POSTGRADUATE
SCHOOL OF MEDICINE
SUPERIOR VENA CAVA OBSTRUCTION
SYNDROME
Dr. Richard Griffiths
MDSC156: Acute Clinical Oncology
A MEMBER OF THE RUSSELL GROUP
CONTINUING PROFESSIONAL DEVELOPMENT
Superior Vena Cava Syndrome
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Superior Vena Cava Syndrome (SVC)
•
Any condition that leads to obstruction of blood through the
SVC
•
Malignancy is the cause
of about 60-80% of cases
Superior Vena Cava Syndrome
Causes
•
•
•
Extrinsic compression - malignant
•
Lung Cancer – usually small cell
•
Diffuse large B-cell and lymphoblastic lymphomas
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Thymoma
•
Mediastinal germ cell tumours
•
Mesothelioma
•
Other solid tumours with mediastinal nodal metastases
Intrinsic
•
Thrombosis
•
Venous catheters/pacemaker leads
Others
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Post radiation fibrosis (e.g. Histoplasma)
•
Post infective fibrosis
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Superior Vena Cava Syndrome
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Presentation
•
The SVC syndrome:
•
Dyspnoea (most common)
•
Facial swelling or fullness exacerbated on bending or lying down
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Arm swelling
•
Facial oedema
•
Venous distension in the neck and chest wall
•
Cyanosis
•
Facial plethora
Superior Vena Cava Syndrome
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Investigation
• The majority of patients will have an abnormal chest X-ray
• Contrast enhanced CT scan will confirm diagnosis and likely
cause
Superior Vena Cava Syndrome
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Management
• Most cases of SVCO develop gradually over several weeks and so immediate
therapy (stent placement +/- radiotherapy) is not usually justified unless
• Tracheal obstruction present
• Coma from cerebral oedema present
• Establishing a histological diagnosis is paramount in determining optimal
therapy
• Percutanous biopsy
• Mediastinoscopy
Superior Vena Cava Syndrome
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General Management
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Raise head to improve venous return
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Avoid intramuscular injections in upper limbs
•
Limit intravascular access unless absolutely necessary. Use a dorsal foot
vein for IV access if possible
•
Glucocorticoids should not be routinely used prior to a diagnosis being
ascertained.
•
There is no clear role for diuretics
Superior Vena Cava Syndrome
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Definitive Management
•
Small cell lung cancer, lymphomas and germ cell tumours all
should be treated with urgent chemotherapy
•
For non-small cell lung cancer and other less chemosensitive
diseases an endovascular stent should be inserted followed by
radiotherapy
Superior Vena Cava Syndrome
Endovascular stent insertion in SVC
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FACULTY OF HEALTH & LIFE SCIENCES – CPD
Institute for Learning & Teaching
Faculty of Health & Life Sciences
Room 2.16A, 4th Floor
Thompson Yates Building
Brownlow Hill
Liverpool
L69 3GB
www.liv.ac.uk/learning-and-teaching/cpd
A MEMBER OF THE RUSSELL GROUP