and is more common between the ages of 40 and 60.

Diagnosis

Your GP will examine you and arrange for any tests that may be necessary. You will be referred to a hospital specialist for these tests and for expert advice and treatment.

The doctor at the hospital will examine you, ask you about your medical history and take blood samples to check your general health.

Cancer of the trachea is rare and can be difficult to diagnose. It may be mistaken for asthma or bronchitis, which sometimes results in a delay in the diagnosis.

You may have some of the following tests to help diagnose your cancer and to find out whether or not the cancer has spread.

X-rays

The doctor may take some x-rays to begin with, although cancer of the trachea may not always show up on an x-ray.

CT 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 will 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 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 that it’s safe for you to have an MRI scan.

Before the scan, you’ll be asked to remove any metal belongings including jewellery. 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 to 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.

Bronchoscopy

A thin, flexible tube is passed down your mouth or nose to examine the trachea. You will be asked not to eat or drink anything for a few hours before it. Just before the test you may be given a mild sedative to help you relax and to relieve any discomfort.

Once you’re comfortable, a local anaesthetic will be sprayed on to the back of your throat, making it numb.

The bronchoscope is then gently passed into your nose or mouth and down into the trachea. The doctor can look through the bronchoscope to check for any abnormalities. Photographs and biopsies can be taken at the same time.

The test may be slightly uncomfortable but only takes a few minutes. You should not eat or drink for at least an hour afterwards, because your throat will be numb.

As soon as the sedation has worn off, you will be able to go home. You shouldn’t drive for 24 hours after the test and should arrange for someone to collect you from the hospital if possible, as you may feel sleepy. You may have a sore throat for a couple of days after your test, but this will soon disappear.

Rigid bronchoscopy

A rigid bronchoscopy is sometimes used to help doctors plan or give treatment. It can help them see the tumour more clearly and keep the trachea steady during the procedure. You will have a general anaesthetic and you may have to stay in hospital overnight.

The results of these tests will help the specialist decide on the best type of treatment for you.

Treatment

Treatment will depend on a number of factors, including your general health, the position and size of the cancer and whether it has spread anywhere else in the body. The main treatments for cancer of the trachea are surgery and radiotherapy. They can be given alone or in combination.

Chemotherapy is usually given to relieve symptoms. This is known as palliative chemotherapy. Your treatment will usually be carried out in a specialist cancer treatment centre. If you’re having surgery, you will be operated on by a surgeon who specialises in lung and chest surgery.

Surgery

In early, small cancers an operation may be able to completely remove the tumour. This is specialised surgery and is only carried out in specialist centres. However, in many cases too much of the length of the trachea is affected to remove the cancer and re-join the cut ends of the trachea.

As well as removing the cancer, the surgeon also usually removes some healthy looking tissue surrounding it (known as a clear margin). This tissue is looked at in the laboratory to see if there are any cancer cells there. If it does contain cancer cells, this may mean having another operation to remove more tissue.

After your operation, you may be looked after in a high dependency unit or intensive care for a few days. You will have a wound in your neck where the cut (incision) was made and a drainage tube to remove any extra fluid or blood in the area. Until you can drink properly, you will have fluids given through a drip (infusion). You’ll have regular painkillers to make sure that any discomfort or pain is kept under control. The nurses will help you get up and about as soon as you are well enough. This will help to keep your circulation moving and prevent complications like blood clots.

After surgery, your trachea will be slightly shorter so you will be encouraged not to stretch your head back for a while after your operation. After your surgery, you will be seen regularly by a physiotherapist who will help you do breathing exercises and to cough up any phlegm (sputum). You may cough up some blood-stained sputum for a few days after the operation.

Radiotherapy may be given after surgery to try to reduce the chances of the cancer coming back. It may also be done if there were any cancer cells left behind after the operation.

Radiotherapy

Radiotherapy uses high energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells.

It can be used on its own to cure people with early, low-grade cancer of the trachea who are unable to have surgery. Radiotherapy is also given after surgery to reduce the chances of the cancer coming back (adjuvant radiotherapy) or to relieve symptoms (palliative radiotherapy).

Radiotherapy is usually given by aiming the high-energy x-rays at the trachea from a radiotherapy machine. This is known as external beam radiotherapy. You usually have treatment Monday-Friday, with a rest at the weekend. The treatment may be given for 3-7 weeks. The length of time it’s given for depends on the type of tumour you have and its size. Radiotherapy to control symptoms (known as palliative radiotherapy) is usually given over a shorter period of time.

Side effects of radiotherapy

Problems with swollowing

After 2-3 weeks of treatment, the main problem you’re likely to notice is difficulty swallowing. This happens because the radiotherapy can cause inflammation in your gullet (oesophagus). You may also have heartburn and indigestion.

Tell your doctors if you have any of these side effects, as they can give you medicines to help. If you don’t feel like eating or have problems with swallowing, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and some can be prescribed by your GP.

Tiredness

Radiotherapy can make you feel very tired. Try to get as much rest as you can, especially if you have to travel a long way for treatment.

Skin changes

Some people develop a skin reaction similar to sunburn. Pale skin may become red and sore or itchy. Darker skin may develop a blue or black tinge. You will be given advice on how to look after your skin.

Hair loss

Your hair will fall out within the area of the body where you had radiotherapy, but it usually grows back again after treatment.

Feeling of sickeness ( nausea)

Your doctor can prescribe anti-sickness (anti-emetic) drugs, which will help relieve nausea.

Most of these side effects should disappear gradually once your treatment is over, but it’s important to tell your doctor if they continue.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. They work by disrupting the growth of cancer cells. Chemotherapy is usually used to help control the cancer or its symptoms (palliative chemotherapy). Chemotherapy drugs that may be used are cisplatin or carboplatin.

Chemotherapy is rarely used for adenoid cystic cancers of the trachea.