What to Know About Cancers of the Trachea and Larynx

Smoking doesn't just cause lung cancer. It's also a major risk factor for cancers of the trachea, which is the main air passageway (also called the windpipe), and the larynx (the voice box). Laryngeal cancer and tracheal cancer are both considered types of head and neck cancers.

"Of the 55,000 head and neck cancers [diagnosed annually], about one-third are laryngeal cancers," says Dr. Randall Hughes, a head and neck cancer specialist at UT Southwestern Medical Center in Dallas. Laryngeal cancer usually occurs in smokers, although it's not quite as common as lung cancer. In contrast, Hughes says, he's only treated three or four cases of trachea cancer over the last 10 years.

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Cancer of the Larynx

The larynx is the organ in your throat that makes it possible for you to breathe, talk and swallow. Because the larynx is made of cartilage, Hughes says, it's more rigid than, say, the lungs. This means cancers of the trachea are more likely to stay localized and not spread. "[The trachea] is a natural barrier. It keeps the cancer confined longer," Hughes says.

Although smoking is the No. 1 risk factor for laryngeal cancer, people who work in industries in which they are exposed to chemicals that can irritate the airways (like coal mining) are also at increased risk. The other big risk factor is another cancer of the head and neck, says Dr. Rafael O. Toro-Serra, a head and neck surgical oncologist at the Rod Taylor Thoracic Care Center and Head and Neck Cancer Center at Orlando Health UF Health Cancer Center. Patients with one head or neck cancer are at increased risk of a second primary head or neck tumor.

Common symptoms of laryngeal cancers include coughing, voice changes, hoarseness and difficulty swallowing. "It feels like food is getting stuck in your throat," Toro-Serra says.

Like lung cancer, most cases of laryngeal cancers are diagnosed at an advanced stage, especially in smokers. Toro-Serra says former smokers tend to catch it earlier because they're more likely to notice a change in their voice.

Historically, people with laryngeal cancer lost their voice box after surgery to remove the tumor. Today, some patients can avoid surgery -- and thus preserve their voice -- by undergoing chemotherapy and radiation as the first line of treatment. This doesn't compromise survival for about two-thirds of patients, Hughes says. "In the 20 to 25 percent of patients who don't respond [to chemotherapy and radiation], we go back and do salvage surgery to get any residual disease." The standard of care for laryngeal cancer is now to try chemotherapy and radiation first. These therapies can be administered either sequentially or simultaneously.

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When we give chemotherapy simultaneously with radiation, it makes the radiation work better, Hughes says. "Radiation kills the tumor, but not all the way. Chemotherapy prevents sublethal repair [repair of damage to cells that's not severe enough to cause cell death]. We get better response and cure rate [this way]. Seventy percent of patients can keep their voice." The flip side, Hughes says, is that patients pay a price from the side effects of both treatments at once. When patients get treatment sequentially, they receive chemotherapy for two to three cycles, followed by radiation. Or, they receive radiation and low-dose chemotherapy at the same time. The side effects of treatment can be less severe this way.

In advanced cases of laryngeal cancer, Toro-Serra says patients undergo surgery right away to remove their larynx (laryngectomy), followed by radiation therapy. If patients must lose their entire voice box, they breathe through an opening (stoma) in the neck. They can still eat, drink and swallow, Toro-Serra says, and with the help of speech therapy, can learn to speak again.

The prognosis for laryngeal cancer depends on how long ago a patient quit smoking or if he or she is still smoking, Toro-Serra says. In people who quit smoking and who have early-stage disease, the cure rate at five years is about 90 percent. That drops to roughly 30 percent in persistent smokers or in patients who have a large tumor.

Cancer of the Trachea

The good news is that tracheal cancers are very rare, accounting for just .01 to .4 percent of all malignancies, according to the National Cancer Institute. The bad news is that patients are typically not diagnosed when the disease is in the early stage.

Tumors in the trachea are more likely to be lung cancer tumors that have invaded the trachea or bronchi (breathing tubes), rather than primary tumors, Toro-Serra says. About 40 percent of all tracheal squamous cell carcinomas (one of the two main types of primary tracheal cancer) seem to occur before, after or in conjunction with carcinoma of the oropharynx (the middle of the throat), larynx or lung.

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People with tracheal cancers describe a "frog in the throat" sensation. It can be misdiagnosed as asthma, chronic obstructive pulmonary disease or cancers of the thyroid or lungs. Despite having shortness of breath, a patient's lungs can look normal on a chest X-ray, even if he or she has tracheal cancer, so a clear lung X-ray can actually delay diagnosis. In advanced cases, tracheal cancer can cause a serious obstruction of the airway. Smoking and chronic bronchitis (especially in heavy smokers) are risk factors for tracheal cancer.

Tracheal cancers are usually treated surgically when possible and with chemotherapy and radiation if the tumor is advanced or can't be removed surgically.

And, remember: The best way to prevent both of these cancers is not to smoke.

Kathleen Hall is a freelance Health reporter at U.S. News. She's a writer and marketing communications professional who writes consumer health education articles for print and online publications and health care marketing material for corporate clients. Kathleen has a BS in psychology from the University of Maryland and an MBA from Virginia Commonwealth University, and she's a member of the Association of Health Care Journalists. She divides her time between Richmond, Virginia, and Bar Harbor, Maine. Kathleen is also a professional artist. Connect with Kathleen on LinkedIn or her website, or email her at Kathy@MarathonMarketingVA.