Oncological Emergencies

Question 1

Describes the signs and symptoms of SVC obstruction

Answer 1

○ Dyspnoea is the most common symptom
○ Swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
○ Headache: often worse in the mornings
○ Visual disturbance
○ Pulseless jugular venous distension
○ Pemberton's Test

Question 2

Describes the causes of SVC obstruction

Answer 2

○ Common malignancies: non-small cell lung cancer, lymphoma (mediastinal lymphadenopathy)
○ Other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
○ Aortic aneurysm
○ Mediastinal fibrosis
○ Goitre
○ SVC thrombosis, or thrombosis around central line

Question 3

Describes the investigation of SVC obstruction

Answer 3

○ CXR / CT

○ Venography

Question 4

Describes the management of SVC obstruction

Answer 4

○ General: dexamethasone 4mg Q6H, balloon venoplasty, SVC stenting
○ Small cell: chemotherapy + radiotherapy
○ Non-small cell: radiotherapy