Superior Vena Cava Syndrome

Definition

The superior vena cava is the major vein in the chest that carries blood from the upper part of the body into the heart. A restriction of the blood flow (occlusion) through this vein can cause superior vena cava syndrome (SVCS).

Description

Superior vena cava syndrome is a partial occlusion of the superior vena cava. This leads to a lower than normal blood flow through this major vein. SVCS is also called superior mediastinal syndrome and/or superior vena cava obstruction.

Causes and symptoms

More than 95% of all cases of SVCS are associated with cancers involving the upper chest. The cancers most commonly associated with SVCS are advanced lung cancers, which account for nearly 80% of all cases of SVCS, and lymphoma. Cancers that have spread (metastasized) to the chest, such as metastatic breast cancer to the chest and metastatic testicular cancer to the chest have also been shown to cause SVCS.

Other causes of SVCS include: the formation of a blood clot in the superior vena cava, enlargement of the thyroid gland, tuberculosis, and sarcoidosis.

The symptoms of SVCS include:

• change in voice
• confusion
• cough
• enlargement of the veins in the upper body, particularly those in the arms
• headache
• light-headedness
• shortness of breath
• swelling of the arms
• swelling of the face
• trouble swallowing

Diagnosis

SVCS should be considered in any cancer patient with swelling of the face and arms. This diagnosis can be confirmed by x ray, computerized tomography (CT) scan, or medical resonance imaging (MRI) of the chest that reveals a partial occlusion of the superior vena cava.

Treatment

Treatment of SVCS depends on the underlying cancer that is causing it. This treatment may include radiation, chemotherapy, or a combination of both. In some cases, surgical procedures may be performed to open (dilate) the vessel. These procedures are generally performed by a trained radiologist or vascular surgeon.

Alternative treatment

Since treatment of SVCS is aimed at treating the underlying disorder that is causing SVCS, alternative treatments must also focus on treating these underlying causes. Alternative treatments for cancer include acupuncture, aromatherapy, herbal remedies, hydrotherapy, hypnosis, and massage, among many others.

Prognosis

The prognosis depends on the underlying cause of SVCS. In cases of SVCS caused by lung cancers, the prognosis is generally rather poor since SVCS does not generally occur until the later stages of these diseases.

Prevention

SVCS may be prevented by early medical intervention to halt and/or reverse the cancer which, in a later stage, would have lead to SVCS.

PERIODICALS

Haapoja, I.S. and C. Blendowski. "Superior Vena Cava Syndrome." Seminars in Oncology Nursing 15 (August 1999): 183-9.

Hemann, Rhonda. "Superior Vena Cava Syndrome." Clinical Excellence for Nurse Practitioners 5 (March 2001): 85-7.

Yellin, A. et al. "Superior Vena Cava Syndrome: The Myththe Facts." American Review of Respiratory Disease 141 (May 1990): 1114-1118.

ORGANIZATIONS

Alliance for Lung Cancer Advocacy, Support and Education. P.O. Box 849 Vancouver, WA 98666. (800) 298-2436 or (360) 696-2436. <http://www.alcase.org/>.

OTHER

Beeson, Michael S. eMedicine - Superior Vena Cava Syndrome. <http://www.emedicine.com/emerg/topic561.htm>. (12 May 2001).

Paul A. Johnson

KEY TERMS

Metastasis—The spread of a cancer from one part of the body (where the cancer originated) to another part of the body.

Sarcoidosis—A disease of unknown origin in which there is chronic (recurrent) swelling in the lymph nodes and other tissues.

Superior vena cava—The major vein that carries blood from the upper body to the heart.

Thymoma—A tumor that originates in the thymus, a small gland just in front of the heart that produces hormones necessary for the development of certain components of the immune system.