Malignant central airway obstruction

Abstract

Central airway obstruction by malignancy usually occurs in situations where there is greater than 50 % obstruction of one of the main stem bronchi, trachea, or bronchus intermedius. Approximately 1/3 of patients with lung cancer present with obstruction. The general approach to these patients is first to stabilize them clinically, then consider the cause. Depending on the etiology and location of the tumor resulting in the obstruction, the management may include debulking techniques and/or airway stenting. The decision regarding the most appropriate therapeutic intervention is based upon review of the diagnostic imaging, the endoscopic appearance, and the responsiveness of the tumor to other therapeutic modalities including surgery, radiation, and chemotherapy. If the patient and the medical conditions are such that the patient is deemed an appropriate candidate for endoscopic management, then the general approach includes devitalizing the tumor followed by debridement, hemostasis of the tumor base, and then consideration of stent.