Malignant Tracheal Tumors: A Review of Current Diagnostic and Management Strategies

Khalid Sherani; Abhay Vakil; Chetan Dodhia; Alan Fein,

Disclosures

Curr Opin Pulm Med. 2015;21(4):322-326. 

In This Article

Abstract and Introduction

Abstract

Purpose of review This article reviews the current literature for the purpose of developing a practical approach for the diagnosis and management of primary tracheal tumors.

Recent findings Because of nonspecific symptoms, tracheal tumors remain a diagnostic challenge. Currently available management strategies are not being optimally utilized due to lack of physician awareness and knowledge. The use of newer diagnostic modalities has increased diagnostic accuracy resulting in earlier detection in recent years. This review describes currently available diagnostic modalities along with relatively newer ones such as virtual bronchoscopy, anatomic Optical Coherence Tomography, spectroscopic techniques, and endobronchial ultrasonography. We will review and discuss management strategies including surgical options, adjuvant therapies, and interventional pulmonary techniques including their role in palliation.

Summary Early detection along with improved surgical and interventional pulmonology techniques has led to a decline in the death rates from tracheal cancer in recent years. However, further studies are required to define the role of chemotherapeutic agents, combination therapies, and novel techniques such as tracheal transplantation, in the management of primary tracheal tumors. More robust evidence-based studies are needed to provide evidence for clinical practice guidelines for the treatment of primary tracheal tumors.

Introduction

Primary tracheal tumors are rare, accounting for less than one-half to one percent of all malignant tumors with an annual incidence of 0.1/100 000.[1,2] Despite a majority of tracheal tumors being malignant, they represent a small fraction of all lung cancer deaths.[3] Squamous cell carcinoma (SCC) is the most common type, accounting for 50–66% of all tracheal tumor cases followed by adenoid cystic carcinoma (ACC) representing 10–15% of cases.[4]

Failure to establish early diagnosis and consequent delayed therapy may reduce survival of these patients.[5] Symptoms sometimes are mistaken for those of asthma,[6] chronic obstructive pulmonary disease (COPD), or pneumonia, therefore, timely diagnosis remains a major clinical challenge. Approximately, 10% of patients had a diagnostic delay of greater than 6 months from the time they initially presented[1] resulting in diagnosis at an advanced stage of disease sometimes beyond the scope of curative treatment.[7]

Increasing use of diagnostic modalities such as computed tomographic (CT) and bronchoscopic techniques has led to an earlier diagnosis in the recent years. This along with the use of better surgical and interventional pulmonology techniques has led to a decline in the tracheal cancer deaths.[3,8]

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