Physicians at Mount Sinai's ENT/Head and Neck Cancer Center are experienced in selecting the appropriate treatment for patients with malignant tracheal and bronchial tumors.

Treatment may include surgery or bronchoscopic treatments, alone or in combination with radiation therapy. Other treatments, including bronchoscopic treatments and palliative surgery, may help restore breathing and slow tumor progression in patients who are not candidates for surgical removal of the tumor. Chemotherapy, usually in combination with radiation therapy, is a treatment option for patients with large squamous cell tracheal tumors.

Surgery

Surgical removal of the tumor (resection) is the preferred treatment for both malignant and benign tumors confined to less than half of the trachea. In these procedures, your surgeon will remove the tumor and a small margin (extra amount) of healthy tissue surrounding it, then reconnect the ends of the trachea.

Surgical removal of tracheal tumors can be complex. The blood supply to the trachea is delicate and easily damaged. Damage to the blood supply makes it more difficult for the trachea to heal, increasing the risk of complications. Mount Sinai Head and Neck Surgery Center surgeons are specially trained in surgical techniques to preserve the blood supply and reduce the risk of complications, improving the chance of a successful outcome.

Bronchoscopic Treatments

Patients who are not candidates for surgery may benefit from a number of treatments that can be delivered through a bronchoscope — a flexible tube attached to a tiny camera that is inserted through the mouth. This is often performed in conjunction with a rigid bronchoscope. In some cases, bronchoscopic treatments may reduce the size of the tumor so that it can be surgically removed.

The most common bronchoscopic treatments include:

• Laser therapy. Tumor tissue is vaporized with a highly focused beam of light to remove the tumor and open the airway.
• Spray cryotherapy. This treatment involves applying liquid nitrogen to the tumor, freezing it so that the surgeon can remove it. Spray cryotherapy may also be used to stop bleeding in patients who cough up blood or during bronchoscopic tumor removal.
• Brachytherapy. This type of radiation therapy uses a bronchoscope to help guide radiation directly to the tumor site, minimizing damage to nearby healthy tissue. Brachytherapy may be selected when the patient is not eligible for external-beam radiation therapy.
• Photodynamic therapy. A strong light activates a photosensitive chemical that is applied to the tumor, which destroys abnormal tissue while causing minimal damage to surrounding tissue.
• Argon beam coagulation. Similar to laser therapy, this treatment uses electricity and argon gas in combination with other bronchoscopic treatments to kill tumor tissue.
• Rigid coring. This palliative procedure involves inserting a rigid bronchoscope into the trachea and pushing it through the center of the tumor to open up the airway. Rigid coring, which is frequently used in combination with other bronchoscopic treatments, can be highly effective.

Tumors in the major airway can be managed with similar techniques, including surgical resection, airway stent placement, and bronchoscopic treatments.

Radiation therapy

Radiation therapy may be used to:

• Treat patients whose tumor involves more than 50 percent of the trachea
• Treat patients whose tumor has spread to nearby lymph nodes or other areas within the chest
• Treat patients who are in poor general health
• Treat patients with adenoid cystic tumors, who may be treated with radiation therapy alone or after surgery.

External-beam radiation, in which a beam of radiation is delivered from an external source to the tumor site, is the main type of radiation therapy used to treat patients with tracheal tumors. Brachyterhapy — a localized form of radiation therapy — may be used to treat patients who are not candidates for external-beam radiation therapy.