Trachea

Picture2 Tumor first involves adjacent lymph nodes 1 || Image courtesy of: Nocolaou N. Prevention and Management of Radiation Toxicity. In: Pazdur R, Coia LR, Hoskins WJ, Wagman LD, eds. Cancer Management: A Multidisciplinary approach [e-book]. 10th ed. CMPMedica; 2007. Available from: CancerNetwork. Accessed June 4, 2012. ||
 * **Epidemiolgy:** || Primary malignant tumors of the trachea are rare. 1 ||
 * **Etiology:** || No consistent etiology has been found for lesions in the tracheal region other than squamous cell cancers link to smoking, and this type of cancer is more prevalent in men over 60. 7 ||
 * **Signs & Symptoms:** || Most common symptoms include hoarseness, cough, dyspenea, and hemoptysis. Vocal cord palsy and recurrent pneumonia may present although not as often. 1 ||
 * **Diagnostic Procedures:** || * Normal Chest X-ray 1
 * Bronchoscopy to determine respectability and relieve possible obstruction 1
 * CT of chest to determine extent of tumor 1 ||
 * **Histology:** || * WHO defines histological typing to include: 1
 * Adenocarcinoma
 * Squamous cell carcinoma
 * Adenosquamous carcinoma
 * Adenoid cystic carcinoma
 * Mucoepidermoid carcinoma
 * Neroendocrine carcinoma
 * **Most common primary carcinoma of the trachea is squamous cell and adenoid cystic carcinomas** ||
 * Lymph node drainage: || [[image:uwlmedicaldosimetry2012/DSCN0927.JPG width="560" height="420"]]
 * Metastatic spread: || * 33% of patients have mediastinal spread or pulmonary metastases when diagnosed
 * Tumors first involves adjacent lymph nodes and mediastinal structures
 * Metastasiss to the liver, lungs and bone are common
 * Adenoid cystic carcinomas are diagnosed with mets in 40-50% of the time
 * Squamous cell carcinoma is more aggressive and local extension by paratracheal lymph nodes and mets are frequent at diagnosis. 6 ||
 * Grading: || There are three grades for tracheal tumors. Grade 1 is considered low-grade, grade 2 is moderate or intermediate and grade 3 is considered high grade. For low-grade cancer cells look like the normal cells of the trachea. They are usually slow growing and are less likely to spread. Example of grade 1 cancer is adenoid cystic carcinoma of the trachea. In high-grade or grade 3 tumors the cells look very abnormal. They are usually faster growing and are more likely to spread. 7 ||
 * Staging: || No staging system exists for primary tracheal tumors. 6 ||
 * Radiation side effects: || Doses of higher than 60 Gy could result in tracheoesophogeal fistula, esophageal stricture, and sever tracheal crusting. 3 ||
 * Prognosis: || ** Prognostic Factors ** 4
 * Histology is the primary prognastic factor
 * Adenoid cystic carcinomas and lymphomas have better prognoses than other histological variants
 * Distant metastases and acute-respiratory comprise are poor outcome predictors
 * Size and location of tumor is also important ||
 * Treatments: || The primary method of treating tracheal cancers is with surgical resection, possibly with adjuvant radiotherapy. Disease-specific and overall survival rates are shown to be higher in patients recieving surgical resection with adjuvant radiotherapy compared with those undergoing primary radiotherapy with or without chemotherapy. 5 The utility of primary chemoradiotherapy is uncertain. 3 ||
 * TD 5/5: || When treating tracheal cancers, it is important to monitor dose to nearby critical structures such as the lungs, heart, esophagus, and spinal cord. Dose constraints should be similar to those used in treatments for lung cancer. 5
 * References:** || # Chao KC, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA; Lippincott Williams & Wilkins. 2011: 347-349.
 * 1) Washington CM. Principles and Practice of Radiation Therapy. 3rd ed. St. Louis, Missouri; Mosby Inc: 402
 * 2) Chow DC, Komaki R, Libshitz HI, et al. Treatment of primary neoplasms of the trachea. The role of radiation therapy. //Cancer// 1993; 71(10): 2946-2952.
 * 3) Perez CA, Brady LA, Halpern EC, Schmidt-Ullrich RK. Principles and Practice of Radiation Oncology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2004.
 * 4) Hoppe RT, Phillips TL, Mack III M. Leibel and Phillips Textbook of Radiation Oncology. 3rd ed. Philadelphia Pa: Elsevier Saunders; 2010.
 * 5) Chao KC, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd ed. Philadelphia, PA; Lippincott Williams & Wilkins. 2011:329-331.
 * 6) Macmillian Cancer Information. Cancer of the Trachea. Available at: [|http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Tracheawindpipe/Trachealcancer.aspx#DynamicJumpMenuManager_6_Anchor_7] . Accessed June 5, 2012. ||

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