Bronchial tumors are cancers that start in the cells that line the lungs. These cancers can be benign or malignant. They can cause symptoms such as cough, wheezing, and blood in the sputum.
CT enables the visualization of these tumors and their extraluminal extensions and carina involvement. Usually, they present as a smooth, lobulated and mildly enhanced intraluminal mass adapting to the branching features of the trachea/bronchi.
If cancer cells grow in the lungs, they can block airways and cause symptoms like coughing or wheezing. These symptoms can vary depending on what type of tumor is growing.
Lung cancers that start in the large airways of the lungs (bronchi) are more likely to spread, or metastasize, to other parts of the body than lung cancers that begin in the smaller airways. If a bronchial tumor is diagnosed, doctors will look at the type of cancer and where it is located to decide on treatment options.
Some bronchial tumors are noncancerous and do not grow or spread quickly. These types of tumors include adenomas, neuroendocrine tumors (carcinoids), and other mixed seromucinous tumors. They form in the mucous glands and ducts of the windpipe and large airways. These types of tumors, which are usually very slow-growing, have a better outlook than some other forms of lung cancer.
Other types of bronchial tumors, such as squamous cell carcinoma and large cell carcinoma, may grow or spread more rapidly. They can appear in any part of the lungs and are linked to smoking.
The most common symptom of a bronchial tumor is chest pain or difficulty breathing. If a patient has both of these symptoms, it is important to see a doctor right away. Other symptoms of a bronchial tumor include fatigue or feeling too tired, weight loss, and coughing up blood.
Another symptom that could be a sign of lung cancer is high calcium levels or anemia. This is because cancer cells use the nutrients in the body to grow. Anemia can lead to heart problems, which can be very dangerous. People with high calcium levels can also have bone pain and swelling of the hands and feet.
Sometimes cancers in the lungs can cause other health problems, such as enlarged lymph nodes in the neck and ribcage or a bluish color of the skin and fingers (finger clubbing). These signs and symptoms are also known as neoplastic syndrome.
A lung cancer diagnosis is made by taking a sample of tissue to check for cancer cells. This is called a biopsy. The doctor can get the sample from the suspicious area of the lung with a bronchoscope or by cutting in through the chest wall. They will check the sample under a microscope to see if it is cancer. They will also use chest x-rays to examine the lungs for any abnormalities.
The trachea (windpipe) and bronchi are airways that connect your larynx (voice box) to the lungs. Although tumors developing in the trachea and bronchi are rare, Mount Sinai’s multidisciplinary head and neck oncology team has extensive experience treating these tumors and restoring normal breathing.
Benign tracheal tumors are called masses and grow very slowly, if at all. They are usually 3 centimeters or less in diameter, and appear as a circular growth on chest X-rays that look like coins or popcorn. They may also appear as a ring around the windpipe, a non-palpable mass on the side of your body or a soft, round lesion in the lungs that looks like a coin or a fluffy ball of cotton wool. The most common benign tracheal tumor is a hamartoma, which consists of “normal” tissues (cartilage, connective tissue and fat) in abnormal amounts. Most hamartomas are solid, but about 15% have a cystic appearance. Chest X-rays show them as well-defined spherical or ovoid masses with sharply defined borders and sometimes a slightly lobulated surface.
Malignant tracheal tumors, on the other hand, tend to grow rapidly and are often found in the later stages of life. The most common malignant tracheal tumor is squamous cell carcinoma, which arises from the outer layers of the tracheal epithelium and grows more quickly than the normal lining. It is more commonly seen in smokers and has a peak incidence in people between 50 and 70 years old.
Other malignant tracheal tumors include atypical carcinoids, mucoepidermoid carcinoma and cylindroma tumors. Mucoepidermoid carcinomas develop from glandular epithelium and are slow-growing. Cylindromas are slow-growing, but they have a high risk of local infiltration and recurrence. Both cylindromas and mucoepidermoid carcinomas can be diagnosed by using chromosomal translocation tests that identify the characteristic chromosome t(11;19).
