What is tracheal cancer?

Tracheal cancer is a rare cancer that starts in the windpipe (trachea). There are two main types:

  • squamous cell starts in the cells that line different parts of the body, such as the airways. This is the most common type
  • adenoid cystic carcinoma starts in glandular tissue. It is much less common.

Tracheal cancer is more common in people over the age of 60. It is more common in men than in women.

What is the trachea?

The windpipe (trachea) is the tube that connects the mouth and nose to the lungs. It splits into two tubes (the right and the left bronchus). The right bronchus joins the right lung and the left bronchus joins the left lung. Air passes through the trachea and goes in and out of your lungs as you breathe.

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). You can feel these if you touch the front of your neck.

The Respiratory System

Symptoms of tracheal cancer

The most common symptoms of tracheal cancer are:

  • breathlessness
  • a cough
  • coughing up blood
  • wheezing or noisy breathing
  • a hoarse voice
  • difficulty swallowing
  • fevers, chills and chest infections that keep coming back.

These symptoms can be caused by other conditions, but it is important to have them checked by your doctor.

Causes of tracheal cancer

We do not know exactly what causes tracheal cancer. Squamous cell cancer is linked to cigarette smoking. But adenoid cystic carcinoma of the trachea does not seem to be linked to smoking.

Diagnosis of tracheal cancer

If you have symptoms of tracheal cancer, you usually start by seeing your GP. If they are unsure what the problem is, or think your symptoms could be caused by cancer, they may:

  • arrange a CT scan
  • refer you to a hospital specialist straight away.

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.

They will arrange any tests you need. You may have the following tests to help diagnose tracheal cancer and to find out if it has spread.

  • X-rays

    X-rays are used to take pictures of the inside of your body. You may have an x-ray of your chest to look at your lungs and windpipe (trachea).

  • CT (computerised tomography) scan

    A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.

  • MRI (magnetic resonance imaging) scan

    An MRI test uses magnetism to build up a detailed picture of areas of your body.

  • Bronchoscopy and biopsy

    A bronchoscopy and biopsy is used to examine your trachea. A biopsy means taking a sample of cells.

  • Rigid bronchoscopy

    Instead of a flexible bronchoscope, the doctor may use a straight, firm bronchoscope to keep your trachea still while they examine it and take biopsies. The test takes about 30 minutes. You usually have a general anaesthetic before this test, and you may have to stay in hospital overnight until the anaesthetic wears off. Your doctor can give you painkillers if your throat, jaw or neck is sore after the test.

  • Endoscopic ultrasound

    This is similar to a flexible bronchoscopy, but it uses soundwaves (ultrasound) to build up a picture of the area on a computer screen.

  • Lung function tests

    These simple tests measure how well your lungs are working. You wear a nose clip and breathe through a mouth piece into a machine. The doctor or nurse will tell you when and how hard to breathe. You usually sit down while you’re having lung function tests. They can take up to an hour.

Staging and grading of tracheal cancer

The stage of a cancer describes its size and whether it has spread. Knowing the stage helps doctors decide on the best treatment for you.

Different types of staging systems are used for different cancers. But because it is rare, there isn’t a standard system for tracheal cancer.

Your doctor can give you more information. They might use the following words to describe the stage of the cancer:

  • Early or local – this is a cancer that is only in the trachea.
  • Locally advanced – this is cancer that spread into nearby areas of the body.
  • Metastatic or advanced – this is a cancer that spread to distant organs, such as the lungs, liver or bones.

Treatment overview for tracheal cancer

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 stage of the cancer the 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. You can decide not to take part in a trial or to withdraw from a trial at any stage. You will still receive the best standard treatment available.

The main treatments for tracheal cancer are:

  • surgery
  • radiotherapy
  • chemotherapy

Radiotherapy and chemotherapy may also be given to relieve some symptoms caused by advanced cancer.

Stopping smoking

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 for tracheal cancer

If the cancer is at an early stage and is only in the windpipe (trachea) the surgeon may be able to remove it completely. They remove the section of trachea where the cancer is and then join the two ends together. 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 any type of surgery can be frightening. Your surgeon or specialist nurse will explain what to expect and answer any questions before your operation.

After the operation

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 will have tubes in your 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.

A physiotherapist will help you do breathing exercises and show you how to cough properly.

You may have a stitch under your 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 removes the stitches or neck brace. Your trachea will be slightly shorter, so you still need to be careful about moving your head for a while. Your surgeon will give you advice about this.

Radiotherapy for tracheal cancer

Radiotherapy uses high-energy x-rays to destroy cancer cells, while doing as little harm as possible to normal cells nearby.

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
  • 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 have radiotherapy in short, daily sessions called fractions over 3 to 7 weeks. It is given using a radiotherapy machine (similar to a large x-ray machine) which directs the radiation beams at the affected area.

If you are having radiotherapy to control symptoms such as pain, you might only need a few days of treatment, or a single dose.

Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

We have more information about radiotherapy.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually disappear over a few weeks or months after treatment finishes. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can help.

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.

If you find it hard to eat and drink, it is important to let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. You can buy some of these at a chemist or supermarket. But your doctor, nurse or dietitian can also prescribe them for you.

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 and usually improves with time.

There are other side effects of radiotherapy that are important to be aware of.

We have more information about the side effects of radiotherapy and coping with them.

Chemotherapy for tracheal cancer

Chemotherapy is sometimes given with radiotherapy (called chemoradiation) if tracheal cancer cannot be removed with surgery.

If the cancer has spread to other parts of the body you may be given chemotherapy to help control the symptoms of cancer.

It is less common for adenoid cystic carcinoma of the windpipe (trachea) to spread. It usually grows very slowly. Even when it has spread, treatment can often control it for many years.

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.

We have more information about having chemotherapy.

You may have side effects during chemotherapy. The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain any treatment you are offered and what to expect.

Other treatments for tracheal cancer

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.

  • Bronchoscopic surgery

    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.

  • Laser treatment

    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

    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

    Diathermy is also called electrocautery. The doctor uses a tube heated by an electrical current to destroy the tumour blocking the trachea.

  • Airway stents

    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.

After tracheal cancer treatment

You will have regular check-ups once your treatment has finished. These may continue for several years.

These appointments are a good chance for you to talk to your doctor or nurse about any concerns you have. But if you have any problems or notice any new symptoms between appointments, contact your doctor or specialist nurse for advice.

Many people feel anxious before their appointments. This is natural. It can help to get support from family, friends or a support group or organisation. You can also talk with one of our cancer support specialists on 0808 808 00 00.

Your feelings

You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, 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, but help is there if you need it.

How we can help

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