Management of airway in the cancer patients

Cancer airway management is complex and challenging. Malignancies may occur internally or externally to the airway lumen and in any segment along the entire airway. The most common histopathologic type of malignancy tumors in the upper aerodigestive tract and trachea is squamous cell carcinoma. The manifestations of airway cancer are primarily determined by the cancer location rather than the underlying histopathology of the cancer. Airflow obstruction and difficult tracheal intubation are the two major issues in cancer airway management. Despite the advancement of technology and diagnostic tools, in order to determine the impact of airway cancer, multiple diagnostic studies, including clinical assessments, advanced imaging studies, and bedside endoscopy evaluations, are required. Oncologic growth and surgery often distort airway anatomy resulting in difficulty of airway assessment and management. The primary and backup plans for management of a highrisk airway should be deliberate and individually tailored. Cancer airway management often requires multi-advanced techniques and awake tracheal intubation. The primary decisions regarding airway management of these high-risk airway patients are between awake and asleep intubation and in a patient with critical airway stenosis between awake tracheal intubation and awake tracheostomy. An airway strategy or series of plans should be developed for these patients by multi-disciplined teams. Each of the team members must be fully cognizant of their role in the team.