If a tracheal or bronchial tumor is causing symptoms, the evaluation usually starts with a chest X-ray, which may show indirect signs of bronchial obstruction (e.g. segmental atelectasis, tracheal dilatation or distal air trapping). In these cases, chest CT scan or bronchoscopy is used to determine the underlying cause.
A tumor in a bronchial tree may be a noncancerous (benign) or cancerous. Noncancerous neoplasms are called adenomas, while cancerous ones are called carcinomas. Cancers are usually treated with surgery, but occasionally chemotherapy or radiation therapy may be used.
The first step in evaluation is a chest X-ray. Although not diagnostic, it often shows indirect signs of bronchial obstruction such as segmental atelectasis or air trapping that compel further evaluations. Chest CT scan and bronchoscopy are helpful in differentiating between congenital lung abnormalities, external compression of the airways and intraluminal foreign bodies from malignant neoplasms such as endobronchial tumors.
Most bronchial adenomas are benign. However, some are malignant and have a worse prognosis. The most common type of malignant neoplasm is the squamous cell carcinoma. It most commonly affects the trachea and bronchi but can occur in other areas of the lungs as well.
Another common neoplasm is the mucoepidermoid tumor. It is a slow-growing tumor that contains squamous and mucus secreting glandular cells. It is found in the bronchial submucosa and resembles salivary gland tumors. It has a low rate of local invasion and metastasis, a favorable long-term prognosis, and is not associated with smoking. Cytogenetic analysis of mucoepidermoid tumors often reveals the chromosomal translocation t(11;19).
Atypical carcinoid and small cell carcinoma of the bronchi also have poor prognoses. They are usually tumors of the neuroendocrine cells and most commonly develop in the lobar bronchi.
Surgical treatment is focused on complete tumor resection. Pneumonectomies and lobectomies are typically performed for these tumors, but parenchyma-saving procedures such as sleeve resections are becoming increasingly popular.
Radiation therapy is sometimes given after surgery or before a lumpectomy in order to reduce the size of the tumor, decrease the chances of it coming back and to help prevent the formation of new lymph nodes.
Some bronchial tumors can return even after successful treatment. The cancer may return as a new lump, or as more advanced cancer that spreads to other parts of the body, such as the lymph nodes or to other organs such as the lungs or brain. Patients with recurrent tumors are treated with the same or new treatments to try to keep them from spreading.
There’s no way to prevent bronchial tumors, but if you’re at risk, regular lung cancer screening may help your doctor find the disease before it starts. To lower your chances of developing lung cancer, don’t smoke and avoid air pollution whenever possible. Eat a healthy diet rich in fruits and vegetables, especially those that are known to fight cancerous cells. Talk to your doctor about how often you should have a screening test.
Lung cancer is when your cells start growing and making too many copies of themselves when they shouldn’t. These damaged cells form masses of tissue that keep your organs from working normally. Some types of lung cancer start in the lungs (bronchi, bronchioles and small air sacs) or in the windpipe (trachea). Other cancers can grow from other parts of your body and move to your lungs. These are called metastatic cancers. Carcinoid tumors are rare cancers that affect hormone-producing cells. They can start in the lungs and also in the stomach and intestines. Nine out of 10 lung carcinoids are typical, but they can also be atypical or tertiary.
Cancer is uncontrolled cell growth that makes copies of itself when it shouldn’t. The extra cells can form masses (tumors) that keep your organs from working properly.
These tumors are often found on X-rays but don’t always cause symptoms. They can be either benign or malignant. Examples include neuroendocrine tumors (carcinoids), mucoepidermoid carcinomas, and cylindromas.
The glands that line the neck and upper chest, called lymph nodes, often enlarge in response to infection. This is because the body’s immune system makes more white blood cells to help fight the infection and remove it from the body. In most cases, enlarged lymph nodes go back to normal when the infection goes away.
However, in some people, swollen lymph nodes don’t go away. When this happens, the condition may be a sign of cancer. It is important to see a doctor to receive an evaluation and determine the proper treatment based on the underlying cause.
A person who has swollen neck nodes that don’t go away should see a doctor right away. The doctor will ask questions about the symptoms and perform a physical examination. The doctor will also ask about the person’s medical history, including any recent illnesses or injuries. The doctor will also perform a chest x-ray and may order other tests to look for signs of lung cancer.
