Tracheal Cancer – Symptoms of a Tumor in the Trachea, Treatment of Tracheal Cancer, and the Right Clinic for Tracheal Carcinoma (Oncology)

In general, tracheal cancer can be classified as either primary or secondary. Primary tracheal carcinoma refers to a tumor that originated in the trachea.

A secondary tracheal carcinoma occurs when a tumor has metastasized to the trachea from another site. The primary tumor is then located in another organ or in the adjacent lymph nodes. Tumor cells then travel through the bloodstream to the trachea, where they form secondary tumors (metastases).

The primary tumor of tracheal carcinoma is often located

• in the lung,
• the larynx,
• in the hypopharynx (lowermost part of the throat),
• in the esophagus, or
• in the thyroid gland. 

Tracheal cancer is usually a secondary form, meaning it consists of metastases from another tumor. The primary formation of a tumor in the trachea is very rare. While primary tracheal tumors in adults are predominantly malignant, they are usually benign in children.

Depending on which tissue of the trachea the primary tumor originates from, different types can be distinguished. In descending order of frequency, these are

• squamous cell carcinoma
• slow-growing adenoid cystic carcinoma
• adenocarcinomas or other tumor types.

This distinction plays an important role in assessing the prognosis.

Illustration of the trachea and bronchi © PIC4U | AdobeStock

At first, tracheal cancer causes no symptoms.

Symptoms often do not appear until the tumor has blocked about half of the trachea. The first sign is often shortness of breath.

Due to the narrowing of the trachea caused by the tumor, other clinical symptoms develop, such as

• a cough,
• hoarseness, and
• breathing sounds when exhaling.

As the tumor grows, bloody sputum may occur.

The symptoms are rather nonspecific and can also occur with other conditions, including

• asthma,
• chronic obstructive pulmonary disease (COPD), and
• pneumonia

As a result, tracheal carcinoma is unfortunately often not diagnosed until an average of 2.5 months after the first symptoms appear. 

Smokers, in particular, have an increased risk of developing tracheal cancer. More than 90 percent of squamous cell carcinomas of the trachea occur in smokers.

Other carcinogenic substances may also contribute to the development of tracheal carcinoma. These include inhaled hydrocarbons or asbestos. Heavy alcohol consumption may also play a role in the development of tracheal cancer.

If you are experiencing persistent shortness of breath, hoarseness, or a cough, or if you have bloody sputum, you should see your doctor. The diagnostic process begins with a medical history, which involves a discussion with the patient. During this discussion, the doctor will ask questions about

• your symptoms,
• your lifestyle habits, and
• any previous medical conditions. 

This helps them narrow down the cause of your symptoms.

Computed tomography provides important clues

However, since the symptoms are often nonspecific, an X-ray of the chest (thorax) is frequently performed first. That said, this test is not particularly well-suited for detecting tracheal cancer.

A computed tomography (CT) scan of the thorax is performed if

• the symptoms do not improve after administration of a bronchodilator,
• there is already bloody sputum, or
• the X-ray examination suggests a malignant condition in the trachea.

In some cases, a pulmonary function test using spirometry can also provide clues as to the cause of the symptoms.

Bronchoscopy in unclear cases and to confirm the diagnosis

A bronchoscopy is performed when

• a CT scan raises suspicion of a malignant condition or
• no clear cause for the symptoms has been identified. 

During the procedure, a special endoscope is usually inserted into the trachea through the mouth. This allows the doctor to identify pathological changes in the trachea. The doctor can also take a sample of the affected tissue from the trachea at the same time.

Illustration of a bronchoscopy © marina_ua | AdobeStock

Examination of a tissue sample

A tissue sample taken during bronchoscopy determines the nature of the lesion:

• whether it is benign or malignant,
• whether it is confined to the mucous membrane or has already spread, or
• whether there is another cause for the tissue change.

This also makes it possible to determine whether the cancer is a primary or secondary tracheal carcinoma. The histologist also identifies the exact type of tumor.

