Squamous Cell Carcinoma of the Trachea

An examination of the literature dealing with carcinoma of the trachea discloses that this condition is frequently not diagnosed during life and that the trachea is rarely the site of a primary carcinoma. Bilz (1), tabulated the results of 700 postmortem examinations in the Pathological Institute of the University of Jena of patients with carcinoma, but did not find a carcinoma of the trachea. Fraenkel (2) discovered seven in 5,063 examinations made at the Pathological Institute of the University of Hamburg. Broman (3) in 1924 collected 57 reports of carcinoma of the trachea and added a detailed description of one found by H. G. Wells among 545 malignant growths examined at the Cook County Hospital and University of Chicago. Many of these reports are rather incomplete because they were based upon tissues removed surgically, and only about three-fourths of the papers listed in Broman9s account include a complete statement of the symptoms, physical findings, and results of a postmortem examination. Carcinomas of the trachea are found almost twice as frequently in men as in women and most of them occur within the age limits of 30 to 70 years. Usually the tumor arises in the lower third of the membranous portion of the trachea just above the bifurcation, but it sometimes begins in the upper third. Carcinomas in the middle third and cartilaginous portion of the trachea are uncommon. The tumors are well localized, and very rarely encircle the lumen, and do not extend widely into the lining of the trachea. The projection of the growth into the lumen sometimes results in considerable obstruction. In most patients treated surgically for carcinoma of the trachea metastases were not noted at the time of operation and many of the postmortem reports state that metastases were not found. When metastases occur they are usually in the peritracheal, cervical, and tracheobronchial lymph nodes. The tissues in which they are less often found are, in the order of frequency, the lungs, liver, supra-clavicular and axillary lymph nodes, and the esophagus. They are also known to occur in the spleen, pancreas, kidney, and skeleton. Because of their location in the membranous portion of the trachea, the carcinomas occasionally grow posteriorly and bulge into the esophagus. The lining of the esophagus, however, is rarely ulcerated. Tumor metastases occur in the large lymph channels which drain the trachea. Here they may injure the recurrent laryngeal nerves which lie close by and cause paralysis of the vocal cords.