Tracheal cancer (cancer of the windpipe)

Tracheal cancer (cancer of the windpipe) is rare. The trachea is the tube that connects your mouth and nose to your lungs.

The main types of tracheal cancer are squamous cell (the most common) and adenoid cystic carcinoma.

Symptoms of tracheal cancer include:

  • breathlessness
  • a cough
  • coughing up blood
  • wheezing when you breathe
  • a hoarse voice
  • difficulty swallowing
  • chest infections that keep coming back.

Tests to diagnose tracheal cancer include a CT or MRI scan and a biopsy (taking a sample of cells). Doctors pass a thin, flexible tube (bronchoscope) through your nose or mouth to look at the trachea and take a biopsy.

The main treatments for tracheal cancer are surgery and radiotherapy. Radiotherapy is often given after surgery to reduce the risk of the cancer coming back. It may also be used on its own or with chemotherapy (called chemoradiation) if surgery is not possible. Chemotherapy is also sometimes used.

If the tumour is affecting your breathing, you can have other treatments to shrink the tumour and improve your breathing.

After treatment, you will have regular check-ups and tests or scans.

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, and is the most common type of tracheal cancer
  • adenoid cystic carcinoma starts in glandular tissue and is much less common than squamous cell. 

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


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. 

Diagram showing the position of the trachea
Diagram showing the position of the trachea

View a large version

Read a description of this image


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.


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’s important to have them checked by your doctor.


Diagnosing 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. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

CT-scanner
CT-scanner

View a large version


You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Bronchoscopy and biopsy

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

Before the test, you should not eat or drink anything for a few hours. The nurse or doctor gives you a sedative to help you relax. They also spray a local anaesthetic onto the back of your throat to numb it.

A doctor or nurse then passes a thin, flexible tube (bronchoscope) through your nose or mouth to look down into your trachea. The tube has a tiny light and camera at the end. This shows a picture of the area on a screen. The doctor or nurse can take samples of cells (biopsies) from your trachea using the bronchoscope.

After the bronchoscopy, you should not eat or drink for at least an hour. You can go home as soon as the anaesthetic has worn off. You should not drive for 24 hours after having the anaesthetic, so someone will need to collect you from the hospital. You may have a sore throat for a couple of days.

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. The doctor uses a bronchoscope with an ultrasound probe on the end. They pass it through your nose or mouth and into the trachea to examine areas nearby. They can also take biopsies.

This test takes less than an hour and you can usually go home on the same day.

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 30–60 minutes.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging and grading of tracheal cancer

Staging

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, and they might use the following words to describe the stage of the cancer:

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

Grading

The grade of a cancer gives the doctor an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer:

  • Low-grade means the cancer cells look similar to normal cells.
  • High-grade means the cells look more abnormal.

A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.


How tracheal cancer is treated

The main treatments for tracheal cancer are surgery and radiotherapy. Your treatment depends on the stage of the cancer and your general health. If it is possible, the cancer is removed completely with surgery.

Radiotherapy is often given after surgery to reduce the risk of the cancer coming back. You may also have it on its own or with chemotherapy (called chemoradiation) if surgery is not possible.

Radiotherapy and chemotherapy are also given to relieve symptoms caused by advanced cancer (see staging section above).

If the tumour is blocking the windpipe (trachea) and making it hard to breathe, other treatments can help.

Before treatment

A team of specialists meet to talk about the treatment plan they think is best for your situation. This is called a multidisciplinary team (MDT). 

After this, your doctor and specialist nurse will talk to you about your treatment options. They will explain what the treatment involves, as well as and the benefits and disadvantages of treatment. You can also talk to them about your preferences. If you need to make decisions about treatment, they can help you. You may want to have a relative or friend with you to help you remember the discussion.

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].

Your hospital or GP can offer support and different options to help you to stop. You could also use a stop smoking service.

There are stop smoking services across the UK:


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.

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.

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.

Your radiotherapy team will give you advice about skincare during treatment. It is common to have a skin reaction in the area of your chest and neck being treated. The skin can become sore and red, or darker if you have dark skin. This usually happens about 2 to 3 weeks after treatment starts and can last for 3 to 4 weeks after treatment finishes. Let your radiotherapy team know if your skin becomes sore. They can give you painkillers and advice about caring for your skin.

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.

Radiotherapy can also make you feel very tired. This may continue for several weeks or longer after treatment has finished. Get plenty of rest but balance this with some gentle exercise, such as short walks. This will help give you more energy.

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

360° (VR) radiotherapy for head and neck cancer

Jerry talks us through his experience of going through radiotherapy for head and neck cancer, in 360° video.

About our cancer information videos

360° (VR) radiotherapy for head and neck cancer

Jerry talks us through his experience of going through radiotherapy for head and neck cancer, in 360° video.

About our cancer information videos


Chemotherapy for tracheal cancer

Chemotherapy  use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

It is sometimes given with radiotherapy (called chemoradiation) if the 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.

Side effects of 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.

Chemotherapy can reduce the number of white blood cells in your blood during treatment. This makes you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects, such as:

Tell your doctor or nurse about any side effects you have. They can often give you advice and help to reduce them.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


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. During a rigid bronchoscopy, the doctor passes a thin, straight, firm tube (bronchoscope) down into your trachea (see more detailed information above on having a bronchoscopy). You usually only need a short stay in hospital. Your doctor or nurse will tell you what to expect and explain any possible side effects.

Bronchoscopic surgery

The doctor uses surgical instruments through the bronchoscope to remove the part of the tumour blocking your trachea.

Internal radiotherapy (brachytherapy)

This type of radiotherapy 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)

This treatment uses a laser, or another light source, and a light-sensitive drug to destroy cancer cells. The doctor gives you the drug as an injection into your vein. This makes cells in your body more sensitive to light. The doctor then aims a light through a bronchoscope at the tumour in the trachea. The light makes the drug start working to destroy the 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. 


Clinical trials

Research trials are done to try to find new and better treatments for cancer. Research into treatments for tracheal cancer is ongoing. Because it is rare, there may not always be many suitable trials in progress.

Your doctor may ask you to take part in a clinical trial. They 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.

Remember that you can pull out of the trial at any stage. You have to trust that it won’t compromise your care, although I do understand that concerns people.

Ben


Follow-up after treatment for tracheal cancer

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

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 find they get 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 things over 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. Our cancer support specialists can give you information about counselling in your area.

'Give us a call, we're here to listen.'

Zahida from our support line talks about how giving us a call can help.

More about our support line

'Give us a call, we're here to listen.'

Zahida from our support line talks about how giving us a call can help.

More about our support line

Back to Information and support

Organising

the practical, work and financial side

Coping

with and after cancer treatment

Resources

and publications to order, download and print