Superior vena cava obstruction (SVCO) is generally caused by extrinsic compression by metastases in
upper mediastinal lymph nodes. It may also be caused by tumour infiltration or thrombus. 95% of SVCO is
caused by malignancy (80% due to lung cancer). Venous thrombosis can cause an acute onset of
Neck and facial swelling
Head fullness / headache
Trunk and arm swelling
Thoracic vein distension 65%
Neck vein distension 55%
Facial / conjunctival oedema 55%
Central / peripheral cyanosis 15%
Arm oedema 10%
Vocal cord paresis 3%
Horner’s syndrome 3%
Assess for hypoxia
CXR – bulky mediastinal shadow, pleural/pericardial effusion
differentiate between thrombosis and tumour
differentiate between compression and infiltration
FBC, U&E, LFT. Clotting screen. Serum calcium. Uric acid
tumour markers: Beta HCG, AFP, LDH, CEA, CA15-3
treatment. Urgent discussion must be carried out with oncology, radiology and thoracic
surgery consultants regarding the optimal way to obtain histology.
CT guided core biopsy: 90-100% positive histology
Mediastinal biopsy: 90-100% positive histology
Bronchoscopic biopsy: 60% positive histology
Sputum cytology: 40%
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SVCO with severe symptoms is an emergency.
Nurse the patient in propped up position.
Prescribe Dexamethasone 16 mg od PO or 8mg b.d PO
If unable to tolerate oral medication prescribe Dexamethasone 16mg CSCI or IV /24 hours.
Analgesics as required but avoid oversedation
Self expanding metal stent
femoral vein. This may be done while waiting for biopsy report and is especially useful in those
patients who have tumours which are not radiotherapy or chemotherapy sensitive. Patients are
anticoagulated with heparin before stent insertion. This treatment may also be considered for
patients who fail to improve with radiotherapy and steroids or in whom SVCO recurs. Discuss
with oncology consultant and interventional radiologist.
Urgent oncology referral:
radiotherapy e.g. non-small cell lung cancer (75-90% respond: response often begins within
2. Chemotherapy may be used for tumours that are sensitive eg small cell lung cancer, lympho-
mas, germ cell tumours.
Patient may need to continue on oxygen.
Dexamethasone needs to be reduced gradually under medical supervision.
Nicholson A et al. Treatment of malignant superior vena cava obstruction: metal stents or radia-
Jackson J. Brooks D. Stenting of superior vena cava obstruction. Thorax 1995;50:531-6
Twycross R, Wilcock A. Symptom Management in advanced cancer. 3
edition Radcliffe Medi-
Yellin A et al. Superior vena cava syndrome. American review of respiratory disease 1990;
Baker GL, Barnes HJ. Superior vena cava syndrome- aetiology, diagnosis and treatment.