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What is tracheal cancer?
Symptoms of tracheal cancer
Causes of tracheal cancer
Diagnosis of tracheal cancer
Staging and grading of tracheal cancer
Treatment for tracheal cancer
Surgery for tracheal cancer
Radiotherapy for tracheal cancer
Chemotherapy for tracheal cancer
Other treatments for tracheal cancer
After tracheal cancer treatment
About our information
How we can help
Tracheal cancer is a rare cancer that starts in the windpipe (trachea).
Types of tracheal cancer
- Squamous cell cancer starts in cells that line different parts of the body, such as the airways. It is the most common type of tracheal cancer. It is more common in people over 60 and usually affects men more than women.
- Adenoid cystic carcinoma starts in glandular tissue. This type of cancer is more slow growing and much less common than squamous cell. It affects men and women equally and is more common in people over 50.
What is the trachea?
The trachea (windpipe) is the tube that connects the mouth and nose to the lungs. It divides into 2 tubes (airways) that go into each lung called the right and left bronchus. As you breathe, air passes through each bronchus into the lungs.The trachea is in front of the gullet (oesophagus) which is the tube that food goes down. The trachea is about 10 to 16cm (5 to 7in) long. It is made up of rings of tough, fibrous tissue (cartilage). These help the trachea to keep its shape and move easily during breathing. The inside wall of the trachea has tiny hairlike structures (cilia). This keeps out tiny pieces of dust, allowing clean air to pass into the lungs.
The most common symptoms of tracheal cancer are:
- a cough
- wheezing or noisy breathing
- a hoarse voice
- coughing up blood
- difficulty swallowing
- fevers, chills and chest infections that keep coming back.
These symptoms can be caused by other conditions, such as asthma or other conditions that affect the airways. But it is important to have any symptoms checked by your doctor.
We do not know exactly what causes tracheal cancer. Squamous cell cancer of the trachea is linked to cigarette smoking. Adenoid cystic carcinoma does not seem to be linked to smoking.
If you have symptoms of tracheal cancer, your GP will refer you to a hospital specialist if they:
- are unsure what the problem is
- think your symptoms may be caused by cancer.
The specialist may be a doctor who is an expert in chest problems (respiratory specialist). Or they may be a doctor who is an ear, nose and throat (ENT) specialist.
At the hospital, the specialist doctor will ask you about your symptoms and general health before examining you. You may have the following tests:
X-rays use high energy rays to take pictures of the inside of the body. Your doctor can use an x-ray of your chest to look at the lungs and windpipe (trachea).
Other tests are usually used to give more detailed information about your trachea.
A CT scan takes a series of x-rays that build up a three-dimensional (3D) picture of the inside of the body.
An MRI scan uses magnetism to build up a detailed picture of areas of the body.
Bronchoscopy and biopsy
A doctor or nurse uses a thin flexible tube (bronchoscopy) to look inside your airways and lungs. During the bronchoscopy they remove a small sample of cells or tissue (biopsy) from any abnormal areas.
Instead of a thin flexible tube (bronchoscope) to examine inside the airways the doctor uses a straight, firm bronchoscope. This helps to keep the trachea still while they examine it and take biopsies.
You usually have a general anaesthetic for this test, and may have to stay in hospital overnight.
If your throat, jaw or neck is sore after the test your doctor can give you painkillers.
Lung function tests
These simple tests measure how well your lungs are working. They are usually done in a hospital outpatient department. You wear a nose clip and breathe through a mouthpiece into a machine.
The doctor or nurse will tell you when and how hard to breathe. You usually sit down while you are having lung function tests. They may take up to 1 hour.
It may take up to 10 days to get the results of your biopsy. Waiting for test results can be a difficult time. We have more information that may help.
Staging of tracheal cancer
Different types of staging systems are used for different cancers. But because tracheal cancer is rare, there is not a standard system for it.
Your doctor can give you more information. They might use the following words to describe the stage of the cancer:
- early or local – the cancer is only in the trachea
- locally advanced – the cancer has spread outside the trachea into tissues nearby
- metastatic or advanced – the cancer has spread to distant organs, such as the lungs, liver or bones.
Grading of tracheal cancer
Tracheal cancer may be graded as the following:
- Low grade – the cancer cells look similar to normal cells and usually grow more slowly.
- High grade – the cells look very different to normal cells. High grade cancers usually grow more quickly and are more likely to spread.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.
Your treatment will depend on:
- the type of tumour
- the stage and grade of the tumour
- your general health.
You may be offered the chance to participate in a clinical trial. Your doctor will discuss it with you so you fully understand what is involved.
The main treatments for treating tracheal cancer are:
- radiotherapy and chemotherapy given together (chemoradiation)
If you smoke, your doctor will usually advise you to stop smoking. Giving up can make treatment more effective, reduce side effects and improve your long-term health.
Surgery is the most effective treatment for tracheal cancer.
If surgery is possible, your surgeon will remove the tumour and a small margin (extra amount) of healthy tissue surrounding it. This will leave a gap in the trachea. The surgeon will then join the trachea back together to close the gap.
This is specialised surgery, so it is only available at some hospitals. You may have to travel to a hospital that has a team of specialist surgeons with experience in this type of surgery.
The thought of having surgery can be worrying. Your surgeon or specialist nurse will explain what to expect and answer any questions before your operation.
We have more information about preparing for surgery.
After surgery for tracheal cancer
You will be looked after in a high dependency unit, or in intensive care, for a few days after the operation. You will have a wound in your neck or chest. To start with, you may have tubes in the wound to drain any extra fluid or blood from the area into a bottle.
