Cancer of the trachea

The trachea or ‘windpipe’ is a long tube which runs from the mouth and nose to the lungs. It resembles an inverted tree trunk with branches which supply air to the lungs.

These branches are known as ‘bronchi’.

It is located in the neck, in front of the oesophagus and is comprised of concentric rings of cartilage. These can be felt if you touch the front of your neck.

Cancer of the trachea is a rare form of cancer which accounts for a very small percentage of cancer cases. This is often known as bronchial cancer.

There are several types of tracheal cancer, for example ‘squamous cell carcinoma’ that develop within cells that line parts of the body such as the airways and throat.

Causes of cancer of the trachea

As with any type of cancer it is difficult to determine the precise causes. There is not a single cause of this type of cancer; rather there are several causes which include:

• Smoking
• Exposure to certain chemicals
• Environmental reasons, e.g. exposure to Radon gas
• Poor diet
• Poor immune system
• Family history

Cancer of the trachea appears to affect middle aged and older people.

Symptoms of cancer of the trachea

The following symptoms can be a sign of another condition which is less serious than cancer. They include:

• Hoarseness
• Breathlessness
• Dry cough
• Coughing up blood
• Repeated chest infections
• Repeated chills and fevers
• Wheezing
• Difficulty in swallowing
• Weight loss
• Fatigue

Consult your GP if you notice some or all of these symptoms.

These may be symptoms of something else such as a throat infection but it is still important to see your GP. Do this if these symptoms have been ongoing for a couple of weeks or more.

Diagnosing cancer of the trachea

Any suspicion of cancer requires further investigation. However, the initial stage starts with a visit to your GP. He or she will discuss your symptoms with you and will ask you about your family history. He/she will also ask about your lifestyle, for example, do you smoke and will also examine you.

If your GP suspects that you may have cancer then he or she will refer you to a specialist. This also includes investigative tests.

Once an appointment has been arranged you will meet with the specialist. He or she will examine you and ask you about your medical history before sending you for blood tests. X-rays will also be carried out.

This is a difficult cancer to diagnose as the symptoms are very similar to those for asthma or bronchitis.

You may undergo some or all of the following tests:

• CT scan
• MRI scan
• Bronchoscopy

(Source: Macmillan Cancer Support: cancer of the trachea)

These tests will help the specialist to determine the type of tracheal cancer you have and the extent. The word ‘extent’refers to the stage of the cancer or in layman’s terms –how far it has spread within the body.

The results of these will help him/her to decide upon a suitable course of treatment for you.

CT scan

A CT scan uses X-rays to obtain a 3D image of the trachea. These X-rays give an accurate image of the trachea and throat in general and enable the specialist to determine the extent of your cancer.

MRI scan

An MRI scan works in a similar way but uses magnetism instead. It also obtains a series of accurate images of your trachea which also includes any tumours. This enables the care team to see how far the cancer has spread.

Bronchoscopy

A bronchoscopy is a form of endoscopy in which a slim, fibre optic tube – with a light and camera mounted at one end – is inserted into your nose or mouth and passed down into your trachea.

The specialist is able to gain a closer look at your trachea to see if there are any growths or similar problems. He/she may take a biopsy at the same time.

Note: a biopsy is the medical name for the procedure in which a sample of cells or tissue is taken from an area of the body for laboratory analysis. This analysis looks for signs of cancer, e.g. cancerous cells.

There are two types of bronchoscopy: rigid and flexible. The flexible version involves the use of a telescopic tube whereas the rigid version is as the name says. It is a stiff type of tube which allows the specialist a clearer view of your trachea.

Waiting for the results

This is a difficult time for many people. You will have to wait for a few days or even a week to obtain your results which can be a stressful and anxious time.

It is natural to fear the worst and assume that a long wait means that you have cancer but this is not the case. The length of time you have to wait for your results is the same whether you have cancer or not.

You may find it helpful to talk to someone during this time. Your partner, a member of your family or a close friend will be able to provide a sympathetic shoulder. Another option is a counselling service or a cancer support group.

There are numerous support groups for various forms of cancer, which consist of people who have been through the same experience as you. People within these groups will have gone through the same emotional stress that you are currently experiencing and can provide advice and support.

Treatment for cancer of the trachea

Once your results have come back the next step is to discuss your treatment. This will be done by a multi-disciplinary team of healthcare professionals which includes a cancer specialist, dietician, cancer nurse (or nurses), surgeons etc. These people are highly trained professionals and experienced in their field who are there to help you.

They will take a variety of factors into account when devising a suitable programme of treatment for you. These factors include:

• Your age
• Your health/fitness
• Your lifestyle
• The extent (or ‘stage’) of your cancer
• The results of the scans, X-rays and blood tests

Everyone is different when it comes to cancer treatment which means that your will be given a treatment plan which is tailored to your needs and requirements.

The most important factor in this is the stage of your cancer.

What do we mean by the word ‘stage?’

Medical experts use the term ‘stage’ to refer to how far a cancer has spread. This is defined as a series of stages from early stage through to advanced stage.

An early stage cancer is easier to treat than cancer at an advanced stage but there is treatment available for all stages of cancer.

The team will devise a treatment plan for you based upon the factors mentioned above which will include some or all of the following:

• Surgery
• Chemotherapy
• Radiotherapy

Surgery

Surgery is performed to remove small and large scale tumours. In some cases the trachea is affected to the extent that a section of it needs to be removed. The remaining sections are joined together which results in a shorter trachea.

You will do breathing exercises with a physiotherapist to adapt to this.

Your lymph nodes may also be affected which will need to be removed at the same time.

This surgery will be followed by a session of radiotherapy to kill off any remaining cancer cells and stop them from returning.

Chemotherapy

Chemotherapy uses a series of drugs to destroy cancer cells. These drugs are extremely powerful and cause a range of side effects which will be explained to your beforehand.

Chemotherapy is effective at destroying these cells and preventing the growth of new cells.

Radiotherapy

Radiotherapy uses high energy X-rays to destroy cancer cells with the aim of minimising any damage to healthy cells. It is used in cases of early stage cancer or after surgery to prevent any re-occurrence of the cancer.

One problem with cancer of the trachea is breathing. If a tumour grows to a large enough size then it can prevent you from breathing as normal. In this situation you will have one or a combination of the following treatments:

• Stent
• Laser treatment
• Photodynamic therapy (PDT)
• Diathermy
• Cryotherapy

Stent

A stent is a small device, such as a tube or wire frame which is inserted into the trachea to aid with breathing. This is done under a general anaesthetic.

Laser treatment

This involves the use of a laser beam to burn away a tumour. A bronchoscope will be inserted into your trachea which allows a laser beam to be passed down it in order to destroy the tumour.

Photodynamic therapy (PDT)

Photodynamic therapy uses a single method or combination of methods to destroy a tumour. This involves a light sensitive drug plus a laser to kill cancer cells. The laser is aimed at the tumour which then allows the light sensitive drug to destroy the cancerous cells.

Diathermy

This procedure uses heat to kill cancer cells. An electrically heated probe kills the cancerous cells which then eases the symptoms.

Cryotherapy

This process uses liquid nitrogen to freeze and then kill cancer cells (think of cryonics). An instrument called a ‘cryoprobe’ is placed near a tumour which emits liquid nitrogen into this to destroy the tumour.

You will continue to have regular follow up appointments with your care team even after these treatments have finished. These appointments will start off at regular intervals but will spread out as time passes.

You will find that you have fewer of these appointments as time goes by. But if you notice anything untoward during this time then see your GP as soon as possible.