Transcript SVC
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 2 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 • Thymoma • Mediastinal germ cell tumours • Mesothelioma • Other solid tumours with mediastinal nodal metastases Intrinsic • Thrombosis • Venous catheters/pacemaker leads Others • Post radiation fibrosis (e.g. Histoplasma) • Post infective fibrosis 3 Superior Vena Cava Syndrome 4 Presentation • The SVC syndrome: • Dyspnoea (most common) • Facial swelling or fullness exacerbated on bending or lying down • Arm swelling • Facial oedema • Venous distension in the neck and chest wall • Cyanosis • Facial plethora Superior Vena Cava Syndrome 5 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 6 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 7 General Management • Raise head to improve venous return • 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 8 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 9 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