Airway Tumors

Airway Tumors

Tumors from the airway could be located from the trachea (windpipe) at the level of the larynx (voice box) to the bronchi and to the lungs.  A primary airway tumor arising from the trachea (primary tracheal tumors) occurs rarely, comprising of only 2% of upper airway tumors and 0.2% of respiratory tract tumors.  These are often malignant tumors.

The most common type of tumor arising from the trachea is the squamous cell carcinoma.  This type is a rapid growing tumor that infiltrates the lining of the airway, causing ulceration and bleeding in the area.  This is usually located in the lower part of the trachea, and is more common in men and smokers.  An adenoid cystic carcinoma tends to be slow-growing tumor.  They tend to cause obstruction in the airway and are found equally among men and women ages 40 to 60 years old.  Carcinoid tumors come from neuroendocrine cells.  These tumors release hormones (eg serotonin) and are found in the bronchi.  Metastatic tumors, or tumors coming from other locations, may also occur. 

Benign tumors may also arise in the airways.  The most common benign tumor found in the trachea among children are papillomas.  These are tumors that look like a cauliflower and are caused by the human papilloma virus (HPV).  Chondromas are composed of firm nodules that come from the cartilage that make up the tracheal rings.  Hemangiomas are an abnormal growth of capillaries or small blood vessels in the trachea. 

Symptoms

Patients with airway tumors typically complain of cough, dyspnea or difficulty of breathing, hemoptysis or coughing up of blood, wheezing, and stridor, which is a high-pitch breath sound occurring as the breath goes in.  This is caused by a blockage in the airways, such as the throat or larynx.  Dysphagia or difficulty swallowing and hoarseness may also occur, and may indicate advanced disease. 

Diagnosis

A CT scan provides an image of the airway, confirming the location and extent of the tumor.  This imaging modality may also be able to help in the management because it would determine which treatment plan would be appropriate for each patient.  Laryngoscopy can also be performed.  This is an endosope where a camera is located on the tip to visualize the upper part of the airway.  An endoscope that examines the trachea and the bronchi is called a bronchoscope.  A tissue sample may be obtained during these procedures to confirm the pathology of the tumor. 

Treatment

The most definitive treatment for airway tumors is surgical resection.  If possible, resection of the trachea, larynx, and carina (bifurcation of the bronchi) are performed.  A margin of the normal tissue is also resected to ensure complete removal of the tumor.  The ends of the trachea are then rejoined.  In some cases, tumors are not respectable because of locally advances disease, metastasis, or the presence of comorbidities making the surgery highly risky for the patient.  In such cases, an alternative would be bronchoscopic treatments where additional procedures could be done to reduce the size of the tumor.  Examples are laser therapy, spray cryotherapy, brachytherapy, photodynamic therapy, rigid coring, and argon beam coagulation.  Radiation therapy can also be done especially in patients whose tumor involves more than 50% of the trachea.  Other candidates are those whose disease has spread to the other areas of the chest or to the lymph nodes. 

Palliative treatment may be given to patients who could not undergo surgery to help restore adequate breathing and in slowing down the progression of the tumor.  A tracheobronchial airway stent involves inserting a tube made of silicone or metal in the trachea to maintain an open airway.

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