SVCO is caused by impaired blood flow through the superior vena cava, typically due to compression by a tumour or lymph nodes. Early identification and treatment can be life-saving.
It may present acutely or more insidiously with chronic dyspnoea.
The most common cause will be carcinoma of the lung (65 to 80%), lymphoma (2 to 10%), other cancers (3 to 13%).
Red flags
- Rapidly progressive symptoms e.g. rapid-onset swelling of the face, neck, or upper limbs
- Symptoms or signs of raised intracranial pressure e.g. headache, visual symptoms, confusion, or syncope
- Symptoms or signs of acute airways obstruction e.g. stridor
Clinical features
The most common clinical features are:
- oedema and plethora of the face, arms and conjunctiva
- breathlessness
- distended neck and chest wall veins
- hoarse voice
- lymphadenopathy
Other symptoms might include; visual changes, headache – worse on bending over or lying flat
An initial approach to treatment
- Do not delay referral – if red flags are present, refer same day to acute oncology or A&E and start oral dexamethasone 16mg stat
- Encourage upright positioning to relieve symptoms
- If airway or neurological compromise: call 999
Specific treatments according to cause
Initial treatment involves relieving the symptoms of obstruction and treating the underlying aetiology.
Decompression of the vein can be achieved with either a combination of corticosteroids and radiotherapy, or percutaneous stenting.