Superior Vena Cava Obstruction (SVCO)

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SVCO is the obstruction of blood flow through the superior vena cava.
SVCO most typically arise from malignancy e.g. lung cancer, lymphoma, mesothelioma, and thymoma.
The treatment is dependent on the cause of the obstruction, the severity of symptoms and the patient’s prognosis.

Symptoms	Signs
Breathlessness	Tachypnea
Headache	Dilated neck veins and collateral veins in arms and chest Cyanosis
Visual changes	Periorbital oedema Papilloedema (late feature)
Dizziness	Cyanosis

If patient is acutely symptomatic with stridor, consider the possibility of tracheal decompression which may need emergency tracheostomy
Immediate Treatment
- Sit patient upright
- Administer 100% oxygen if no contraindication
- IV Dexamethasone 8mg b.d. with gastric protection
- IV Opioids for breathlessness
Further Treatment
- Supportive care includes symptomatic control, discussion of potential palliative sedation, as well as keeping family/next-of-kin updated
- Endovascular Stent (Symptom relief in ~48 hours)
- Direct thrombolysis, if it is thrombus
- Radiotherapy (may take weeks to see full benefit)
For patients with very chemosensitive tumours (e.g. small cell lung cancer, lymphoma, germ cell tumour), chemotherapy is often 1st line treatment

United Kingdom. National Health System. Diagnostic Algorithm for superior vena cava obstruction (SVCO). https://www.nwcscnsenate.nhs.uk/files/8814/7204/6362/FACTS_leaflet_-_Diagnostic_Algorithm_for_superior_vena.pdf
Scotland. Scottish Palliative Care Guidelines. (2019). Superior Vena Cava Obstruction. https://www.palliativecareguidelines.scot.nhs.uk/guidelines/palliative-emergencies/Superior-Vena-Cava-Obstruction.aspx