Tracheal Tumors
Tracheal tumors constitute 2% of upper airway tumors.
Malignant tumors are as follows:
- Squamous cell carcinoma
- Most common, advanced age, smoking, and male gender are risk factors.
- Progression is fast, may invade a long segment of the trachea, tends to invade surrounding tissues and mediastinum, and may metastasize to cervical and mediastinal lymph nodes.
- Adenoid cystic carcinoma (cylindroma)
- It is the second most common; young age and female gender are risk factors
- It grows slower than squamous cell carcinoma, can reach massive sizes, and compresses surrounding tissues. Still, direct invasion is rare, and metastasis to cervical and mediastinal lymph nodes is not common as in squamous cell carcinoma.
- Carcinoid tumor
- Mucoepidermoid carcinoma
- Adenocarcinoma
- Adenosquamous carcinoma
- Small cell carcinoma
- Chondrosarcoma, rhabdomyosarcoma
Benign tumors: Papilloma, Fibrous histiocytoma, Leiomyoma, Chondroma, Hemangioma
Secondary Tumors: Tumors of organs and tissues surrounding the trachea. They press on the trachea by invading or externally compressing the trachea. 90% of tracheal tumors are squamous cell carcinoma, adenoid cystic carcinoma, mucoepidermoid and carcinoid tumors.
Symptoms of Tracheal Tumors
Cough, wheezing and stridor, dyspnea, hemoptysis, hoarseness, dysphagia, and recurrent pneumonia are the most common symptoms. Since tracheal tumor symptoms are not specific, diagnosis may be inaccurate and cause delays. The patient's complaints may imitate asthma and COPD patients; many patients are followed up with asthma and later diagnosed with tracheal tumors.
When patients complain of recurrent asthma, we should consider tracheal tumors.
Diagnosis of Tracheal Tumors
Radiology
- Chest X-ray
- Lateral Chest X-ray
- Thorax CT (Picture 1)
- Reconstructed Thorax CT
- Virtual Bronchoscopy (Picture 2)
- Thorax MRI: If necessary
Figure 1. Mass appearance in the lumen of the trachea.
Figure 2. Virtual bronchoscopy with Thorax CT
Bronchoscopy
- Flexible Bronchoscopy (FOB)
- Rigid Bronchoscopy
Tracheal Tumor Treatment
In benign tumors, local endoscopic excision is usually sufficient, and sometimes an end-to-end anastomosis is performed with segmental resection of the trachea.
In Malignant Tumors: An end-to-end anastomosis is performed with segmental resection (Picture 3). The trachea can be excised up to 4-6 cm. Even if the neck flexes at 15-35 degrees (Picture 4), it allows us to resect the trachea up to 4 cm. Therefore, after the operation, the neck is usually left in flexion (4-6 days) to protect the anastomosis from injury.
Figure 3. Tracheal anastomosis after cervical incision (Collar incision) and segmental tracheal resection
Figure 4. Segmental Tracheal resection and Neck Flexion
Surgical Technique
- If the tumor is located in the upper part of the trachea, we prefer the anterior collar incision; very rarely, we prefer a vertical partial sternal division.
Complications of the surgery; include bleeding, infection, and anastomosis leakage (end-to-end suturing of the cut in the trachea).
Oncology
Chemotherapy/radiotherapy is necessary for some patients after a pathology examination. Especially in adenoid cystic carcinomas, postoperative radiotherapy is recommended to prevent a recurrence.
Palliative treatments:
- Radiotherapy
- Endobronchial Treatments
- Therapeutic bronchoscopic interventions
- Mechanical dilation with rigid bronchoscopy
- Therapeutic bronchoscopic interventions
- Preferred in tumors that cover 2/3 of the tracheal lumen and occupy a large space in the trachea. After diagnosing the tumor with Flexible Bronchoscopy (FOB) and Rigid bronchoscopy, we remove the tumor with methods such as argon plasma, cautery, laser, brachytherapy, and cryotherapy (freezing treatment). It is a palliative treatment.
- A stent is placed if necessary.
- There may be some complications related to this treatment:
- Perforation of the trachea
- Complaints concerning the general condition (heart, respiratory)
- Intensive care hospitalization