Superior Vena Cava Syndrome, Part 2

by National Cancer Institute

(Page 5 of 5)

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment unless symptoms appear or change. A patient who has good blood flow through other veins and mild symptoms may not need treatment.

The following may be used to relieve symptoms and keep the patient comfortable:

• Keeping the upper body raised higher than the lower body.
• Corticosteroids (drugs that reduce swelling).
• Diuretics (drugs that make excess fluid pass from the body in urine). Patients taking diuretics are closely monitored because these drugs can cause dehydration (loss of too much fluid from the body).

Radiation therapy

If the blockage of the superior vena cava is caused by a tumor that is not sensitive to chemotherapy, radiation therapy may be given. Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Chemotherapy

Chemotherapy is the usual treatment for tumors that respond to anticancer drugs, including small cell lung cancer and lymphoma. This treatment would not be changed for patients who have SVCS. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Thrombolysis

SVCS may occur when a thrombus (blood clot) forms in a partially blocked vein. Thrombolysis is a method used to break up and remove blood clots. This may done using a drug put directly into the clot, through a catheter, or by a thrombectomy (the use of a device inserted into the vein).

Stent placement

A stent may be used to open up the blocked vein. A stent is a tube-like device that is inserted into the blocked area of a vein to allow blood to pass through. This helps most patients. Patients may also receive an anticoagulant to keep more blood clots from forming.

Surgery

Surgery to bypass (go around) the blocked part of the vein is sometimes used for cancer patients, but is used more often for patients without cancer.

Social Considerations of Superior Vena Cava Syndrome

Superior vena cava syndrome is serious and the symptoms can be upsetting to the patient and family. It is important that patients and family members receive information about the causes of superior vena cava syndrome and how to treat it. This can help relieve anxiety over symptoms such as swelling, trouble swallowing, coughing, and hoarseness.

When a patient has chosen not to receive aggressive treatment because of terminal cancer, palliative treatment can help keep the patient comfortable by relieving symptoms. Patients and family members can be taught how to provide palliative care to relieve symptoms and improve quality of life.

Superior Vena Cava Syndrome in Children

Superior vena cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked.

Superior vena cava syndrome (SVCS) in children can be life threatening. This is because blockage of the child's trachea (windpipe) can quickly occur along with SVCS. In adults, the windpipe is fairly hard, but in children, it is softer and can more easily be squeezed shut. Also, the diameter of a child's windpipe is smaller, so any amount of swelling can cause breathing problems. Squeezing of the trachea is called superior mediastinal syndrome (SMS). Because SVCS and SMS often occur together in children, the two syndromes are considered to be the same.

The most common symptoms of SVCS in children are similar to those in adults.

Common symptoms include the following:

• Coughing.
• Hoarseness.
• Problems breathing.
• Chest pain.

There are other less common but more serious symptoms:

• Fainting.
• Anxiety.
• Confusion.
• Tiredness.
• Headache.
• Vision problems.
• A sense of fullness in the ears.

The causes, diagnosis, and treatment of SVCS in children are not the same as in adults.

The most common cause of SVCS in children is non-Hodgkin's lymphoma.

SVCS in children is rare; the most common cause is non-Hodgkin's lymphoma. As in adults, SVCS may also be caused by a blood clot that forms as a side effect of using an intravenous catheter.

SVCS in children may be diagnosed and treated before a definite diagnosis of cancer is made.

A physical exam, chest x-ray, and medical history are usually all that are needed to diagnose superior vena cava syndrome in children. If cancer is suspected, a biopsy is not done unless the lungs and heart of the child with SVCS are able to handle the anesthesia needed. Other imaging tests may be done to help determine if anesthesia can be safely used. In most cases, treatment will begin before a definite diagnosis of cancer is made.

It is important that treatment begins right away.

The following treatments may be used for SVCS in children:

Radiation therapy

Radiation therapy is usually used to treat a tumor that is causing the blocked vein. After radiation therapy, breathing may become more difficult because swelling narrows the windpipe. A drug to reduce swelling may be given.

Drugs

Anticancer drugs, steroids, and/or other drugs may be used. If the tumor does not respond, it may be benign (not cancer).

Surgery

This may include surgery to bypass (go around) the blocked part of the vein or to place a stent to open the vein.

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