The airway can be affected by primary tracheobronchial tumors, primary tumors that are adjacent to and invade or compress the airway, or cancers that metastasize to the airway.
Primary tracheal tumors are rare, accounting for 0.2% of all respiratory tumors (1). They are often malignant and found at a locally advanced stage. Other tumors (eg, thyroid, lung) can locally invade the airways.
The most common malignant tracheal tumors include:
Adenoid cystic carcinoma
Squamous cell carcinoma
Mucoepidermoid carcinomas
The most common benign airway tumor is a:
Squamous cell papilloma (most often related to human papillomavirus)
Pleomorphic adenomas and granular cell and benign cartilaginous tumors also occur.
General reference
1. Shu C, Liu YJ, Zheng KF, et al. Diagnosis and Treatment of Primary Tracheobronchial Tumors. Cancer Med. 2025;14(9):e70893. doi:10.1002/cam4.70893
Symptoms and Signs of Tracheal Tumors
Patients often present with:
Dyspnea
Cough
Wheezing
Hemoptysis
Stridor
Hemoptysis, while uncommon, more often occurs with a squamous cell carcinoma and can potentially lead to earlier diagnosis, whereas wheezing or stridor occurs more often with the adenoid cystic variant. Dysphagia and hoarseness can also be present initially and usually indicate advanced disease. Symptoms of airway narrowing (eg, stridor, dyspnea, wheezing) can herald life-threatening airway obstruction.
Diagnosis of Tracheal Tumors
Bronchoscopic biopsy
Imaging (chest radiographs, CT)
The diagnosis is based on bronchoscopy combined with radiographic or ,often, CT imaging to assess tumor location, extent, and resectability (1). An airway tumor should be considered a possible cause if symptoms of narrowed airways are unexplained, are of gradual onset, are associated with other symptoms of airway tumors (eg, unexplained hemoptysis), and respond poorly to standard treatments (eg, if aggressive asthma treatments do not relieve wheezing, or antibiotics for apparent pneumonia do not reduce symptoms and improve radiograph findings).
If an airway tumor is suspected, patients require immediate evaluation with fiberoptic bronchoscopy. Bronchoscopy can both treat airway obstruction and allow specimens to be obtained for diagnosis. If cancer is found, more extensive testing is done for staging.
Diagnosis reference
1. Shu C, Liu YJ, Zheng KF, et al. Diagnosis and Treatment of Primary Tracheobronchial Tumors. Cancer Med. 2025;14(9):e70893. doi:10.1002/cam4.70893
Treatment of Tracheal Tumors
Surgery
Sometimes radiation therapy
Obstruction reduction techniques
Surgical resection (wide resection with negative margins) with or without radiotherapy is the preferred treatment option for primary airway tracheal tumors amenable to resection (1). Tracheal, laryngotracheal, or carinal resections are the most common procedures. When a lung or thyroid cancer invades the airway, surgery may sometimes still be feasible if assessment indicates sufficient tissue is available for airway reconstruction. Adjuvant radiation therapy is recommended for unresectable, medically inoperable tumors or if adequate surgical margins cannot be obtained. Chemotherapy has not been found to be effective, and immunotherapy remains investigational.
Most primary tumors of the trachea are not resectable because of local extension, metastasis at the time of diagnosis,, or patient comorbidities. In cases of endoluminal tumors, therapeutic bronchoscopy (rigid is preferred) can mechanically core-out the tumor (2). Techniques to eliminate obstruction include laser vaporization, photodynamic therapy, cryotherapy, and endobronchial brachytherapy. Tumors that compress the trachea are treated with airway stenting, radiation therapy, or both.
Treatment references
1. Shu C, Liu YJ, Zheng KF, et al. Diagnosis and Treatment of Primary Tracheobronchial Tumors. Cancer Med. 2025;14(9):e70893. doi:10.1002/cam4.70893
2. Mahmood K, Frazer-Green L, Gonzalez AV, et al. Management of Central Airway Obstruction: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2025;167(1):283-295. doi:10.1016/j.chest.2024.06.3804
Prognosis for Tracheal Tumors
Prognosis depends on the histology.
Squamous cell carcinomas tend to metastasize to regional lymph nodes and directly invade mediastinal structures, leading to high local and regional recurrence rates. ,The estimated overall median survival is 8 years, which may increase to 15 years with definitive surgical resection (1).
Adenoid cystic carcinomas are typically indolent but tend to metastasize to the lungs and to spread perineurally, leading to high recurrence rates after resection. However, these patients have a 5-year survival of approximately 75% because of the slow tumor growth rate (2).
Prognosis references
1. Mallick S, Benson R, Giridhar P, Rajan Singh A, Rath GK. Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: A systematic review and individual patient data analysis of 733 patients. Lung Cancer. 2019;132:87-93. doi:10.1016/j.lungcan.2019.04.017
2. Lavareze L, Kimura TC, Cacita N, et al. Survival Outcomes in Adenoid Cystic Carcinoma of the Head and Neck: A Systematic Review of 17,497 Cases and Meta-Analysis. Head Neck. 2025;47(5):1541-1553. doi:10.1002/hed.28132
Key Points
Primary tracheal tumors are rare, often malignant, and commonly locally advanced when recognized.
Suspect airway tumors in patients with gradual, unexplained, or intractable dyspnea, cough, wheezing, hemoptysis, and stridor.
Hemoptysis may occur but is uncommon and is typically due to squamous cell carcinoma.
Treat with local resection with or without radiation therapy, or, if resection is not indicated, other locally destructive therapies.
