Superior Vena Cava Obstruction Flashcards
Is superior vena cava obstruction due to primary or secondary tumours?
Can be either
What are the most common causes of SVCO?
- Lung cancer
- Lymphoma
- Metastatic tumours
What % of cases of SVCO are due to lung cancer?
85%
What are the symptoms of SVCO?
- Oedema of face and arms
- Development of swollen colateral veins on the front of the chest wall
- Shortness of breath and coughing
- Difficulty swallowing
- Stridor
- Headaches
- Dusky skin colouration over the chest, arms, and face
What feature of the oedema of face and arms may be present in SVCO?
May resolve as the day goes on if the patient is standing upright
Over what time frame does SVCO present?
It usually presents more gradually, however can present acutely
Why does SVCO usually present gradually?
Symptoms increase over time as malignancies increase in size or invasiveness
What do the severity of symptoms relate to in SVCO?
- Rate of obstruction
- Presence of compensatory venous collateral circulation
What is an important clinical feature of SVCO?
Elevated but non-pulsatile JVP
What investigations are done in SVCO?
- CXR
- CT scan with contrast of chest, abdomen, and pelvis
- Transbronchial needle aspiration at bronchoscopy
- Mediastinoscopy
What % of people with SVCO have a normal CXR?
15%
What is the purpose of CT scan with contrast in SVCO?
Can show underlying cause, and the extent to which the disease has progressed
What should immediate management of SVCO include?
- Sitting patient upright
- Treating breathlessness with oxygen
- Opiates
- High dose steroid therapy
What is the purpose of opiates in SVCO?
- Reduce pain
- Relieve dyspnoea
What steroid should be used in SVCO?
Dexamethasone
What is the purpose of high dose steroid therapy in SVCO?
To reduce oedema around the tumour
What is definitive therapy for SVCO directed at?
The underlying cause
What normally is the definitive therapy for SVCO?
Chemotherapy for lymphoma/SCLC
What is the usual outcome of chemotherapy in SVCO?
Early response and resolution of the SVC obstruction within weeks
When is radiotherapy used in SVCO?
- Non-chemosensitive tumours
- Patients who do not respond to chemotherapy
