Expert Care for Bronchial Tumour

A bronchial tumour is an abnormal growth that develops in or near the bronchi—the airways that carry air from the windpipe into the lungs. These tumours may narrow or block an airway, leading to coughing, wheezing, breathing difficulty or repeated chest infections.

Bronchial tumours may be:

• Benign: Non-cancerous growths that do not spread but may still obstruct an airway.
• Malignant: Cancerous tumours that can invade nearby tissue or spread elsewhere.
• Primary: Begin in the bronchus or lung.
• Secondary: Spread to the bronchial region from another cancer.

“Bronchial tumour” is a broad description rather than one specific diagnosis. A biopsy is generally required to determine the tumour type.

At AIROC Hospitals, Kondapur, Hyderabad, patients with suspected or confirmed bronchial tumours receive coordinated evaluation and personalised treatment planning through a multidisciplinary cancer-care team.

Overview and Types

Non-Small Cell Lung Cancer

Non-small cell lung cancer, or NSCLC, is the most common category of lung cancer. It frequently develops from cells lining the bronchi or other parts of the lung.

Major subtypes include:

• Adenocarcinoma
• Squamous-cell carcinoma
• Large-cell carcinoma
• Other less-common subtypes

Small Cell Lung Cancer

Small cell lung cancer usually begins near the central airways. It generally grows and spreads more rapidly than NSCLC and is commonly treated with chemotherapy and radiation therapy.

Bronchial Carcinoid Tumour

Bronchial carcinoids are neuroendocrine tumours that often develop in the larger bronchial tubes. They are classified as:

• Typical carcinoid: Usually grows slowly and is less likely to spread.
• Atypical carcinoid: May grow faster and has a greater possibility of spreading.

Although many bronchial carcinoids behave less aggressively than common lung cancers, they are not always benign.

Salivary-Gland-Type Bronchial Tumours

Rare tumours can develop from glandular cells in the bronchial wall. These include:

• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Epithelial-myoepithelial carcinoma

Benign Bronchial Tumours

Non-cancerous airway growths may include:

• Hamartoma
• Papilloma
• Lipoma
• Leiomyoma
• Inflammatory myofibroblastic tumour

Even a benign tumour may require treatment if it blocks airflow, causes bleeding or leads to recurrent infections.

Symptoms and Causes

Small bronchial tumours may initially cause no symptoms. Symptoms become more noticeable when the tumour irritates, narrows or obstructs an airway.

Possible symptoms include:

• Persistent or worsening cough
• Coughing up blood
• Wheezing, particularly on one side
• Shortness of breath
• Chest discomfort or pain
• Repeated pneumonia in the same part of the lung
• Fever associated with recurrent infection
• Hoarseness
• Persistent tiredness
• Reduced appetite
• Unexplained weight loss
• Facial flushing, diarrhoea or rapid heartbeat in rare hormone-producing carcinoid tumours

Central lung neuroendocrine tumours can cause cough, wheezing, breathlessness, chest pain and recurrent pneumonia by partially or completely blocking an airway.

These symptoms can also occur with asthma, tuberculosis, bronchitis and other non-cancerous conditions. Persistent symptoms require medical evaluation.

What Causes a Bronchial Tumour?

A tumour develops when genetic changes cause cells within the bronchial lining or nearby tissues to grow abnormally. The exact cause depends on the tumour type and is sometimes unknown.

Bronchial tumours:

• Are not contagious
• Are not always related to smoking
• Cannot be diagnosed from symptoms alone
• May develop without an identifiable risk factor

Smoking is strongly associated with many bronchial and lung cancers, particularly squamous-cell carcinoma and small cell lung cancer. However, bronchial carcinoids and certain rare airway tumours may occur in people who have never smoked.

Diagnosis and Treatment

Diagnostic Evaluation

The evaluation of a suspected bronchial tumour may include:

• Medical-history and smoking-exposure assessment
• Physical and respiratory examination
• Chest X-ray
• Contrast-enhanced CT scan of the chest
• PET-CT when clinically appropriate
• MRI for selected cases
• Pulmonary-function tests
• Bronchoscopy
• Endobronchial ultrasound
• Bronchial washing, brushing or biopsy
• CT-guided biopsy when appropriate
• Histopathology and immunohistochemistry
• Molecular and biomarker testing
• Assessment of lymph nodes and possible distant spread

Bronchoscopy and Biopsy

During bronchoscopy, a thin flexible or rigid instrument is passed through the nose or mouth into the airways. This allows the specialist to:

• Examine the bronchial passages
• Identify an obstructing lesion
• Collect tissue samples
• Control selected areas of bleeding
• Perform certain airway-relieving procedures

A biopsy establishes whether the tumour is benign or malignant and identifies its exact cell type.

