The occurrence of tracheogenic carcinoma has not paralleled the increasing occurrence of primary cancer of the bronchi and larynx. Only one of 1,000 patients with cancer can be expected to have primary carcinoma of the trachea. Early diagnosis may be obscured and delayed because of the paucity of identifying symptoms and findings. Tracheogenic carcinoma should be suspected in a patient with a negative chest x-ray film who has a hacking, irritating cough with paroxysmal, alarming, wheezing episodes and occasionally blood-streaked sputum. Surgical resection procedures and cobalt-60 therapy have increased the effectiveness of treatment.