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The trachea (windpipe) is the tube that connects your mouth and nose to your lungs. It goes on to divide into the two airways (right and left bronchi) which supply air to each lung.
The trachea is in the neck and lies in front of your oesophagus (gullet). It’s about 10–16cm (5–7in) long and is made up of rings of tough, fibrous tissue (cartilage). You can feel these if you touch the front of your neck.
Diagram to show the position of the trachea
Cancer of the trachea is rare and only makes up about 0.1% (1 in 1000) 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 which line different parts of the body such as 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.
We don’t know exactly what causes cancer of the trachea. For most people the cause is unknown. However, smoking is linked with squamous cell cancer of the trachea. This type of tracheal cancer is 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. It seems to affect men and women equally and is more common between the ages of 40 and 60.
The most common symptoms are:
These symptoms are common in many conditions other than cancer. However, it is important to tell your doctor if you have any of these symptoms.
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.
There are some other tests which may be used to help diagnose cancer of the trachea and to find out whether or not the cancer has spread. The results of these tests will help the specialist to decide on the best type of treatment for you.
You may have some of the following tests:
X-rays The doctor may take some x-rays to begin with, even though cancer of the trachea doesn’t usually show up on an x-ray.
CT (computerised tomography) scan This is a sophisticated type of x-ray which builds up a detailed three-dimensional picture of the inside of the body. The scan is painless and takes around 15 minutes. It may be used to identify the exact size of the tumour, or to check for any spread of the cancer. Most people who have a CT scan are given a drink or injection of a fluid that allows particular areas to be seen more clearly. Before you have the injection or drink, it is important to tell the person doing this test if you are allergic to iodine or have asthma.
MRI (magnetic resonance imaging) scan This type of scan uses magnetism instead of x-rays to form a series of cross-sectional pictures of the inside of the body. During the scan, you will be asked to lie very still on a couch inside a metal cylinder. You will usually be given an injection to allow the picture to be seen more clearly. The test can take up to an hour and is completely painless. If you don't like enclosed spaces you may find the machine claustrophobic. The machine is also quite noisy, but you will be given earplugs or headphones to wear.
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. You will be given another medicine which reduces the production of natural fluids in the mouth and throat. This can make your mouth feel dry.
Once you’re comfortable, a local anaesthetic will be sprayed onto 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 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 to 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 stage of a cancer is a term used to describe its size and whether or not it has spread beyond where it started in the body. Once doctors know the stage of the cancer they can decide on the most appropriate treatment for you.
Because it is rare, there is no standard staging system for cancer of the trachea. The TNM system is commonly used to stage cancers. Your doctors may use this to describe the stage of your cancer.
Your doctor or specialist nurse can give you more details about the stage of your cancer.
Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades: grade 1 (low-grade), grade 2 (moderate or intermediate grade) and grade 3 (high-grade).
Low-grade or grade 1 means that the cancer cells look very like the normal cells of the trachea. They are usually slow growing and are less likely to spread. Adenoid cystic cancers of the trachea are usually low-grade.
In high-grade or grade 3 tumours the cells look very abnormal. They usually grow faster and are more likely to spread.
Your 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 are having surgery you will be operated on by a surgeon who specialises in lung and chest surgery.
In early, small cancers an operation may be able to completely remove the tumour. This is specialised surgery| which 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 trachea.
As well as removing the cancer, the surgeon also usually removes some healthy looking tissue surrounding it. 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 to be 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 to do breathing exercises and to cough up any phlegm (sputum) which may be blood-stained. You may cough up some blood for a few days after the operation.
Radiotherapy may be given after surgery to try and reduce the chances of the cancer coming back, or if there were any cancer cells left behind.
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 every day (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.
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| 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|.
The following treatments may be used to relieve symptoms if the tumour is blocking your airway and making it difficult for you to breathe.
Some people may have a combination of these treatments. Your specialist will advise you which treatments are appropriate for you.
Internal radiotherapy (brachytherapy|) may be used to open up the airway and relieve your symptoms.
A thin tube is put inside your trachea using a bronchoscope. A source of radiation is then put inside this tube close to the tumour. It is left in place for a few minutes to deliver the treatment and is then removed. The treatment does not hurt. You usually need only one session of treatment and it can be repeated if needed.
There aren’t usually many side effects. You may find you have a cough and produce more phlegm (sputum) for a while.
Laser treatment relieves symptoms by burning the tumour with a laser light. It’s carried out under a general anaesthetic. You will have a bronchoscopy, and a laser beam is passed down it. The beam is aimed at the tumour and destroys as much of it as possible. There aren’t usually any side effects and you can go home the following day or the same evening.
This treatment can be repeated, if needed. Sometimes radiotherapy is given as well, to try to make the benefits of the treatment last longer.
Cryotherapy uses liquid nitrogen, which is extremely cold, to freeze and destroy cancer cells. It’s carried out under general anaesthetic. Using a bronchoscope, the doctor puts an instrument, called a cryoprobe, close to the tumour. Liquid nitrogen is then circulated through the probe to kill off parts of the tumour. The doctor moves the probe around until enough of the tumour has been removed to improve your symptoms.
There aren’t usually many side effects. You may find you cough up more phlegm for a couple of days after the treatment.
Diathermy is also known as electrocautery. This is done through a bronchoscope. The doctor uses a probe heated by an electrical current to destroy cancer cells and relieve symptoms. There aren’t usually many side effects with this treatment.
Photodynamic therapy (PDT)| uses laser, or other light sources, combined with a light-sensitive drug to destroy cancer cells. The light-sensitive drug is given as a liquid into a vein. After waiting for the drug to be taken up by the cancer cells, the laser light is directed at the tumour using a bronchoscope. This starts the drug working to destroy the cancer cells.
PDT will make you temporarily sensitive to light and you will need to avoid bright light for between a couple of days and a few months, depending upon the photosensitising drug that is used. Your specialist will tell how long you should avoid bright light for. Other side effects include swelling, inflammation, breathlessness and a cough.
PDT is a relatively new treatment and is only available at some centres. It is not suitable for everyone. Your doctor can give you more information about this.
Sometimes an airway can become blocked by pressure on it from the outside, which makes it close. This can sometimes be relieved using a small device, called a stent, which is put inside the airway to hold it open. The most commonly used stent is a small wire frame. It is inserted through a bronchoscope in a folded up position and as it comes out of the end of the bronchoscope it opens up, like an umbrella. This pushes the walls of the narrowed airway open.
Airway stents are usually put in under a general anaesthetic. When you wake up you won’t usually feel it and you will be able to breathe more easily. The stent can stay in your trachea permanently and should not cause any problems.
You will have regular check-ups once your treatment has finished. These will often continue for several years, frequently at first and then less often. If you have any problems or notice any symptoms between visits, let your doctor know.
During your treatment you are likely to experience a number of different emotions|, from shock and disbelief to fear and anger. At times emotions can be overwhelming and hard to control. These feelings are quite natural. It is important to be able to express them.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to friends or family, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope and help is there if you need it. The nurses in our cancer support service can give you information about where to get counselling.
This section has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography|.
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