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
Cancer of the trachea is rare and only makes up about 0.1% (1 in 1,000) 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 the 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.
CausesBack to top
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.
Signs and symptoms
The most common symptoms are:
- a dry cough
- breathlessness
- hoarse voice
- difficulty in swallowing
- fevers, chills and chest infections (that keep coming back)
- coughing up blood
- wheezing.
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.
How it is diagnosed
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.
You may have some of the following tests to help diagnose your cancer and to find out whether or not the cancer has spread:
X-rays
The doctor may take some x-rays to begin with, although cancer of the trachea may not show up on an x-ray.
CT (computerised tomography) scan
A CT scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10-30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with.
You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to 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 during the scan. It’s also noisy, but you’ll be given earplugs or headphones.
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 result of these tests will help the specialist to decide on the best type of treatment for you.
Staging and grading
Staging
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. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment for you.
TNM staging
The most commonly used staging system is called the TNM system, where:
T refers to the tumour size.
N refers to whether or not lymph nodes are affected.
M refers to whether or not the cancer has spread to other parts of the body (metastases).
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.
The exact details of the T, N and M will depend on the type of cancer.
Number staging system
In addition to TNM staging, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.
Stage 1 describes a cancer at an early stage when it's usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in-between these stages.
The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.
Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
Talking about staging
In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.
However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn't spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body.
Your doctors can give you more information about the stage of your particular cancer
Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how the cancer may behave.
Low-grade means that the cancer cells look like normal cells. High-grade means the cells look abnormal. A low-grade tumour will usually grow more slowly and be less likely to spread than a high-grade tumour.
Treatment
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.
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 cut ends of 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). You may cough up some blood-stained sputum for a few days after the operation.
Radiotherapy may be given after surgery to try to reduce the chances of the cancer coming back, or if there were any cancer cells left behind.
Radiotherapy
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.
Side effects of radiotherapy
Problems with swallowing After 2-3 weeks of treatment, the main problem you are likely to notice is difficulty swallowing. This happens because the radiotherapy can cause inflammation in your gullet (oesophagus). You may also have heartburn and indigestion.
Tell your doctors if you have any of these side effects, as they can give you medicines to help. If you don’t feel like eating or have problems with swallowing, you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and some can be prescribed by your GP.
Tiredness Radiotherapy can make you feel verytired . Try to get as much rest as you can, especially if you have to travel a long way for treatment.
Skin changes Some people develop a skin reaction similar to sunburn. Pale skin may become red and sore or itchy. Darker skin may develop a blue or black tinge. You will be given advice on how to look after your skin.
Hair loss Your hair will fall out within the area of the body where you had radiotherapy, but it usually grows back again after treatment.
Feelings of sickness (nausea) Your doctor can prescribe anti-sickness drugs (anti-emetics), which will help relieve this.
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
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 .
Chemotherapy is rarely used for adenoid cystic cancers of the trachea.
Controlling symptoms
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)
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
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
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
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)
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.
Airway stents
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's 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 shouldn't cause any problems.
Follow-up
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.
Your feelings
During your treatment you are likely to experience a number of different emotions , from shock and disbelief to fear and anger. At times your emotions can be overwhelming and hard to control. These feelings are natural and it's 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.
References
This section has been compiled using information from a number of reliable sources, including:
- Webb et al. Primary Tracheal malignant neoplasms. Journal of the American College of Surgeons . 2006. 202 2, 237-246
- Macchiarini P (2006). Primary tracheal tumours. Lancet Oncology. 2006. 7:83-91
- Myers et al. Cancer of the head and neck . 4th edition. 2003. WB Saunders.
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