Oncological emergencies (except neutropenic sepsis!) Spinal cord compression

Any other local symptoms e.g. pain, stridor.

Superior Vena Cava Obstruction

• Examination:

• Extent of problem.
• Any evidence of malignancy elsewhere
• Lymphadenopathy.
• Hepatomegaly.
• collapse/consolidation of lung.

Superior Vena Cava Obstruction

• Initial Investigations:

• CXR – is there a mass?
• Venogram – is there a clot?

• If extrinsic compression from mass try and obtain tissue (SCLC, lymphoma treated with chemo)

• FNA node.
• Mediastinoscopy.

Superior Vena Cava Obstruction

Superior Vena Cava Obstruction

Treatment options: Clot

• Local thrombolysis with streptokinase.
• Anti-coagulation – heparin (IV or LMWH) for at 5/7 whilst starting warfarin.

Treatment Options: Extrinsic compression

• Steroids:

• frequently prescribed but no evidence to support their use (Cochrane review)

• Chemotherapy:

• used for SCLC, lymphoma and teratoma
• response rate >70%.

• Radiotherapy:

• used for other malignant causes
• response rate ~60%.
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