Overview: What are tumors of the trachea?
Tumors in the windpipe (trachea) are a real rarity – this applies to both benign and malignant tumors. They are very rare in everyday medical practice. Around 90 percent of all tumors in the trachea are malignant. Squamous cell carcinomas and adenoid cystic carcinomas make up the majority of tracheal cancers. Various types of benign tumors are known – they range from fibromas (the connective tissue proliferates excessively) to hemangiomas (“blood sponges”) and chondromas (they consist of cartilage tissue).
The most common cause of malignant tumors in the trachea is smoking, especially squamous cell carcinoma. Tobacco consumption therefore not only increases the likelihood of lung, laryngeal and esophageal cancer, but also malignant tracheal tumors.
Typical for tumors in the trachea is a long-lasting cough that does not go away. Hoarseness and shortness of breath can also occur if the tumor grows and continues to narrow the windpipe. Doctors usually treat tumors of the trachea by means of surgery. Cancer of the trachea is often followed by radiotherapy to remove any remaining cancer cells.
Tumors of the trachea – frequency and age
Benign tracheal tumors are a rarity. There are no figures on how often they occur. The frequency of malignant tumors in the trachea cannot be precisely quantified either. However, they are also extremely rare. Experts estimate that only around 1 in 1 million people in the population develop tracheal cancer. Lung and esophageal cancer are significantly more common than this type of cancer.
An exact age of onset cannot be determined either. In principle, tracheal tumors can occur at any age. Squamous cell carcinomas in the trachea occur particularly frequently between the sixth and seventh decade of life. Men outnumber women here. Adenoid cystic carcinoma often develops around the age of 50.
Tumors of the trachea: causes and risk factors
The causes of malignant tumors in the trachea are still largely unclear. However, there appear to be some risk factors for malignant tracheal tumors. One of these is smoking. In the case of squamous cell carcinoma in particular, there appears to be a connection with tobacco consumption. The majority of those affected are smokers. In adenoid cystic carcinoma and adenocarcinoma, however, smoking appears to be involved to a lesser extent.
In contrast to lung and throat cancer, smoking plays a lesser role overall in tracheal cancer. In addition, contact with asbestos could be involved in tracheal tumors. However, this connection is not certain because the number of cases is too low.
Malignant tumors of the trachea – three main forms
The cancer usually forms in the upper and lower third of the windpipe. In the middle section, it is found less frequently at ten to 15 percent. Experts distinguish between different types of malignant tumors – depending on the cell type from which the cancer originates:
- Squamous cell carcinoma (approx. 60 percent): It originates from the epithelial cells of the skin and mucous membranes. Squamous cell carcinoma of the trachea is significantly more common in men than in women.
- Adenoid cystic carcinoma (approx. 20 percent): This type of cancer originates in the glandular tissue. Men and women are affected about equally often.
- Adenocarcinoma (approx. 5 percent): The tumor originates from the covering cell layer (epithelium) of the glandular tissue. Men fall ill just as often as women.
Experts also differentiate between other, rarer types of carcinoma in the trachea. And the malignant tumor does not always develop in the trachea from the outset (primary). More often the origin lies in another organ or a neighboring structure (secondary). For example, cancer of the larynx, pharynx, esophagus or thyroid gland can grow into the trachea.
Symptoms: Tumors of the trachea cause coughing
There are several symptoms that may indicate a tumor in the trachea. However, they can also occur in some other diseases. You should always visit your doctor if you notice the following signs:
- Long-lasting cough that does not go away
- Hemoptysis (blood in the sputum)
- Shortness of breath and shortness of breath, especially during physical exertion – it continues to progress
- “Lumpy feeling” in the throat
- Unusual breathing sounds: first wheezing, later whistling and hissing (stridor) as the tumor continues to grow and the airways become increasingly constricted
- Hoarseness (lasting longer than two weeks) if the so-called recurrent laryngeal nerve (vocal cord nerve) is impaired or the tumor has grown into the larynx or vocal cords
Hemoptysis is more common with squamous cell carcinoma in the trachea – which is why WE usually diagnose this form of cancer earlier. In contrast, narrowed airways with shortness of breath and breathing noises occur more frequently with adenoid cystic carcinoma. Sometimes we have been treating patients for bronchial asthma or chronic obstructive pulmonary disease (COPD) for some time. If they do not respond to therapy with bronchodilator medication, a closer look is usually taken. They usually find the adenoid cystic carcinoma later – in 20 to 40 percent of cases only when metastases have already formed.
Tumors of the trachea: Diagnosis with us
The diagnosis of tumors in the trachea always begins with a discussion of your medical history, the anamnesis. For example, we ask you the following questions:
- What symptoms do you have and how long have you had them? (e.g. cough, shortness of breath?)