Neck lumps are most often caused by enlarged lymph nodes. However, they can also be caused by a benign or malignant tumor, such as a fibrosarcoma or adenoid cystic carcinoma. A person who has a neck lump that causes pain, sore throat, difficulty swallowing, or changes in the quality of the voice should visit a doctor immediately.
If a person has a neck lump that is not painful, it is more likely to be caused by an infection. In this case, the doctor will likely prescribe antibiotics and recommend resting the area until the symptoms improve.
It is also possible for a neck lump to be caused by cancer that has spread to the lungs. This is usually seen on an x-ray or CT scan that is done for another reason. The lump is also more common in older adults and people who smoke.
Headaches are the second most common symptom of lung cancer, and may be the first sign of cancer in some people. This is because the cancer may be pressing on nerves that run from the brain to the chest and neck. In rare cases, the tumor may spread to the brain (metastasize) and cause headaches and seizures.
A tumor near the superior vena cava (the large vein that returns blood from the head and arms) can squeeze it and make it harder for the blood to flow, causing a pounding headache. This condition, called superior vena cava syndrome or pancoast tumor, is considered a cancer-related emergency and must be treated immediately. High calcium levels (hypercalcemia) can also give you splitting headaches.
Some people with lung cancer develop a change in the shape of their fingers and toes (clubbed fingers or clubbed toes) due to poor circulation, which causes tissue around the fingertips and toes to become warm and discolored. Bone pain is another symptom of metastatic lung cancer and is caused when the cancer cells invade and interfere with normal bone function and structure.
Breathing is a vital process, bringing oxygen to the cells and flushing carbon dioxide out. Problems with the heart and lungs, such as lung cancer, can make breathing difficult.
A lung cancer tumor can interfere with your breathing in a number of ways: It may grow to block the airway passages, blood clots might form and block blood flow to the lungs, or fluid might build up around the lungs and chest wall making it harder to breathe.
The chemotherapy that you receive to treat your cancer can also cause breathlessness. Generally, this is only temporary and should improve after your treatment ends, but it’s important to tell your healthcare team immediately if this occurs. They can advise you on what to do next and contact your hospital advice line if necessary.
Infection during your cancer treatment can also affect your ability to breathe. Some infections, such as pneumonia, are serious and can lead to life-threatening complications. If you have a fever, contact your doctor immediately and ask to be seen at a walk-in clinic or A&E.
Taking control of your symptoms can help to reduce the effect on your quality of life. For example, try not to overdo things and take regular rest breaks. Eat well and drink plenty of fluids. If you have difficulty breathing, try to avoid crowded rooms or warm temperatures. Breathe clean, cool air and stay away from smoke and pet dander. Exercise regularly, but don’t overdo it.
It’s important to note the time and circumstances when you feel breathless, for example does it happen when climbing stairs or during certain activities? Do you have any other concerning symptoms such as a fast or irregular heartbeat, a feeling of chest pressure, blue skin, lips or nails (cyanosis), confusion or high fever?
Some treatments can prevent shortness of breath. Immunotherapy drugs stop cancer from using proteins that camouflage itself and hide from the body’s defences, while targeted therapy targets specific genes or protein expressions that help cancer cells to grow. Both of these treatments can reduce the tumours that are causing you to feel breathless and help you breathe easier.
A chronic cough that does not go away can be a sign of cancer in the lungs. The cough may be dry or it might produce phlegm, which can sometimes be tinged with blood. This is one of the most common signs of lung cancer, and it is often one of the first symptoms that people notice.
A cough that persists for more than eight weeks is considered to be chronic. A persistent cough can cause other problems, such as shortness of breath, and it may be a sign that the cancer is spreading.
Tracheobronchial tumors are abnormal growths that form in the windpipe (trachea) or in the large airways in the lungs called the bronchi. These tumors can be either benign, which means they are not cancer, or malignant, which means they are cancer.