You will also have a drip (infusion) giving you fluids until you are able to drink normally. You may have a scan or a bronchoscopy to check that the join in the trachea is healing well.
A physiotherapist will help you do breathing exercises and show you how to cough properly.
You may have a stitch under the chin, or a neck brace. This keeps your head in a position that protects the trachea as it heals.
About a week after the operation, the doctor or nurse will remove the stitches or neck brace. Your trachea will be slightly shorter, so you will need to be careful about moving your head. Your surgeon will give you advice about this.
We have more general information about what happens after surgery.
Radiotherapy uses high energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. If all of the tumour can be removed by surgery, you may not need radiotherapy.
You may have radiotherapy:
- after surgery to reduce the risk of cancer coming back
- as your main treatment if the cancer cannot be removed with surgery, or if you are not well enough to have surgery because of your general health
- with chemotherapy to make treatment work better (chemoradiation). This can cause more severe side effects, so you need to be well enough to cope with it
- to control symptoms if the cancer has spread to other parts of the body (palliative radiotherapy).
You may have treatment in small doses called fractions. You have these over 3 to 7 weeks.
If you are having radiotherapy to control symptoms such as pain, you might only need a few days of treatment, or a single dose.
We have more information about radiotherapy.
Side effects of radiotherapy
Your radiotherapy team will explain what to expect and give you advice on how to manage side effects. Always tell them about your side effects. There are usually things they can do to help.
Sore throat and indigestion
Radiotherapy can make your throat sore and dry, so after 2 to 3 weeks you may have some difficulty swallowing. You may also have heartburn or indigestion. Your doctor can prescribe drugs that will help with these side effects.
Difficulty eating and drinking
Effects on the lungs
Radiotherapy to the windpipe (trachea) can cause inflammation in the lungs. This may make you feel breathless, give you a dry cough or cause chest pain. This can start in the weeks after treatment. Always tell your doctor if you have these symptoms. It usually gets better with time.
Side effects usually disappear a few weeks or months after treatment has finished.
We have more information about the side effects of radiotherapy and coping with them.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given:
- with radiotherapy (called chemoradiation) if tracheal cancer cannot be removed with surgery.
- to help control symptoms if the cancer has spread to other parts of the body (palliative chemotherapy).
Some of the chemotherapy drugs used to treat tracheal cancer are:
You may have a drug on its own or with other chemotherapy drugs. Your nurse will give you the chemotherapy drugs into a vein (intravenously). You can usually have chemotherapy as an outpatient. Some people may have it during a short stay in hospital.
Your cancer doctor or nurse will talk to you about your treatment. They will explain the possible side effects and how they can be managed or controlled.
If the tumour in your windpipe (trachea) is making your breathing difficult, you may need other treatments. These can shrink the tumour and improve your breathing. These treatments are sometimes used before you start your main treatment.
There are different treatments that can be used. Your doctor will explain which treatment is best for your situation. Some of these treatments can be given more than once.
The following treatments are usually done using a rigid bronchoscopy while you are under general anaesthetic.
The doctor uses surgical instruments through the bronchoscope to remove the part of the tumour blocking your trachea.
Internal radiotherapy (brachytherapy)
Internal radiotherapy (brachytherapy) can be used to shrink the tumour in the trachea. The doctor uses a bronchoscope to put a thin tube inside your trachea close to the tumour. A solid radioactive material is then put inside this tube and left in place for a few minutes.
This treatment destroys the tumour inside the trachea with a laser light. The doctor aims a laser light through a bronchoscope at the tumour to remove as much of it as possible.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) uses a laser, or another light source, and a light-sensitive drug to destroy cancer cells.
Cryotherapy uses extreme cold to freeze and destroy cancer cells. The doctor uses a bronchoscope to put a thin tube with a probe on the end close to the tumour. They use the end of the probe to freeze the tumour. They move the probe around until they have removed enough of the tumour to open up your airway.
Diathermy is also called electrocautery. The doctor uses a tube heated by an electrical current to destroy the tumour blocking the trachea.
Sometimes a small device called a stent is put inside the trachea to hold it open if the tumour is causing a blockage. The doctor uses a bronchoscope to put the folded up stent into the trachea. As it comes out of the end of the bronchoscope, the stent opens up and holds the airway open.
You cannot usually feel the stent after it has been put in, and you should be able to breathe more easily. It can stay in your trachea permanently. Some people may need to have another stent if there are more problems with a blockage.
You will have regular follow-up appointments after treatment. These may continue for several years. You may have tests, such as CT scans.
After treatment, some people are cured of tracheal cancer. But for others, the cancer may come back after treatment. If this happens, you may be able to have further treatment.
If you have any problems or notice new symptoms between appointments, let your cancer doctor or nurse know as soon as possible.
You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.
Macmillan is also here to support you. If you would like to talk, you can:
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.
Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.
Below is a sample of the sources used in our tracheal cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
S. Mallick, R. Benson, P. Giridhar et al. Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: A systematic review and individual patient data analysis of 733 patients. Lung Cancer Journal 2019; 132: 87-93 available from https://www.lungcancerjournal.info/article/S0169-5002(19)30404-0/fulltext (accessed Aug 2021)
Madariaga M, Gaissert H. Overview of Malignant Tumors. Annals of Cardiothoracic Surgery 2018; 7(2): 244-254. Available from https://www.annalscts.com/article/view/16457/16668 (accessed Aug 2021)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr David Gilligan, Consultant Clinical Oncologist.
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