[25] Superior Vena Cava Obstruction Flashcards

1
Q

Is superior vena cava obstruction due to primary or secondary tumours?

A

Can be either

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2
Q

What are the most common causes of SVCO?

A
  • Lung cancer
  • Lymphoma
  • Metastatic tumours
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3
Q

What % of cases of SVCO are due to lung cancer?

A

85%

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4
Q

What are the symptoms of SVCO?

A
  • Oedema of face and arms
  • Development of swollen colateral veins on the front of the chest wall
  • Shortness of breath and coughing
  • Difficulty swallowing
  • Stridor
  • Headaches
  • Dusky skin colouration over the chest, arms, and face
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5
Q

What feature of the oedema of face and arms may be present in SVCO?

A

May resolve as the day goes on if the patient is standing upright

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6
Q

Over what time frame does SVCO present?

A

It usually presents more gradually, however can present acutely

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7
Q

Why does SVCO usually present gradually?

A

Symptoms increase over time as malignancies increase in size or invasiveness

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8
Q

What do the severity of symptoms relate to in SVCO?

A
  • Rate of obstruction

- Presence of compensatory venous collateral circulation

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9
Q

What is an important clinical feature of SVCO?

A

Elevated but non-pulsatile JVP

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10
Q

What investigations are done in SVCO?

A
  • CXR
  • CT scan with contrast of chest, abdomen, and pelvis
  • Transbronchial needle aspiration at bronchoscopy
  • Mediastinoscopy
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11
Q

What % of people with SVCO have a normal CXR?

A

15%

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12
Q

What is the purpose of CT scan with contrast in SVCO?

A

Can show underlying cause, and the extent to which the disease has progressed

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13
Q

What should immediate management of SVCO include?

A
  • Sitting patient upright
  • Treating breathlessness with oxygen
  • Opiates
  • High dose steroid therapy
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14
Q

What is the purpose of opiates in SVCO?

A
  • Reduce pain

- Relieve dyspnoea

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15
Q

What steroid should be used in SVCO?

A

Dexamethasone

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16
Q

What is the purpose of high dose steroid therapy in SVCO?

A

To reduce oedema around the tumour

17
Q

What is definitive therapy for SVCO directed at?

A

The underlying cause

18
Q

What normally is the definitive therapy for SVCO?

A

Chemotherapy for lymphoma/SCLC

19
Q

What is the usual outcome of chemotherapy in SVCO?

A

Early response and resolution of the SVC obstruction within weeks

20
Q

When is radiotherapy used in SVCO?

A
  • Non-chemosensitive tumours

- Patients who do not respond to chemotherapy