Symptoms
The symptoms of SVC syndrome are caused by the buildup of pressure in the superior vena cava above the blockage and may include:- Swelling of the face, arms, or chest wall
- Difficulty breathing (dyspnea)
- Widening of the veins in the neck and chest
- Cough and/or coughing up blood (hemoptysis)
- Headache
- Chest pain
- Hoarseness
- Difficulty swallowing (dysphagia)
- Bluish tinge to the skin of the face or upper body
Causes
The most common cause of SVC syndrome today is compression of the superior vena cava (SVC) by a cancerous tumor. The SVC is a soft-walled vein and can be easily compressed by tumors growing nearby. Lung cancers, especially those growing in the right upper lung, are the most common cause, followed by lymphomas. Spread of other tumors, such as breast cancer, to lymph nodes in the mediastinum (the area of the chest between the lungs) can also be responsible. Less common causes include blood clots within the SVC (often secondary to central intravenous lines or pacemaker wires) or infections like tuberculosis.Diagnosis
SVC syndrome is often suspected by the signs and symptoms noted above. Radiological studies such as a chest x-ray or CT scan may show a tumor or signs suggestive of SVC syndrome. Other tests, such as MRI, ultrasound, or venography (a test done using a dye to x-ray veins) may be recommended as well. If your doctor suspects a cancer is causing your symptoms (and you are otherwise stable medically), further tests are then needed to diagnose the cancer before treatment is started.Treatment
The treatment of SVC syndrome depends in large part upon the cause. If symptoms are due to a tumor pushing on the superior vena cava, methods to treat the tumor such as chemotherapy and radiation therapy are often used. Depending on the severity of your symptoms, a stent may be placed to hold the superior vena cava open. Blood thinners may be used to prevent clotting. In rare cases, surgery to bypass the obstruction may be needed.Prognosis
The prognosis of SVC syndrome is variable and depends upon the underlying cause.Sources:
Cheng, S. Superior vena cava syndrome: a contemporary review of a historic disease. Cardiology in Review. 2009. 17(1):16-23.
National Cancer Institute. Cardiopulmonary Syndromes (PDQ). Superior Vena Cava Syndrome. Updated 02/17/09. http://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/patient/page5.
Nunnelee, J. Superior vena cava syndrome. Journal of Vascular Nursing. 2007. 25(1):2-5,quiz 6.
Walji, N. Common acute oncological emergencies: diagnosis, investigation, and management. Postgraduate Medicine Journal. 2008. 84(994):418-27.
Wilson, L. et al. Superior Vena Cava Syndrome with Malignant Causes. Then New England Journal of Medicine. 2007. 356:1862-1869.
