Trachea (commonly known as the windpipe) extends from the base of the neck up into the chest. It is a semi-elastic tube which has flexible and rigid components, allowing passage of air from the outside to the lungs. Because of the complexity of the surrounding structures and the importance of the trachea, problems associated with this can be life-threatening.
Here at the International Centre for Thoracic Surgery (ICTS), we specialise in the treatment of tracheal tumours and tracheal obstructions.
Tracheal Stenosis is the narrowing of the trachea. This can cause breathing problems and it can come on suddenly or gradually depending on the type of disease inside the trachea.
Sometimes, stenosis happens when a tube that has been inserted in the trachea for a long time gets removed. It could also happen after removal of a tracheostomy (a surgical opening in the neck into the windpipe), and the healing results in scarring.
Tracheal stenosis itself requires treatment because it obstructs the breathing of the patient. And the type of procedure for the stenosis depends on where it is located and the type of pathology.
Tracheal tumours are uncommon and form less than 2% of all tumours. They can be malignant (cancerous) or benign. However, because they obstruct a narrow tube the problems regarding the symptoms are similar.
Primary tumours of the trachea are rare. And secondary tumours (from other places of origin to the trachea) are more common. At our centre, we collaborate closely with other specialities to reduce the risk of complications, relieve symptoms quickly and proceed with further treatment.
The benign tumours of the trachea can be equally debilitating if they end up blocking the track. Thus, tracheal stenosis (narrowing of the windpipe) or tracheobronchial malacia (weakness of the wall of the trachea) can be a common defining factor as to whether the tumour is benign or malignant.
Symptoms of Tracheal Tumours and Tracheal Stenosis are mostly related to the obstructive features:
- Stridor (abnormal, high-pitched, ‘musical’ breathing sound) is among the most common symptoms
- Difficulty in breathing
- Rarely, they can present with compressive symptoms from the outside with nerve palsy leading to hoarseness of voice.
Diagnosis and Investigation
Diagnosis in these cases may be difficult till they become overtly symptomatic. Rarely, they can be diagnosed as an incidental finding if they’re being screened for other conditions.
A flexible and rigid bronchoscopy will be needed to diagnose diseases in the trachea and the bronchus and sometimes to obtain a tissue diagnosis. The bronchoscopy at times can be both diagnostic and therapeutic depending on the presentation of the disease.
To determine the size of the tumour, the lumen of the trachea and the relation to the surrounding structures. The 3D reconstruction is done sometimes find out the extent of the tumour including the luminal narrowing.
To determine the extent of local spread and also extrathoracic spread and further metastatic disease in the body. As a biological scan, it will also give a picture and status of the surrounding lymph nodes.
To give an idea of how well the lungs are working and the pattern of obstruction in the trachea.
The biopsy of the tumour is usually done at the same time the bronchoscope is done at the in the initial outset. This may require a rigid and inflexible bronchoscope with biopsy catheters.
Treatments for Trachael Tumour
The surgical removal of the tumour, whether benign or malignant, is usually the preferred choice. This is because the tracheal tube is responsible for conveying air and if it gets a block, the patient can get into respiratory distress very quickly.
The removal of the tracheal tumour by surgery is a complex procedure because the anatomy and blood supply to the trachea is complex. Here at ICTS, we carry out the surgery of the trachea using advanced techniques. A successful surgery on the trachea will be to remove the tumour completely, maintain its delicate blood supply and manage the complications which come with the surgery.
Your surgeon will explain to you in detail with the use of schematic diagrams and live surgical pictures for you to have a better understanding.
Not all patients with tracheal tumour and disease are eligible for surgery. Many of them
may require palliative therapies which will help them to get back to breathing.
Bronchoscopic treatments are delivered by a bronchoscope with a tiny camera which is inserted through the mouth and then looks at the trachea. There are many kinds of treatment which can be performed by using a bronchoscope and a tracheal scope. At ICTS, many bronchoscopic treatments are available to help our patients.
- Treatment with STENTS: An airway stent is where a tube made of silicone or metal is inserted into the trachea to keep it open. This is done using specialised equipment and techniques and this can be used either before surgery after surgery and also helps in the palliation of the patient. It helps to open up a narrow airway and restores the patients’ respiration. It can be adjuvant to surgery or laser therapy.
This is usually done with the help of a rigid bronchoscope and a set of advanced equipment which comes with it which is available at ICTS.
- Laser Treatment: At ICTS, we use advanced laser therapy to either remove or shrink the tumour. This can be done in the before surgery or sometimes after surgery and it may be followed up with a stent treatment. It can be also used as palliative therapy to help the patient restore his respiration and make is breathing better.
When the patient is not eligible for surgery or after surgery is found to have lymph nodes, then the patient may be offered radiation therapy. Sometimes radiation therapy is used before surgery to shrink the size of the tumour and at times it’s used as adjuvant therapy after surgery to sterilise the area to prevent recurrence of the tumour.
Your surgeon will refer you to a radiation oncologist will explain to you in further detail about how this treatment is delivered.
Chemotherapy is used in combination with radiation therapy or surgery to treat large tracheal tumours. This is usually given alone or in a combination of other drugs which will try to stop or slow the growth of tumour cells. The new class of therapy is called immunotherapy.
Details of this therapy will be discussed with the medical oncologist who will review your case.
Treatments for Tracheal Stenosis
The widening of the trachea done by either a balloon or a set of tracheal dilators. This will allow the stenosis to open up and give temporary relief. During this procedure, a biopsy may be taken to give us the pathology of the disease.
This is usually done with the help of a rigid bronchoscope and specialised equipment where a passage is created through the stenosis with the help of a laser and then a stent is inserted so that the passageway is maintained.
Different kinds of stents can be used depending on the pathology and the need of the patient.
This involves the resection of the stenotic segment. After removal of the
constricted section of the trachea the remaining two parts of the trachea are rejoined to maintain the airway.
Treatment for tracheal stenosis has very good long-term results because they are benign. Sometimes, stenosis can be also caused by diseases such as tuberculosis and the results from this varies depending on the length of the stenosis.