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Carcinoma at the tracheostoma site in a chronic

smoker who smoked through the tracheostoma
Madhup Rastogi,1 Raghav C Dwivedi,2 Swaroop Revannasiddaiah,3 Sudhir Singh4
1

Department of Radiation
Oncology, Dr. Ram Manohar
Lohia Institute of Medical
Sciences, Lucknow, Uttar
Pradesh, India
2
Head and Neck Unit, Royal
Marsden Hospital, London, UK
3
Department of Radiation
Oncology, HealthCare GlobalBangalore Institute of
Oncology, Bengaluru,
Karnataka, India
4
Department of Radiotherapy,
King Georges Medical
University, Lucknow, Uttar
Pradesh, India
Correspondence to
Dr Swaroop Revannasiddaiah,
swarooptheone@gmail.com

DESCRIPTION
A man had suffered trauma to the neck about two
decades ago, for which he had undergone permanent tracheostomy. Over the years, the patient
ignored repeated calls for reconstruction of his
airway. The patient happened to be a chronic
smoker, and he continued with his habit of
smoking, even after tracheostomy, despite suggestions to the contrary. Since the airway above the
tracheostoma was not patent, he would smoke directly through the tracheostoma.
The patient was brought to the hospital recently,
when a large mass was seen around the tracheostoma
(gure 1). There was a limited patency in the airway,
leading to severe stridor. Local excision of the mass
was performed (gure 2) with the emergent intention
of restoring airway patency. Histopathology was
established as a moderately differentiated squamous
cell carcinoma and the patient has now been initiated
on radiotherapy. Concurrent chemotherapy has been
avoided given the advanced age (76 years) of the
patient.
The patient was supposedly reluctant to be
brought to the hospital, and a psychiatric consultation was sought during his stay in the hospital. He
was also diagnosed to be suffering from schizophrenia, which could possibly explain the reason why
the patient did not visit the hospital before the
disease could grow to such an enormous size.
Indeed, it has been estimated that patients with psychiatric illnesses who develop malignancies have a

Figure 2 Following excision and re-establishment of

patency of the tracheostoma.

50% lesser chance of survival in comparison to the

general population of cancer patients. This could
be attributed to neglect, late detection and also
non-adherence to standard treatment.1 2

Learning points
Certain patients with long-standing smoking
habits may indeed continue to smoke through
the tracheostoma, after tracheostomy.
Smoking through the tracheostoma exposes
the mucosa or the mucoepithelial junction to
carcinogens, while it is possible that repeated
irritation too could play a role in causing or
promoting local carcinogenesis.3
Patients with psychiatric disorders may avoid
seeking medical care despite a dire necessity
for the same.

Competing interests None.

Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer
reviewed.
To cite: Rastogi M,
Dwivedi RC,
Revannasiddaiah S, et al.
BMJ Case Rep Published
online: [ please include Day
Month Year] doi:10.1136/
bcr-2012-008504

REFERENCES
1

Figure 1 Patient at presentation, note the large growth

around the tracheostomy site. There was severe stridor
and his metallic tracheostomy tube had been displaced.

Rastogi M, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2012-008504

2
3

Lambert TJ, Velakoulis D, Pantelis C. Medical comorbidity in

schizophrenia. Med J Aust 2003;178(Suppl):S6770.
Harris EC, Barraclough B. Excess mortality of mental disorder. Br J
Psychiatry 1998;173:1153.
Hecht SS. Cigarette smoking: cancer risks, carcinogens and
mechanisms. Langenbecks Arch Surg 2006;391:60313.

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Rastogi M, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2012-008504