Key notes on symptom control issues in Palliative Care

Investigations for Superior Vena Cava Obstruction

• 
  Chest X ray may be helpful in identifying the mass
  
• 
  CT scan of chest may identify the mass
  
• 
  Venography may help define the site of the obstruction and will be necessary if a stent is to be inserted.
  

Treatment of Superior Vena Caval Obstruction

• 
  Always consider admission to hospital to allow adequate investigation and treatment to improve symptom control and prevent the development of stridor.
  

• 
  Whilst waiting for a definitive management plan the patient should be started on 12mg oral dexamethasone as a single dose. If the patient is at risk of GI side effects start appropriate GI protection using a proton pump inhibitor. This should be continued until other interventions have been carried out, and then the steroids should be tailed off as dictated by the patient’s condition.
  

• 
  Discuss with local oncologist and/or specialist in palliative medicine about the use of an SVC stent inserted under radiological control and/or the role of oncological treatment to reduce the size of the tumour.
  
• 
  Manage symptoms particular headache and breathlessness. Both may warrant oral opioids.