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Flashcards in Superior Vena Cava Obstruction Deck (20)
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1

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

Can be either

2

What are the most common causes of SVCO?

- Lung cancer
- Lymphoma
- Metastatic tumours

3

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

85%

4

What are the symptoms of SVCO?

- 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

5

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

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

6

Over what time frame does SVCO present?

It usually presents more gradually, however can present acutely

7

Why does SVCO usually present gradually?

Symptoms increase over time as malignancies increase in size or invasiveness

8

What do the severity of symptoms relate to in SVCO?

- Rate of obstruction
- Presence of compensatory venous collateral circulation

9

What is an important clinical feature of SVCO?

Elevated but non-pulsatile JVP

10

What investigations are done in SVCO?

- CXR
- CT scan with contrast of chest, abdomen, and pelvis
- Transbronchial needle aspiration at bronchoscopy
- Mediastinoscopy

11

What % of people with SVCO have a normal CXR?

15%

12

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

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

13

What should immediate management of SVCO include?

- Sitting patient upright
- Treating breathlessness with oxygen
- Opiates
- High dose steroid therapy

14

What is the purpose of opiates in SVCO?

- Reduce pain
- Relieve dyspnoea

15

What steroid should be used in SVCO?

Dexamethasone

16

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

To reduce oedema around the tumour

17

What is definitive therapy for SVCO directed at?

The underlying cause

18

What normally is the definitive therapy for SVCO?

Chemotherapy for lymphoma/SCLC

19

What is the usual outcome of chemotherapy in SVCO?

Early response and resolution of the SVC obstruction within weeks

20

When is radiotherapy used in SVCO?

- Non-chemosensitive tumours
- Patients who do not respond to chemotherapy