Treating a blocked airway

Sometimes people with lung cancer develop a blockage or narrowing of one of the main airways – the left or right bronchus. The narrowing can make it hard to breathe and may be caused by a tumour growing in the windpipe or airway or pressure from a tumour outside the airway. There are several ways of treating breathlessness caused by a blockage. You may have one or more of the following treatments.

Remember that there are many causes of breathlessness. It is not always caused by a blocked airway. Or by cancer. Do check with your doctor if your breathing changes. You may have a chest infection and need a course of antibiotics.

Radiotherapy is often used to treat a blocked airway. You can have external beam radiotherapy (given from outside the body), or internal radiotherapy. Internal radiotherapy for lung cancer is also called brachytherapy or endobronchial radiotherapy. You have internal radiotherapy through a tube put down your windpipe (bronchoscope). There is detailed information about external and internal radiotherapy for lung cancer in this section.

Electrocautery might be used on its own, or with internal radiotherapy. You have electrocautery through a tube put down your windpipe (bronchoscope). After putting the bronchoscopy tube down, your doctor uses a probe heated by an electric current to destroy the tumour tissue blocking your airway. Electrocautery can help the doctor put down the tube needed for internal radiotherapy if your airway is quite blocked.

A laser is a very powerful and hot beam of light. It can be used to burn away a tumour. The laser does not get rid of the tumour completely, but it helps to relieve breathlessness by clearing the airway. You usually have this treatment under strong sedation or a general anaesthetic. Your doctor will do a bronchoscopy and pass the laser down the bronchoscope tube. When it is in the right place, the doctor turns the laser beam on to burn away as much of the tumour as possible. Then, they pull the bronchoscope tube out. If you have had a general anaesthetic they will then bring you round.

There are usually no side effects from laser treatment. So, you may be able to go home that evening. Or you may need to stay in hospital overnight. If the blockage in your lung has caused an infection, you may have to stay in hospital for a couple of days to have antibiotics through a drip.

If the tumour grows back, you can have laser treatment again. Your doctor may also suggest radiotherapy to slow down the growth of the cancer.

If your airway is blocked by a tumour or is being squashed closed by pressure from outside the airway, your doctor may be able to use a stent to hold it open. You can see a stent in place in the diagram.

Some stents are rigid, plastic tubes. The type of stent used most often to keep an airway open is a wire mesh tube that expands outwards in the airway (an expandable stent).

You have this treatment under a general anaesthetic. While you are asleep, the doctor does a bronchoscopy. When the bronchoscope tube is in the right place, the doctor pushes the folded up stent down the tube. As it comes out of the end of the tube, the stent opens up and pushes the walls of the airway open. Your doctor then takes out the bronchoscopy tube and wakes you up from the anaesthetic.

When you come round you will probably not feel the stent. But you will be able to breathe more easily. The stent can stay in your airway permanently.

PDT treatment can reduce the size of a tumour blocking the airway. This makes it easier for you to breathe. You first have an injection of a drug that makes you sensitive to very bright light. The drug collects in the tumour cells. Then, a few days later, you go into hospital. While you are asleep, you have a bronchoscopy. The doctor puts a tube down the bronchoscope that shines a very bright light at the tumour. The light triggers the drug to destroy the cancer cells. The drug makes you sensitive to light for up to 6 weeks. You can have this treatment repeated if you need to.

We have detailed information about photodynamic therapy and the possible side effects in this section.

When the National Institute for Health and Clinical Excellence (NICE) looked at the evidence for PDT for lung cancer, it seemed to give similar relief of symptoms as laser treatment. But patients who had PDT seemed to have more improvement in how well their lungs were working. The effects of PDT also seemed to last longer than the effects of laser. Patients who had PDT also generally lived for longer than those who had laser. But it is very difficult to say that this was due to the treatment. It may be that patients who had PDT had less advanced cancers, or were not as ill as the people having laser treatment.

Radiofrequency treatment (RFA) can reduce the size of a tumour blocking an airway. You can have it along with other types of lung cancer treatment and it can be done more than once. You have RFA under local or general anaesthetic. Your doctor puts a small probe (like a needle) through the skin of your chest and directly into the tumour. The treatment is usually done under CT scan guidance so that the doctor can make sure the probe is in exactly the right place. Radiofrequency energy then passes through the electrode, producing heat which destroys the tumour tissue. You may need to stay in hospital overnight afterwards.

You may have some discomfort or pain at the site of the treatment and your doctor or nurse will prescribe painkillers for you to take for a few days. You may also have a slight temperature and feel a bit weak and tired. You may need to take it easy for the first few days and avoid any strenuous activity. The most common complication is air getting into the chest cavity (a pneumothorax). This is not serious though and usually goes away on its own with no treatment.

We have a page about radiofrequency ablation for lung cancer in this section of CancerHelp UK.

Cryotherapy treatment uses extreme cold to destroy a tumour. It can shrink a tumour blocking an airway and so can relieve breathlessness. It is sometimes called cryosurgery.

You have a general anaesthetic. While you are asleep, you have a bronchoscopy. The doctor puts a probe down the bronchoscope. The probe freezes parts of the tumour and kills it. The doctor moves the probe around until it has killed off enough of the tumour to relieve your blockage. The doctor will take out as much of the tumour tissue as possible. But you may cough up more over a few days after this treatment. You can have cryotherapy repeated if the tumour grows back.

The National Institute for Health and Clinical Excellence(NICE) looked at cryotherapy for advanced lung cancer. They found that it helped to relieve symptoms in over 8 out of 10 people treated, including reducing a cough, difficulty breathing, and coughing up blood. The possible side effects include coughing up blood for a short time afterwards, changes in the heartbeat, great difficulty breathing (respiratory distress) or chest infection. Some studies have reported cases where people died after having cryotherapy for advanced lung cancer but this is rare. A very rare complication is the development of a fistula. An oesophageal fistula is a hole joining the airway and the food pipe (oesophagus).

NICE say that it is important for you to know all the risks before you agree to the treatment, as well as any other treatment options open to you. And NICE have asked doctors to continue to monitor the results of cryotherapy for lung cancer.