PET-CT for Staging

If a diagnosis of tracheal cancer has been made based on the bronchoscopic examination, further tests are performed. The size and extent of the tumor, as well as any metastases in other parts of the body, are important factors in cancer treatment. For this so-called staging, additional imaging techniques, such as positron emission tomography (PET-CT), are used.

Since tracheal cancer is a rare disease, patients should be treated by experienced specialists at specialized centers. 

Whenever possible, the goal is to completely remove the cancerous tissue surgically. In earlier stages, the cancer may be curable. In some cases, it is necessary to remove entire sections of the trachea. Between 50 and 70 percent of tracheal tumors can generally be surgically removed at the time of diagnosis.

If the cancer has already progressed, complete surgical removal of the tumor may no longer be possible. In these cases, radiation therapy (radiotherapy) is used. It can shrink the tumor and thus, in some cases, make it operable after all. It can also destroy tumor cells that cannot be removed surgically. 

Chemotherapy may be considered in addition to surgery and radiation therapy for patients

• in whom the cancer could not be completely removed and
• the tumor has spread to surrounding tissue.

Palliative Care

Chemotherapy alone is used only when a complete cure is no longer possible and life expectancy is significantly reduced. In such cases, it is palliative in nature, meaning it is intended to alleviate symptoms.

In palliative care, attempts are sometimes made to shrink the tumor using laser treatment and/or to keep the trachea open by inserting stents. This can reduce symptoms.

The Earlier, the Better

The timing of the diagnosis is crucial for the course of the cancer and the prognosis. The earlier the correct diagnosis is made, the sooner

• the tumor can be completely removed surgically and
• metastases have not yet formed.

Thus, patients whose cancer can be completely removed have the best chance of a cure.

This means that if you experience symptoms such as those described above, you should see a doctor so that they can determine the cause of your symptoms at an early stage.

Importance of Tumor Type

The histological classification of the tumor tissue also provides important information regarding the chances of survival.

Patients with squamous cell carcinoma have a poorer prognosis than those with adenoid cystic carcinoma. The latter grows more slowly than squamous cell carcinoma.

Patients with adenoid cystic carcinoma have a 5-year survival rate of up to 74 percent. For patients with squamous cell carcinoma, this rate is up to 45 percent.

The only way to prevent tracheal cancer is to avoid carcinogenic substances. This means quitting smoking and avoiding excessive alcohol consumption.

Smoking is a major risk factor for numerous types of cancer and for many cardiovascular diseases. Therefore: Try to quit smoking sooner rather than later. Within just a few years, your risk of developing cancer will decrease significantly. 

Quitting smoking is the best way to prevent tracheal cancer and many other diseases © methaphum | AdobeStock

But passive smokers are also at risk: Be careful not to be unintentionally exposed to these harmful substances. 

If you’re exposed to carcinogenic substances (such as asbestos) at work, your employer must provide you with appropriate protective equipment, including respiratory protection. Wear it conscientiously and in accordance with the guidelines. This is the only way to help keep these dangerous substances out of your body.

What is tracheal cancer?
Tracheal cancer is a malignant tumor of the trachea. The tumor in the trachea usually develops from the tracheal mucosa and is medically referred to as tracheal carcinoma.

What are the symptoms of tracheal cancer?
The most common symptoms include coughing, shortness of breath, hoarseness, difficulty swallowing, and sputum. If the tumor narrows the airway, the symptoms often become more severe. Initial signs should be evaluated by a doctor.

How is tracheal cancer diagnosed?
Diagnosis is made through bronchoscopy, MRI, X-ray, and biopsy. In addition, the treating hospital will determine whether metastases have already formed or if the tumor has spread to the lungs, throat, or esophagus.

What treatment options are available for tracheal cancer?
Treatment options for tracheal cancer include surgery, radiation therapy, and chemotherapy. The choice of treatment depends on the size of the tumor, the patient’s overall health, and the prognosis for tracheal cancer.

What risk factors increase the risk of tracheal cancer?
Risk factors include smoking, asbestos exposure, and consumption of high-proof alcohol. Other types of cancer, such as lung cancer or laryngeal cancer, can also be associated with tumor formation in the trachea. Follow-up care is particularly important after treatment for tracheal cancer has been completed.