Bronchial tumors

Bronchial carcinoid tumors are neuroendocrine tumors that range in severity from low-grade typical carcinoids to more aggressive atypical carcinoids, exhibiting a wide variety of clinical and histologic characteristics. The imaging characteristics of both conventional and atypical bronchial carcinoids are identical. Because the majority of bronchial carcinoids are found in the central airways, radiologic observations are often associated with bronchial obstruction.

Endobronchial nodules, hilar or perihilar masses with a close anatomic connection to the bronchus, are all signs of central bronchial carcinoids. At radiography and computed tomography, the mass is usually a well-defined, round, or oval lesion that is somewhat lobulated (CT). There may also be atelectasis, air trapping, obstructive pneumonitis, and mucoid impaction.

Solitary nodules develop as peripheral bronchial carcinoids. Calcification is prevalent and can be seen on a CT scan. T2-weighted and short-inversion-time inversion recovery magnetic resonance imaging of bronchial carcinoids shows a high signal intensity. Histologic features determine the prognosis of bronchial carcinoids: Certain characteristics of atypical carcinoids indicate that they are more aggressive.

Atypical bronchial carcinoids have a poor prognosis, but typical bronchial carcinoids have a better prognosis. As a result, knowing the histologic, clinical, and radiologic characteristics of bronchial carcinoids aids in correct diagnosis and surgical planning.

Common symptoms of bronchial tumors are cough, fever, expectoration, wheezing, hemoptysis, and chest discomfort. Some patients have symptoms that are similar to asthma. Hemoptysis occurs in at least 50% of patients, indicating that these tumors are extremely vascular. Because about 25% of patients are asymptomatic, bronchial carcinoids are discovered by chance.

In addition to the typical adult triad of cough, hemoptysis, and pneumonitis, the majority of affected children experience wheezing and atelectasis. Patients with ectopic hormone synthesis by the tumor, notably ACTH, may experience symptoms.

Only approximately 2% of bronchial carcinoids show signs of Cushing syndrome. Carcinoid syndrome is uncommon (2%–5% of patients) and is not caused by bronchial carcinoids unless there are liver metastases. Metastases are found in 15% of bronchial carcinoids, and they are most commonly found in the liver, bone, adrenal glands, and brain. Here’s the list:

• Development of a cough
• Changes in an existing chronic cough
• Coughing up blood
• Hoarseness
• Shortness of breath
• Wheezing
• Chest pain
• Frequent lung infections (bronchitis, pneumonia, etc.)
• Unintended weight loss
• Loss of appetite
• Headaches
• Bone pain

Tumors in the trachea and bronchi can obstruct the airway, resulting in breathing difficulties. The majority of tumors that develop in the trachea and bronchi in adults are malignant, although there are a few that are not. The most prevalent type of malignant tracheal tumor is squamous cell carcinoma, which develops in the lower region of the trachea.

The multidisciplinary experts in complex airway illnesses at Memorial Sloan Kettering have extensive experience in determining the best treatment options for individuals with tracheal and bronchial malignancies. Surgery, bronchoscopic therapies supplied through a tube with a tiny camera put through the mouth and into the airways, or radiation therapy, alone or in combination, are all options for treatment.

This therapy may be used to help restore breathing and reduce tumor progression in patients who are not candidates for complete surgical excision of the tumor.

Surgery in bronchial tumors

If you have a cancerous (malignant) or noncancerous (benign) tumor that covers less than half of the trachea, surgical removal is the chosen treatment. Before reuniting the upper and lower portions of the trachea, our surgeons can remove the tumor and a little quantity of healthy tissue surrounding it.

A tracheal tumor might be difficult to remove surgically. The trachea’s blood supply is fragile and readily damaged. Any damage to the blood arteries around the trachea makes the trachea more difficult to recover, thereby increasing surgery risks.

Our surgeons have received particular training in techniques that conserve the blood flow and limit the danger of severe problems, increasing the likelihood of a successful outcome.

Bronchoscopic Treatments

If your tumor is more advanced and surgery is not an option, you may be eligible for various palliative therapies to help you breathe again while also slowing tumor development.

A bronchoscope is a tube attached to a small camera that is placed through the mouth to deliver bronchoscopy therapy. The doctor examines the airways using a bronchoscope and inserts an endotracheal tube.

• Stent Therapy — This technique involves placing a narrow tube made out of metal or silicone—known as a tracheobronchial airway stent—in a narrowed or constricted airway to keep it open.
• Laser Therapy — This treatment involves using a highly focused beam of light to shrink or remove the tumor.
• Argon Beam Coagulation — Similar to laser therapy, this treatment uses electricity and argon gas to kill tumor tissue.
• Brachytherapy — A bronchoscope is used to help deliver radiation therapy directly to the tumor site, destroying tumor cells. Brachytherapy may be recommended when a patient is not eligible for external-beam radiation therapy (described below).
• Rigid Bronchoscopy — This palliative procedure involves inserting a rigid bronchoscope (a straight, hollow tube) into the trachea and removing the tumor tissue inside the airway with the scope.

To ease symptoms and provide the best possible outcome, the above bronchoscopic therapies are frequently used in combination.

Radiation therapy in bronchial tumors

Some patients with trachea or bronchial tumors, as well as those with tumors that have progressed to surrounding lymph nodes or other parts of the chest, may be treated with radiation therapy alone or after surgery.

External-beam radiation is the most common method of radiation therapy for tracheal cancers, where a beam of radiation is administered to the tumor location from an external source. Patients who are not candidates for external-beam radiation therapy may benefit from brachytherapy, a localized kind of radiation therapy.

Chemotherapy in bronchial tumors

Chemotherapy is an injectable medicine or combination of chemicals used to inhibit or delay the growth of malignant cells. Chemotherapy may be used to treat big squamous cell tracheal tumors that cannot be surgically removed, usually in conjunction with radiation therapy.