Oncological Emergencies Dr. Gary Harding md, frcpc

Signs and Symptoms

• Facial swelling or head fullness

• exacerbated by bending forward or lying down

• Cough

• Arm edema

• Cyanosis

Physical Findings

• Venous distension

• neck
• chest wall

• Pemberton’s Sign

• Facial Edema

Etiology: Malignancy

• Lung cancer is the most common2

• Lymphoma is second most common

• together represent 94% of cases

NSCLC

• 2-4% of bronchogenic cancer patients develop SVC syndrome3

• extrinsic compression or direct invasion

• primary tumor or by enlarging mediastinal nodes

Small Cell Lung Cancer

• Greatest risk

• 20% will develop SVC obstruction3

• more common because SCLC tends to occur centrally in contrast to other types

Lymphoma

• 2-4% of patients

• predominantly non-Hodgkin’s lymphoma4

• Hodgkin’s rarely causes SVC syndrome

Lymphoma

• Extrinsic compression caused by enlarging lymph nodes

• subtypes of large B cell can be intravascular and cause occlusion (angiotropic)

• diffuse large cell and lymphoblastic are most commonly associated with SVC syndrome

Other cancers

• Thymoma

• primary mediastinal germ cell neoplasm

• solid tumors with mediastinal nodal metastases

• breast cancer most common type