Most tracheobronchial tumors are malignant. The most common types of malignant tracheobronchial tumors include squamous cell carcinoma, small-cell lung cancer and carcinoid cancer. Benign tracheobronchial tumors, such as adenoid cystic carcinoma and adenocarcinoma of the bronchi, are rare and usually occur in children.
Other symptoms of tracheobronchial tumors can include difficulty breathing, wheezing, weight loss, fatigue and feeling sick or feverish. Hemoptysis, which is the spitting up of blood from the lungs, is also seen in some patients with tracheobronchial tumors.
The diagnosis of tracheobronchial tumors is often delayed because chest radiographs are often unremarkable, and symptoms are nonspecific. CT imaging is the standard diagnostic procedure. CT scanning demonstrates a tracheal or bronchial mass, and it often shows distal bronchial dilatation with mucoid impaction or subsegmental atelectasis.
Other tests that can be done to check for a tracheobronchial tumor include MRI, which uses powerful magnets and radio waves to make pictures of organs and structures inside your body. During an MRI, you might be given a liquid that is dyed with contrast to help your doctor see the area more clearly. You might also have an echocardiogram, which is a special type of ultrasound of your heart. Your doctor might also order a biopsy to get samples of the tissue for further testing.
Cancer starts when cells grow out of control. Sometimes these cells form masses, called tumors. They can grow in the lungs or spread to them from other parts of your body.
Several types of tests can find these tumors. Your provider may do a biopsy to remove a small sample of tissue for testing.
A bronchoscopy (bron-KOS-koep) is a test that allows doctors to see the inside of your airways. During this procedure, a long flexible tube with a magnifying lens and light on the end of it is passed through the nose or mouth into the lung. (See Picture 1). Medicine is given before the procedure to relax you or put you to sleep. You must not eat anything for 6 hours before the procedure. During the bronchoscopy, doctors might take samples of mucus and tissue to send to a lab for testing. They might also use the bronchoscope to place a stent if a tumour is blocking an airway. They might also deliver radiation directly to the bronchial tumor with a device attached to the bronchoscope.
The doctor will numb your nose and throat with spray or gel. This will prevent you from coughing or choking during the test. You will sit or lie on a procedure table while the doctor inserts the bronchoscope into your nose or mouth. The doctor will guide the bronchoscope past your vocal cords and into the lungs with help from X-ray imaging. Other instruments attached to the bronchoscope can be used to remove foreign objects, secretions and abnormal growths. They can also be used to perform other procedures such as placing a stent or delivering radiation therapy.
If a biopsy is done during a bronchoscopy, blood tests might be needed to make sure you do not have a problem with your blood clotting. You may be asked to stop taking certain medications before the procedure, including aspirin and other drugs that affect blood clotting. You might also need to stop taking blood thinners several days before the bronchoscopy, especially if you are having tissue samples taken.
A bronchoscopy is a safe procedure with rare complications. You will need to stay at the hospital for a few hours after it is finished, while the healthcare team watches your heart rate, blood pressure and breathing. You will need someone to drive you home because the sedatives used can affect your ability to operate a car.
Surgery involves cutting through the ribs and other tissues to remove cancerous or non-cancerous tissue. This is also the time to treat other underlying conditions with medications or radiation therapy, as needed. Surgery can be physically challenging and stressful. For this reason, many patients choose to only consider it as a last resort. However, if your doctor recommends surgery, you should be aware of what to expect from the process and understand the risks that come with it.
The goal of surgical treatment is to completely remove the tumor, restoring normal lung function and improving your quality of life. Your care team will perform several tests to check for other medical issues before surgery, which is known as a preop. These may include blood work, chest X-ray, electrocardiogram (ECG), endoscopy, colonoscopy or upper and lower endoscopy, lung function tests, and imaging such as an MRI or CT scan.
A bronchoscope is used to guide the procedure, which can involve a variety of techniques. For example, a laser can be used to shrink or destroy tumor cells. The bronchoscope can also be used to insert small metal tubes, called stents, into a narrowed or constricted airway to help keep it open. Another method is cryosurgery, which uses an electrified knife to freeze and kill the tumor. Lastly, argon plasma coagulation uses a catheter to release and electrify argon gas, changing it from gas to plasma and killing tumor cells.