- How pronounced are your complaints?
- Do you have any known respiratory diseases, such as bronchial asthma, chronic bronchitis or COPD?
- Are there any other known diseases?
- Do you smoke? If yes: Since when and how much?
- Do you come into contact with harmful substances at work or in your everyday life?
- Are you taking any medications? If yes: Which and since when?
We can already draw initial conclusions about the causes of your complaints from your answers. This is usually followed by a physical examination. We palpate the head and neck region and try to detect changes with his hands, for example enlarged lymph nodes. In addition, we usually listen to the lungs with a stethoscope (auscultation) and listen for unusual noises when breathing in and out.
A blood test is also routine, but this does not usually provide any particular indications of a tracheal tumor. For example, there are no tumor markers that would indicate tracheal cancer. The sputum examination, in which laboratory technicians examine the cough sputum, only reveals evidence of a malignant tumor in the trachea in up to 50 percent of cases.
This is followed by imaging procedures that allow us to take a look inside the airways. The most important are:
- X-ray examination of the chest (chest X-ray; only limited informative value))
- Computed tomography (CT): An X-ray examination that provides detailed cross-sectional images of the trachea and airways
- Magnetic resonance imaging (MRI = magnetic resonance imaging): A radiological method that works with strong magnetic fields and takes very precise cross-sectional images of organs and tissue.
- Lung endoscopy (bronchoscopy): We examine the airways with a special instrument, a bronchoscope. This allows us to assess the condition of the trachea and lungs. In addition, tissue samples (biopsies) can be taken at the same time as part of the bronchoscopy. Pathology specialists then examine the tissue under a microscope. This makes it possible to distinguish between benign and malignant cells.
- Laryngo-tracheoscopy: an endoscopic examination of the larynx and trachea
It is always important to rule out other cancers that also affect the neck and chest. Examples include lung, laryngeal, esophageal, pharyngeal or thyroid cancer. The same applies to tumors that develop in the ear, nose and throat area. We must also rule out other respiratory diseases that may be associated with coughing and shortness of breath.
We often diagnose malignant tracheal tumors late, when they are already larger and more advanced. The airways are then often life-threateningly narrowed. Quite a few sufferers are also initially given the wrong diagnosis, for example bronchial asthma – and subsequently do not receive the right treatment. Decreasing physical resilience is sometimes misinterpreted as a reaction to exhaustion.
This is probably also due to the fact that malignant tumors in the trachea are so rare and doctors have little experience with this type of cancer. It is therefore important to raise awareness of the condition among both patients and professionals. In some cases, it is no longer possible to operate on the tumors – which would mean a chance of recovery.
Tumors of the trachea – there is no stage classification
Malignant tumors in the trachea are not classified according to stage – as is usual for other types of cancer. Tracheal carcinomas are not included in either the head and neck tumors or the lung and pleural tumors. Doctors normally use the TNM classification or the UICC stages to make statements about the size, aggressiveness and spread of tumors. This in turn determines the treatment. Tumors in the trachea can only be classified as squamous cell carcinomas, adenoid cystic carcinomas and adenocarcinomas.
Tumors of the trachea: prevention, early detection, prognosis
There are no special measures for the prevention and early detection of malignant tumors in the trachea. The best way to prevent malignant tracheal tumors is not to start smoking in the first place. This also protects you from other types of cancer associated with smoking, such as laryngeal, throat or lung cancer. And: Always go to the doctor promptly if you experience respiratory problems and other complaints.
Course and prognosis of tumors of the trachea
The course and prognosis of malignant tracheal tumors always depend on the tumor type as well as the size, aggressiveness and spread of the tumor. For example, adenoid cystic carcinomas have a better prognosis than squamous cell carcinomas – the survival time after surgery can be up to two decades. And some do not have a relapse (recurrence) within 15 to 20 years. However, in some cases the tumor returns after five to seven years – regular follow-up care is therefore particularly important.
In general, the earlier we detect tracheal cancer, the better the chances of recovery. It can still be cured if the tumor is limited to the trachea and no cancer cells have spread to other organs. We can then remove it during an operation.
However, not everyone succeeds because the diagnosis is often made late. The chances of survival decrease if the tumor has already metastasized to other organs. This correlation basically applies to all types of cancer. This is why it is so important to seek medical help if you have symptoms.
Tumors of the trachea: treatment consists of surgery
The treatment of benign and malignant tumors in the trachea always depends on how large the tumor is and how far it has spread. In the case of malignant tumors, the decisive factor is whether it has metastasized to other organs or is still confined to the trachea. The chances of recovery also depend on this. Because there are so few patients with tracheal cancer and hardly any experience from studies that can be generalized, the right treatment is often tricky for us. Some sufferers benefit from a therapy, while the same treatment is less effective for others.