Treatment Options

Treatment depends on:

• Tumour type and grade
• Size and bronchial location
• Cancer stage
• Lymph-node involvement
• Molecular and biomarker findings
• Lung function
• Age and overall health
• Whether complete surgical removal is possible

Surgery

Surgery may be recommended for an operable localised tumour.

Procedures can include:

• Bronchoscopic removal for carefully selected lesions
• Sleeve resection of the affected bronchial segment
• Wedge resection
• Segmentectomy
• Lobectomy
• Bilobectomy
• Pneumonectomy in selected extensive cases

For central tumours, bronchial sleeve surgery may sometimes remove the tumour while preserving more healthy lung tissue.

Bronchoscopic Treatment

Selected tumours causing airway obstruction may be managed using:

• Laser treatment
• Electrocautery
• Argon plasma coagulation
• Cryotherapy
• Mechanical tumour removal
• Airway stent placement
• Endobronchial radiation in selected cases

These procedures may be used as definitive treatment for carefully selected lesions or to improve breathing and relieve obstruction.

Radiation Therapy

Radiation therapy may be used when:

• Surgery is not suitable
• Cancer remains after surgery
• The tumour involves nearby structures
• Chemoradiation is recommended
• Cancer has spread
• Airway obstruction, pain or bleeding requires relief

Chemotherapy

Chemotherapy may be used before or after surgery or as the principal treatment for locally advanced or metastatic disease. It is an important component of treatment for small cell lung cancer.

Targeted Therapy

For selected non-small cell lung cancers, molecular testing may identify changes involving genes such as EGFR, ALK, ROS1, BRAF, MET, RET, NTRK, KRAS or HER2. An appropriate targeted medicine may then be considered.

Immunotherapy

Immunotherapy may help the immune system recognise and attack cancer cells. Eligibility depends on the cancer type, stage, biomarker results, previous treatment and general health.

Surgery, chemotherapy, radiation, targeted therapy and immunotherapy may be used individually or in combination for NSCLC.

Treatment for Bronchial Carcinoid Tumours

Surgery is generally the main treatment for a localised bronchial carcinoid when complete removal is possible. Advanced or unresectable neuroendocrine tumours may require specialised systemic treatment, symptom-control medicines or other tumour-directed therapies based on their type and stage.

Supportive Care

Supportive treatment may include:

• Management of breathlessness
• Treatment of chest infections
• Cough and pain control
• Oxygen support when required
• Pulmonary rehabilitation
• Nutritional counselling
• Smoking-cessation assistance
• Psychological support
• Palliative care

Prevention and Risk Factors

Not every bronchial tumour can be prevented. Risk factors vary significantly between common lung cancers, carcinoid tumours and rare benign or malignant airway growths.

Possible risk factors include:

• Cigarette, bidi, cigar or pipe smoking
• Exposure to second-hand smoke
• Radon exposure
• Occupational contact with asbestos, arsenic, chromium, nickel, diesel exhaust or other carcinogens
• Long-term air-pollution exposure
• Previous radiation therapy involving the chest
• Personal history of lung cancer
• Family history or inherited susceptibility
• Increasing age
• Certain genetic syndromes, including MEN1 in relation to some neuroendocrine tumours
• Chronic lung disease in relation to certain lung cancers

Having a risk factor does not mean that a person will develop a bronchial tumour. Some patients, particularly those with carcinoid or rare airway tumours, have no recognised risk factor.

Risk-Reduction Measures

Helpful measures include:

• Do not smoke or use tobacco
• Seek professional support to stop smoking
• Avoid second-hand smoke
• Follow workplace respiratory-safety standards
• Test for and reduce radon where relevant
• Limit unnecessary exposure to known carcinogens
• Attend follow-up after previous chest radiation or lung cancer
• Discuss lung-cancer screening when eligible
• Seek evaluation for a persistent cough, coughing up blood or recurrent pneumonia

Low-dose CT screening may be recommended for certain adults at high risk because of their age and smoking history. It is not a general screening test for every type of bronchial tumour.