SVCO

Question 1

What is SVCO?

Answer 1

Superior vena cava obstruction

Obstruction to flow of blood through the SVC secondary to cancer

Question 2

What are the two most common causes of SVCO?

Answer 2

Lung carcinoma
NHL

Question 3

What does long-term SVCO lead to?

Answer 3

Formation of collateral vessels

Question 4

What are the symptoms of SVCO?

Answer 4

Dyspnoea
Facial swelling
Head fullness
Symptoms exacerbated by bending forwards / lying down
Cough
Dysphagia

Question 5

What are the signs of SVCO?

Answer 5

Facial swelling
Distended neck and chest wall veins
Upper limb oedema
Facial plethora
Cyanosis
Cognitive dysfunction
Coma

Question 6

What sign is characteristic of SVCO?

Answer 6

Pemberton’s Sign

Ask patient to raise arms above head
If this causes congestion, cyanosis or respiratory distress = positive

Due to increased venous return from upper extremities, worsening obstruction

Question 7

What is used to diagnose SVCO?

Answer 7

CXR

• Mediastinal widening
• Malignant pleural effusion

Contrast Chest CT

• Reveals extent and level of obstruction
• Collateral vessel formation

Duplex USS

• Look at blow flow at the area

PET CT and CT CAP

• Can be used for staging

Question 8

What is the definitive management of SVCO?

Answer 8

Endovascular stent

Shunt or thrombolysis can be used

Question 9

What can be tried while awaiting surgery to help symptoms?

Answer 9

Elevate head and neck
Oxygen
Dexamethasone
Anticoagulation

Question 10

In patients where surgery is not an option what medical treatment can be used?

Answer 10

Radiotherapy

Many tumours are radiosensitive

Chemotherapy can be used but less sensitive generally

Question 11

What is the prognosis of SVCO

Answer 11

6 months

Question 12

Please state how you would manage the patient

Answer 12

So, there’s a few things we can do in the mean time

That will involve you trying to sit up more, I know it can be uncomfortable but this should help with your symptoms

In SVCO there can be some swelling which can make your symptoms worse, so we want to give you a steroid to help reduce that swelling and improve your symptoms

And then because the blood doesn’t flow as well because of the obstruction, this can make the blood more likely to clot, so we need to give you some medications to stop that from happening

I’ll pass on all of this information to our team of specialist doctors and nurses at our multidisciplinary team meeting and they can decide what treatment is best for you

That might involve surgery to place something called a stent which helps the blood continue to flow, or using radiotherapy to try and reduce the obstruction