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During the period 1967-1985, 95 primary tracheal carcinomas occurred in Finland. The mean annual incidence rate was one per one million inhabitants, the male:female ratio being 7:3. There was a significant increase of the disease by increasing age with the exception of 70-79 years. The most common location was the lower third of the trachea. Over two-thirds of the tumours were squamous carcinomas. Smoking seems to be an important risk factor at least in males.

Five cases of primary carcinoma of the trachea are summarized together with a review of 97 cases recorded at the Birmingham Cancer Registry between 1957 and 1974. Squamous cell carcinoma is the most frequent type (46.4%) followed by anaplastic and oat cell carcinoma (18.5%). The annual incidence rate is 0.15 per 100 000 in males and 0.06 per 100 000 in females. The mean age at presentation is 60.08 years and 63.89 years for males and females respectively. Although there has been an increase in the number of cases reported over this period, the increase in larynx (43%) and trachea (50%) has not kept pace with that for bronchial carcinoma (85%). Some experimental studies in animals and the results of treatment in 97 cases from the Cancer Registry are reported. A brief summary of methods of treatment for carcinoma of the trachea is included. In suitable cases, primary surgery with direct anastomosis offers the best survival rates, although the overall survival rate is poor.

The incidence of the location within the bronchi related to the cell types was investigated with the flexible fiberoptic bronchoscope in 355 cases of lung carcinoma. In 5 patients carcinoma was situated only in the trachea. In the other 350 cases the cell types other than adenocarcinoma were found to show different locations following their cell type. Epidermoid carcinoma was found more frequently in the two upper lobes (p less than 0.001), while small cell carcinomas showed predilection for the main bronchus on the right side, and the upper lobe in the left (p less than 0.001). No difference could be found between the upper, lower lobes and main bronchi for adenocarcinoma. It was also observed that large cell carcinomas were situated more often in the right upper lobe. The most important finding in this investigation was that, apart from adenocarcinoma, the other types were located mainly in the upper lobes, and much less frequently in the lower lobes. The predilection of localization of epidermoid and small cell carcinomas in the upper lobes suggests a possible relationship to tobacco smoke inhalation as these regions have been shown to be more affected by the smoke.

Ectopic thyroid tissue within the submucosa of the trachea is a rare cause of upper airway obstruction. Most case reports in the literature record examples of intratracheal goiter with only occasional reports of neoplasms arising from such thyroid rests. This report describes a young female patient with a malignant tumor, thought to be primary in the trachea, treated first by radiotherapy and eventually successfully surgically excised. The surgical resection required total thyroidectomy with partial laryngectomy and major tracheal resection, and provided an excellent functional result. The clinical history, laboratory findings and histologic sections strongly suggest that this tumor arose within the tracheal submucosa from ectopic thyroid tissue. In a series of 250 serially sectioned larynges, such ectopic thyroid tissue has been identified in only two patients.