Superior Vena Caval Obstruction Flashcards Preview

Yr4 Oncology > Superior Vena Caval Obstruction > Flashcards

Flashcards in Superior Vena Caval Obstruction Deck (11)
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1
Q

what are the most common causes of SVCO

A

malignant causes

  • bronchogenic carcinoma (typically small cell lung cancer)
  • lymphoma
  • met tumours (renal, germ cell)
2
Q

what are some rarer causes of SVCO

A

benign causes

  • SVC thrombosis
  • mediastinal fibrosis
3
Q

what will be noted in the history

A

facial swelling/feeling of fullness in the head - worse after waking up, less by the end of the day
arm swelling
dysphagia/dyspnea (may coexist due to mediastinal compression)
other features of malignancy

4
Q

on examination

A
distention of neck and chest wall veins 
fixed (ie non-pulsatile) elevated JVP
facial oedema/puffiness
oedema of the arms
plethora of the face (redness due to increased blood)
peripheral cyanosis
Pembertons sign
other signs of malignancy
5
Q

what is pembertons sign

A

manoeuvre to demonstrate latent pressure in the thoracic inlet

patient elevated with arms until they touch the sides f the face
- a positive sign is marked by facial congestions (redness) and cyanosis with resp distress after ~ 1 minute

6
Q

what investigations should be carried out

A

new presentation - staging biopsy prior to therapy

known malignancy - CXR, CT, superior venocavogram, bronchoscopy is lung primary suspected

7
Q

what are the groups of management

A
steroids and supportive
radiotherapy
chemotherapy 
stunting of SVC
thrombolysis and anticoagulation if SCVO due to thrombosis o SVC
8
Q

what steroids/supportive management can be given

A

high dose CCS - dexamethasone 8mg bd (+gastroprotection and daily BM)

encourage patient to sit up in bed (oedema may be worse when lying flat)

9
Q

what determines what radiotherapy/chemotherapy is used

A

tumour type (chemo/radiosensitive)
prior treatment
extent of disease elsewhere

10
Q

when is stenting used

A

for recurrent SCVO or for benign causes

11
Q

how do you manage catheter induces SVC thrombosis

A

remove catheter
thrombolysis
anticoagulation