Rigid bronchoscopy is useful in the management of malignant airway obstruction due to compression or infiltration (CAO). It can be used to provide direct visualization of the tumour, for biopsy or excision, and for placing stents. In addition, it can also be used to deliver radiation directly to the site of a tumour.
Typical carcinoids can be successfully eradicated by an endoscopic approach with curative intent. This is associated with a favorable prognosis (87-100% five year survival). The success of this therapy is related to the neoplasm characteristics (centrally located, totally endobronchial, small base of implant, not infiltrating the submucosal layer), the proper technique of resection and the appropriate follow-up with the delayed endoscopic reevaluation and laser treatment of the implant scar.
Some patients with tracheal or bronchial tumors may need palliative care or radiation therapy in addition to surgery or other bronchoscopic treatments. Memorial Sloan Kettering’s multidisciplinary experts in complex airway diseases can help select the right treatment, or combination of treatments for each patient.
Radiation therapy uses a machine called a linear accelerator to deliver a stream of particles, or photons, that are directed toward the site of the tumor. This machine uses an outer shell, or gantry, that moves around the patient. The gantry and motorized collimators can be adjusted to reach the target area from different angles. A team of radiation therapists, who are specially trained to help ensure that you receive the correct dose of radiation, stays in another room with you during the treatment sessions.
They might use a machine called a simulator to plan the course of your therapy and mark the areas that will receive radiation with marks on the skin. They might also make body molds to help hold you in place while receiving the treatment. Each radiation session lasts 10 to 30 minutes. After putting you in the correct position, the therapists will start the treatment machine. It will make a buzzing sound and move to different positions around your body as it delivers the treatment.
Radiation can cause side effects, including swelling and a temporary drop in blood cell counts (called anemia). To reduce these side effects, your doctor might prescribe medication that works to protect healthy cells from radiation. Your doctor may also give you medicine that makes your heart rate and blood pressure slow down.
Some people with tracheal or bronchial cancers might need a procedure called cryosurgery. This involves putting an extremely cold liquid or gas, known as a cryoprobe, into the airways through a tube called a bronchoscope. It will freeze and destroy the cancer cells in the lung. It might need to be repeated a few times.
Other techniques that can be used to manage a tracheal or bronchial mass include stent placement and brachytherapy. A stent is a small metal or silicone tube placed in a narrowed or constricted airway to keep it open. Another option is brachytherapy, which involves inserting radioactive seeds into the tumor through a catheter threaded into the bronchoscope. This can destroy the tumor and relieve symptoms.
Palliative care focuses on improving quality of life by relieving symptoms and helping patients cope with side effects from medical treatments. It is available to people with any illness, at any stage of the disease and it can be given alongside other treatment options. It can also be given to family members who may feel stress and strain as a result of caring for a loved one. Palliative care teams include doctors, nurses, social workers, chaplains and other specialists. They work together with you and your other providers to add an extra layer of support to your care.
Symptoms that can be managed with palliative care include pain, shortness of breath and fatigue. If your cancer has spread to the area around the heart (the pericardial sac) you may have fluid buildup in this area, which can cause pressure on the heart and interfere with how well it works. Your palliative care team can insert a tube through the skin into the chest area to drain the excess fluid on a regular basis.
If you are experiencing uncontrollable nausea or vomiting as a result of chemotherapy, your palliative care specialist can teach you how to use a pump-like device that delivers medication through the mouth to relieve these symptoms. They can also provide other medications to help with a variety of symptoms, including anxiety and depression.
Many patients with advanced lung cancer experience a lot of physical and emotional stress because of their illness, especially if they are caregivers. A palliative care team can help by arranging for support groups, counseling and other community resources to help you and your loved ones cope with the illness. They can also help you find caregivers to assist with daily activities and caregiving, and they can help you write advance directives such as living wills and health care proxies. They can also discuss your spiritual needs and answer any questions you might have about death and dying. They can even help you complete a do-not-resuscitate order. This is important because you want to make sure your wishes are respected if you should become critically ill and are unable to speak for yourself.
