Advertisement

Management of Airway in the Cancer Patients

  • Gang Zheng
  • Carin A. HagbergEmail author
Reference work entry

Abstract

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 high-risk 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.

Keywords

Airway management Cancer airway Aerodigestive tract Head and neck radiotherapy Tracheal intubation 

References

  1. 1.
    Chan KC, Hung EC, Woo JK, Chan PK, Leung SF, Lai FP, Cheng AS, Yeung SW, Chan YW, Tsui TK, Kwok JS, King AD, Chan AT, van Hasselt AC, Lo YM. Early detection of nasopharyngeal carcinoma by plasma Epstein-Barr virus DNA analysis in a surveillance program. Cancer. 2013;119(10):9–22.  https://doi.org/10.1002/cncr.28001.CrossRefGoogle Scholar
  2. 2.
    Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990–2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017;3(4):524–48.  https://doi.org/10.1001/jamaoncol.2016.5688.CrossRefPubMedGoogle Scholar
  3. 3.
    American Cancer Society. Cancer facts & figures. 2017. www.cancer.org/.../cancer-facts-and-figures-2017.pdf. Accessed 23 June 2018.
  4. 4.
    Urdaneta AI, Yu JB, Wilson LD. Population based cancer registry analysis of primary tracheal carcinoma. Am J Clin Oncol. 2011;34:32–7.  https://doi.org/10.1097/COC.0b013e3181cae8ab.CrossRefPubMedGoogle Scholar
  5. 5.
    Deschler DG, Moore MG, Smith RV. Quick reference guide to TNM staging of head and neck cancer and neck dissection classification. 4th ed. Alexandria: American Academy of Otolaryngology–Head and Neck–Surgery Foundation; 2014.. www.entnet.org/sites/default/files/NeckDissection_QuickRefGuide_highresFINAL.pdf. Accessed 23 June 2018Google Scholar
  6. 6.
    Barnes L, Eveson JW, Reichart P, Sidransky D. WHO classification of tumors, pathology and genetics, head and neck tumors. Lyon: IARC Press; 2005.. www.iarc.fr/en/publications/pdfs-online/pat-gen/bb9/BB9.pdf. Accessed 23 June 2018Google Scholar
  7. 7.
    Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guideline for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.  https://doi.org/10.1097/ALN.0b013e31827773b2.CrossRefPubMedGoogle Scholar
  8. 8.
    Higgins WE, Ramaswarmy K, Swift RD, McLennan G, Hoffman EA. Virtual bronchoscopy for three- dimensional pulmonary image assessment: state of the art and future needs. Radiographics. 1998;18:761–78.  https://doi.org/10.1148/radiographics.18.3.9599397.CrossRefPubMedGoogle Scholar
  9. 9.
    Coxson HO, Lam S. Quantitative assessment of the airway wall using computed tomography and optical coherence tomography. Proc Am Thorac Soc. 2009;6(5):439–43.  https://doi.org/10.1513/pats.200904-015AW.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wang CJ, Huang EY, Hsu HC, Chen HC, Fang FM, Hsiung CY. The degree and time-course assessment of radiation-induced trismus occurring after radiotherapy for nasopharyngeal cancer. Laryngoscope. 2005;115(8):1458–60.  https://doi.org/10.1097/01.mlg.0000171019.80351.46.CrossRefPubMedGoogle Scholar
  11. 11.
    Patterson JM, Hildreth A, Wilson JA. Measuring edema in irradiated head and neck cancer patients. Ann Otol Rhinol Laryngol. 2007;116(8):559–64.  https://doi.org/10.1177/000348940711600801.CrossRefPubMedGoogle Scholar
  12. 12.
    Hagberg CA, Artime CA, Aziz F. Hagberg and Benumof’s airway management. 2018. p. 668–91.Google Scholar
  13. 13.
    Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax. 2013;68(Suppl 1):i1–i44.  https://doi.org/10.1136/thoraxjnl-2013-203618.CrossRefPubMedGoogle Scholar
  14. 14.
    Giordano D, Panini A, Carmine Pernice C, Raso MG, Barbieri V. Neurologic toxicity of lidocaine during awake intubation in a patient with tongue base abscess. Case report. Am J Otolaryngol. 2013;35(1):62–5.  https://doi.org/10.1016/j.amjoto.2013.08.009.CrossRefPubMedGoogle Scholar
  15. 15.
    Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaeth. 2015;115(6):827–48.  https://doi.org/10.1093/bja/aev371.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  • Ninotchka Brydges
    • 2
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations