Trachea

​ -A bronchoscopy can help in evaluating tumors resectability. A rigid bronchoscope or laser resection can be used. 1 Figure 1: Bronchoscopy. 4 -A ct scan is the study of choice to show tumor extent. 1 A CT is used to determine the extent of tracheal tumors, as seen in figure 2. 3
 * Epidemiology: || Primary malignant tumors of the trachea are rare. 1 ||
 * Etiology: || " Apart from squamous papillomas, which have been associated with viral infection, no consistent etiology has been found. Smoking is a known risk factor." 7 ||
 * Signs & Symptoms: || Tumors arising in the trachea most commonly present with hemoptysis (60%), dyspnea (56%), hoarseness (40%) and/or cough (36%). 1 ||
 * Diagnostic Procedures: || -Patients receive a chest xray for nonspecific symptoms.

figure 2: CT showing tracheal tumor. ||
 * Histology: || The most common primary tumors arising in the trachea are squamous cell and adenoid cystic carcinomas, the other malignant types are rare. Malignant lesions can include adenocarcinomas, squamous cell, adenosquamous, adenoid cystic, mucoepidermoid, and neuroendocrine carcinomas. According to the world health organization classification of tracheal tumors, histologic typing includes epithelial tumors, precancerous lesions, soft tissue tumors, tumors of bone and cartilage, lymphomas, and tumor like lesions. 1 ||
 * Lymph Node Drainage: || "The trachea drains to the paratracheal lymph nodes, which may empty directly into the jugular trunk or indirectly via the bronchomediastinal lymph nodes." 6  ||
 * Metastatic Spread: || Approximately one-third of patients have mediastinal spread or pulmonary metastases when first seen. Tumors first involves adjacent lymph nodes and, by direct extension, the mediastinal structures. Metastases to distant organs (lungs, liver, bone) are common. 1  ||
 * Grading: || For tracheal tumors there are three grades. Grade 1 is considered low-grade, grade 2 is moderate or intermediate and grade 3 is considered high grade. For low-grade or grade 1 this means that cancer cells look like the normal cells of the trachea. They are usually slow growing and are less likely to spread. Adenoid cystic cancers of the trachea are usually low-grade. In high-grade or grade 3 tumors the cells look very abnormal. They are usually faster growing and are more likely to spread. 5  ||
 * Staging: || There is no universally accepted staging system for tracheal carcinomas. 1 ||
 * Radiation Side Effects: || Doses of 60 to 70 Gy and higher are said to cause side effects in the tracheal cartilage and esophagus. The majority of patients develop acute odynophagia, cough, and local irritation. "Late effects include softening of the cartilage, tracheitis, and tracheal stenosis." Strictures of the esophagus have been reported. In surgically treated patients, esophageal and mediastinal fistulas, vocal cord paralysis from laryngeal nerve damage, and other postop compliations such as moratlity, pulmonary edema, and infection have been observed. 1 ||
 * Prognosis: || Prognostic factors include histologic type, location (upper vs. lower), and resectability, which is related to the first two factors. Lymph node involvement and positive surgical margins after resection also appear to have prognostic significance. In all reported series, adenoid cystic carcinoma has had improved survival and an indolent progression of disease. 1 ||
 * Treatments: || Surgical resection is the first strategy used for most tracheal primaries. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">2 <span style="color: #0000ff; font-family: Georgia,serif;"> See figure 3 below. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">3 <span style="color: #0000ff; font-family: Georgia,serif;"> 4-6 weeks of healing time should be allowed, then postoperative radiotherapy should begin. 3-D or IMRT treatment techniques should be employed. See treatment planning screen shot and patient immobilization/ field photo figure 4 below. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">3 <span style="color: #0000ff; font-family: Georgia,serif;"> Radiation doses should be limited to 60 Gy. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">2 <span style="color: #0000ff; font-family: Georgia,serif;"> Mediastinal and cervical nodes are included in the field of treatment if found positive by CT or surgery. Elective nodal irradiation is still uncertain for primary tracheal tumors. Patients presenting with emergent airway obstructions should undergo a rigid bronchoscopy instead of urgent external beam radiation therapy. At this time the role of chemotherapy(alone or concurrent) is unknown. In palliative cases, intraluminal brachytherapy can be useful. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">2 <span style="color: #0000ff; font-family: Georgia,serif;">

Figure 3: diagram of tracheal surgery and tracheal scar. <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">3 <span style="color: #0000ff; font-family: Georgia,serif;">Figure 4: Treatment planning and field photo of Trachea .<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 90%; vertical-align: super;">3 ||
 * TD5/5: || <span style="color: #0000ff; font-family: Georgia,serif;">Organ tolerances TD 5/5 cGy

Spinal cord 4500 heart--- 4500 esophagus- 6000 bone marrow- 3000 skin 5500 liver ---2500 lung 4500 || Kim is the <span style="color: #008080; font-family: 'Times New Roman',Times,serif; font-size: 121%;"> teal green <span style="font-family: 'Times New Roman',Times,serif; font-size: 131.76%;">. <span style="font-family: 'Times New Roman',Times,serif; font-size: 119.79%;">Kristy is the <span style="color: #ff00ff; font-family: 'Times New Roman',Times,serif; font-size: 119.79%;">fushia/bright purple <span style="font-family: 'Times New Roman',Times,serif; font-size: 119.79%;">. <span style="font-family: 'Times New Roman',Times,serif; font-size: 121%;">Stacy is the <span style="color: #298000; font-family: 'Comic Sans MS',cursive; font-size: 120%;">darker green <span style="font-family: 'Times New Roman',Times,serif; font-size: 121%;">. Shae is the <span style="color: #ff0000; font-family: 'Times New Roman',Times,serif; font-size: 121%;"> red <span style="font-family: 'Times New Roman',Times,serif; font-size: 121%;">. <span style="font-family: 'Times New Roman',Times,serif; font-size: 110%;"> || <span style="color: #008000; font-family: 'Comic Sans MS',cursive; font-size: 110%;">1. Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 2nd edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2002: 328-330. <span style="color: #0000ff; font-family: Georgia,serif;">2. Halperin EC, Perez CA, Brady LW. //Principles and Practice of Radiation Oncology.// fifth edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2008; 1119-1122. 3. Adenoid Cystic Carcinoma (ACC). available at []. Accessed Jan. 20, 2010. 4. Non-Small Cell Lung Cancer Treatment. (n.d.) Retrieved from National Cancer Institute's website: [] 5. Macmillian Cancer Information. Cancer of the Trachea. Available at: []. Accessed January 24, 2010. 6. Schunke M, Schulte M, Schumacher U, Ross L, Lamperti E, Wesker K. Thieme Atlas of Anatomy: Neck and Internal Organs. New York, NY: Georg Thieme Verlag 2006: 136. 7. Daley, JD. & Rouke, LL. (June 2009). Tracheal Tumors. Retrieved on January 24, 2010, from eMedicine's website: [].
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