Types of cancer

Trachea

Tracheal cancer develops in the tube that connects the mouth and nose to the lungs. Wheezing when breathing, shortness of breath and coughing are some of the symptoms. Smoking is the main risk factor for the onset of the disease. Know more.
5 min read
per: Grupo Oncoclínicas
Trachea
Breathing difficulties are often the first sign of a problem with the trachea, whether the tumor is benign or malignant.

What is tracheal cancer

The trachea, made up of rings of fibrous tissue, is the tube that connects the mouth and nose to the lungs. Tracheal cancer arises when its cells multiply uncontrollably and develop a tumor.

Primary tracheal tumors, which originate in the organ, are uncommon. When they do occur, they are usually malignant in adults and benign in children. They present with symptoms that mimic other conditions, which often leads to a delay in diagnosis and discovery when the tumor is at an advanced stage.

Tumors that have metastasized to the trachea, originating in organs such as the thyroid, esophagus, larynx (voice box) or lung, are called secondary and are more common than primary.

Regardless of where these tumors originate and whether they are benign or malignant, they usually result in a narrowing of the windpipe opening, restricting airflow to the lungs.

Tracheal cancer subtypes

There are three types of carcinomas – malignant tumors – in the trachea:

  • Squamous cell carcinoma – develops more often in men between the ages of 50 and 70 and is usually associated with smoking, accounting for more than half of cases;
  • Cystic adenoid carcinoma – unlike squamous, cystic carcinoma spreads along the lining of the trachea, is usually slow growing, and is not related to smoking. It occurs equally in men and women aged between 40 and 60 years. The incidence of this type of cancer is 10% to 15% of cases;
  • Carcinoid tumor – an abnormal, slow-growing mass that originates in cells of the endocrine (hormonal) or nervous system. These tumors can occur anywhere in the body, including the windpipe.

The benign types of tumors in the trachea are:

  • Chondroma – most common type of tracheal tumor. It is formed from the cartilage that makes up the trachea and can become cancerous after a period;
  • Hemangiomas – Tumors in small blood vessels that can affect children and adults. If a child with a hemangioma birthmark (abnormal accumulation of blood vessels in the skin or internal organs) begins to have breathing problems, a hemangioma tumor could be the cause.
  • Papillomas – These are tumors caused by the human papilloma virus (HPV).

Symptoms and signs of trachea cancer

Breathing difficulties are often the first sign of a problem with the trachea, whether the tumor is benign or malignant. In any case, it is important to remember that breathing difficulties can result from other diseases such as asthma, bronchitis or chronic obstructive pulmonary disease (COPD), and are not necessarily a sign of cancer.

Therefore, in addition to shortness of breath, other symptoms must be associated to suggest a tumor in the trachea. The most important are:

  • Wheezing, shortness of breath and coughing, with or without blood;
  • Noisy breathing, including a wheezing sound;
  • Frequent infections of the upper respiratory tract;
  • Difficulty swallowing and hoarseness (it suggests that a tumor of the trachea is pressing on the esophagus).

Tracheal cancer diagnosis

Tracheal tumors are difficult to diagnose because they are rare and, in most cases, grow slowly. The tumor may also be misdiagnosed as another respiratory problem, such as asthma or COPD.

Tests that should be ordered to confirm a diagnosis of tracheal cancer:

  • Computed tomography – the exam can form images that can define the size of a tumor, the narrowing of the trachea and the state of the surrounding lymph nodes;
  • Bronchoscopy – a test done with a bronchoscope (a tube with a small camera on the end) inserted into the windpipe. This allows the doctor to see any abnormalities in the trachea, as well as remove cells for a biopsy.
  • Virtual bronchoscopy – an “image” of the trachea is taken by a CT scan without the need for a bronchoscope. This exam does not allow the removal of fragments for biopsy;
  • Pulmonary function test – measures how well the lungs work and can find out if there is a loss of breathing capacity that suggests a blockage in the trachea.

Treatment

Surgery is the main treatment for tracheal cancer. Whenever possible, it is followed by other therapies, such as radiation or chemotherapy. Understand commonly adopted procedures.

Surgery – Surgical resection improves the patient’s prognosis, symptoms and quality of life. Five-year survival is 50% for patients treated with surgery, while it is only 10% for patients who are not candidates for surgery. Several factors are considered when deciding on a surgical intervention, such as age, comorbidities, neck mobility, extent of cancer and degree of invasion.

Surgery is not recommended in patients with tumors involving more than 50% of the trachea length, due to a correlation with increased mortality. Other contraindications to surgery include respiratory failure, dependence on oral corticosteroids, invasion of the heart or aorta, distant metastases, and involvement of multiple groups of lymph nodes.

Radiotherapy – Can be used to treat tumors that involve more than 50% of the trachea or have spread to the lymph nodes or other areas of the chest. It should be used in patients who are not good candidates for surgery. In case of an adenoid cystic tumor, radiation therapy may be used after surgery. There are two types of radiation therapy for tracheal tumors:

  • External beam radiation: performed daily as an outpatient, it lasts a few minutes and the patient usually does not feel anything, but side effects such as queasiness may occur; and
  • Brachytherapy: it involves the insertion of radiation “seeds”, which are temporarily implanted near the tumor to kill it. It is done on an outpatient basis using a bronchoscope that passes a tiny catheter through the tumor. The seeds are implanted in this catheter for a few minutes and then the catheter and seeds are removed.

Chemotherapy – The literature lacks randomized clinical trials examining chemotherapy in patients with tracheal cell cancer, and the role of chemotherapy remains unclear. However, cisplatin-based chemotherapy is used in combination with radiotherapy in unresectable disease or after surgery, mainly for the squamous subtype, based on the similarity with head and neck tumors, where this combination is already well established.

Prevention

The most common tracheal tumor – squamous cell carcinoma – is thought to be a direct result of smoking. In other words, quitting smoking is a measure that reduces the likelihood of this type of cancer, and many others associated with the habit.

Another risk factor is hemangioma, which can spread from the face to the neck but is not a controllable risk.

Any of the symptoms associated with cancer of the trachea needs to be investigated early on, increasing the chances of a cure in case of diagnosis for the disease.

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