Acute respiratory distress syndrome (ARDS) is a heterogeneous form of acute, diffuse lung injury that is characterized by dysregulated inflammation, increased alveolar-capillary interface permeability, and non-cardiogenic pulmonary edema. Epidemiologic studies identify infection as a major underlying cause of ARDS in patients with cancer, especially in those with hematologic malignancies or neutropenia. As such, close collaboration between the intensivists and a multidisciplinary team is essential in identifying and reversing the underlying causes and optimizing treatments for patients with cancer and ARDS. This chapter reviews the diagnosis and common causes of ARDS in cancer and provides an updates on the management principles for cancer patients in the intensive care unit.