A basic distinction can be made between primary and secondary forms of tracheal cancer.
Primary tracheal cancer is when the tumor originally developed in the trachea.
A secondary tracheal carcinoma is present if it has entered the trachea as a metastasis of another tumor. The primary tumor is then located in another organ or in the neighboring lymph nodes. Tumor cells then enter the trachea via the blood, where they form metastases.
The primary tumor of a tracheal carcinoma is often located
Tracheal cancer is usually a secondary form, i.e. metastases of 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 the tissue of the trachea from which the primary tumor forms, different types can be distinguished. In descending order of frequency, these are
- squamous cell carcinoma
- the slow-growing adenoid-cystic carcinoma
- adenocarcinoma or other tumor types.
This differentiation plays an important role in assessing the prognosis.
Illustration of the trachea and bronchi © PIC4U | AdobeStock
At the beginning, tracheal cancer does not cause any symptoms.
It often only causes symptoms when the tumor blocks about half of the windpipe. The first sign is often shortness of breath.
Due to the narrowing of the windpipe by the tumor, further clinical symptoms occur, such as
As the size of the cancer increases, bloody sputum may be produced.
The symptoms are rather unspecific and can also occur with other diseases, including
Unfortunately, tracheal carcinoma is therefore 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 cancer-causing substances may also be involved in the development of tracheal cancer. These include inhaled hydrocarbons or asbestos. Intensive alcohol consumption could also play a role in the development of tracheal cancer.
If you suffer from persistent shortness of breath, hoarseness or coughing or have bloody sputum, you should see your doctor. The diagnostic process begins with a medical history, i.e. the patient interview. The doctor will ask questions about
- Your symptoms,
- your lifestyle habits and
- illnesses you have already suffered.
In this way, he tries to narrow down the cause of the symptoms.
Computer tomography provides important clues
However, as the symptoms are often unspecific, an X-ray examination of the chest (thorax) is often carried out first. However, this examination is less suitable 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 medication,
- there is already bloody sputum or
- the X-ray examination provides evidence of a malignant disease in the trachea.
In some cases, a lung 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 ("lung endoscopy") is used if
- a malignant disease is suspected after the CT scan or
- there is no clear cause for the symptoms.
A special endoscope is inserted into the windpipe, usually via the mouth. This allows pathological changes in the windpipe to be detected. The doctor can also take a sample of the altered tissue from the windpipe.
Illustration of a bronchoscopy © marina_ua | AdobeStock
Examination of a tissue sample
A tissue sample taken during the bronchoscopy provides information about the type of change:
- Whether it is benign or malignant,
- whether it is localized 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 it is a primary or secondary tracheal carcinoma. The histologist also determines the exact type of tumor.
PET-CT for the diagnosis of spread
Once a diagnosis of tracheal cancer has been made on the basis of the bronchoscopic examination, further examinations are carried out. The size and extent of the tumor and any metastases in other parts of the body are important for cancer treatment.
Further imaging techniques, such as positron emission tomography (PET-CT), are used for this so-called spread diagnosis.
As tracheal cancer is a rare disease, patients should be treated by experienced experts and in specialized centers.
Whenever possible, complete surgical removal of the cancerous tissue is aimed for. In earlier stages, the cancer may be curable in this way.
In some cases, it is necessary to remove entire sections of the trachea.
50 to 70 percent of tracheal tumors can generally be surgically removed at the time of diagnosis.
If the cancer growth is already advanced, 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 make it operable after all. It can also destroy tumor cells that cannot be removed surgically.
Chemotherapy is considered in addition to surgery and radiotherapy for patients
- in whom the cancer could not be completely removed and
- the tumor has spread to neighboring tissue.
Palliative care
Chemotherapy alone is only used if a complete cure is no longer possible and life expectancy is significantly reduced. It then has a palliative character, i.e. serves to alleviate symptoms.
In palliative care, attempts are occasionally also made to reduce the size of the tumor using laser treatment and/or to keep the windpipe open by inserting stents. This can reduce the symptoms.
The earlier the better
The time of diagnosis is decisive for the course of the cancer and the prognosis. The earlier the correct diagnosis is made, the sooner the tumor can be
- the tumor can be completely removed surgically and
- has not yet metastasized.
Patients in whom the cancer can be completely removed have the best chance of recovery.
This means that if you have symptoms such as those described above, you should see a doctor so that they can clarify the cause of your symptoms at an early stage.
Significance of the tumor type
The histological classification of the tumor tissue also provides important information regarding the chance of survival.
Patients with squamous cell carcinoma have a worse 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 is up to 45 percent.
The only way to prevent tracheal cancer is to avoid carcinogenic substances. This means stopping smoking and excessive alcohol consumption.
Smoking is the main risk factor for numerous cancers and many cardiovascular diseases. Therefore: try to stop smoking sooner rather than later. The risk of developing cancer is significantly reduced within just a few years.
Quitting smoking is the best prevention against tracheal cancer and many other diseases © methaphum | AdobeStock
But passive smokers are also at risk: Be careful not to be unintentionally exposed to harmful substances.
If you are occupationally exposed to carcinogenic substances (e.g. asbestos), your employer must provide you with appropriate protective equipment, including respiratory protection. Wear these conscientiously and in accordance with the specifications. This is the only way to keep the hazardous substances out of your body.
