National Cancer Institute


Posted Date: Jan 23, 2003

TABLE OF CONTENTS


Introduction

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This patient summary on superior vena cava syndrome is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Superior vena cava syndrome is a collection of symptoms that can occur in patients who have lung cancer, non-Hodgkin's lymphoma or other cancers. It also can occur from noncancer causes. Although serious when it occurs in adults, this syndrome is life threatening in children. This brief summary describes superior vena cava syndrome and its treatment.


Overview

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Superior vena cava syndrome (SVCS) is a collection of symptoms caused by the partial blockage of the vein that carries blood from the head, neck, chest, and arms to the heart. Symptoms that may indicate this syndrome include difficulty breathing, coughing, and swelling of the face, neck, upper body, and arms. In rare occasions, patients may complain of hoarseness, chest pain, difficulty swallowing, and coughing up blood. Physical signs of SVCS include swelling of neck or chest veins, collection of fluid in the face or arms, and rapid breathing. Rarely, cyanosis (lack of oxygen in the blood causing a bluish color to the skin), Horner's syndrome (constricted pupil, drooping eyelid, and no sweating on one side of the face), and a paralyzed vocal cord may also be present.

SVCS is usually a sign of locally advanced lung cancer. Survival depends on the status of the patient's disease. Most non-Hodgkin's lymphoma patients with SVCS respond to appropriate chemotherapy or to combined types of treatment.


Causes

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Nearly 95% of superior vena cava syndrome cases are attributed to cancer, with the most common cause being small cell lung cancer, followed by squamous cell lung cancer, adenocarcinoma of the lung, non-Hodgkin's lymphoma, and large cell lung cancer. Another cause in cancer patients is a blood clot associated with intravenous catheters or pacemaker wires. A rare cause of superior vena cava syndrome is an infection of the mediastinum (in the chest), that causes thickening and hardness of the mediastinal tissues. Other rare causes of superior vena cava syndrome include metastatic germ cell tumors, metastatic breast cancer, colon cancer, Kaposi's sarcoma, cancer of the esophagus, fibrous mesothelioma (cancer of the epithelium), Bechet's syndrome (a disease of the immune system), thymus tumor, thyroid tumor, Hodgkin's lymphoma, and sarcoidosis (disease of the lymph nodes that acts like tuberculosis).

The major veins connected to the right atrium (a chamber of the heart) are the superior vena cava and the inferior vena cava. The superior vena cava returns blood from the upper body to the heart, and the inferior vena cava returns the blood from the lower part of the body. Two valves in the right atrium connect these two major veins and control the flow of the blood into the heart. The superior vena cava is thin-walled, and the blood is under low pressure. It lies near lymph nodes in the chest. Therefore, when the lymph nodes or the aorta of the heart get bigger, the superior vena cava is squeezed, blood flow slows, and complete blockage may occur.

The speed of the blockage and its location determine the seriousness of the syndrome. The more rapidly the obstruction occurs, the more severe the symptoms, since the other veins do not have time to widen to adjust to the increased blood flow. If the blockage occurs above where the superior vena cava and inferior vena cava meet, the syndrome is less obvious, since the veins can swell more easily and handle the increased blood flow. If the blockage occurs below this point, more symptoms are seen, since the blood must be returned to the heart by the veins in the upper abdomen and the inferior vena cava, which requires higher pressure.

Sometimes, the other veins can take over for the superior vena cava if it is obstructed, but this takes time.


Diagnosis

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Once superior vena cava syndrome is recognized, prompt attention is important. A definite diagnosis should be made before starting therapy because most patients have symptoms for longer than 1 week before getting medical help; cancer patients diagnosed with superior vena cava syndrome do not die of the syndrome itself but rather from the cancer; and 3% to 5% of patients diagnosed with superior vena cava syndrome do not have cancer.

As long as the trachea is not blocked, superior vena cava syndrome is not usually a life-threatening emergency; therefore, a definite diagnosis should be made before treatment is begun.

A chest x-ray, computed tomography (CT) scanning of the chest, imaging of the veins, magnetic resonance imaging, and ultrasound may all be used in determining the site and type of blockage.

If lung cancer is suspected, a sputum specimen should be collected. If the sputum specimen is negative, a biopsy may be taken. The results of the biopsy will help the doctor decide on the best treatment.


Treatment

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Treatment of superior vena cava syndrome depends on the cause of the obstruction, the seriousness of the symptoms, the prognosis of the patient, and the patient's preferences. Radiation therapy and chemotherapy should not be started until the cause of the blockage is determined. The treatments discussed in this summary will focus on superior vena cava blockage caused by cancer. Since the treatment of the blockage may depend on the type of cancer, this diagnosis should be made before treatment is started. Unless the airway is blocked or the brain is swelling, waiting to start treatment usually presents no problem. The following treatments can be used for superior vena cava syndrome.


Medical Management

A patient with good blood flow through other veins and few symptoms may not need treatment. If the blockage is above the area where the superior and inferior vena cava veins join, and other veins are able to take over for the superior vena cava, the symptoms may stabilize and the patient may be comfortable enough to forego more therapy. Short-term relief for a patient who has symptoms, but who does not want aggressive treatment, may include raising the head, using corticosteroids, and increasing elimination of fluids using drugs such as diuretics. Diuretics may help symptoms of swelling, but can cause problems such as dehydration.


Radiation Therapy

If the blockage of the superior vena cava is caused by a tumor that is not sensitive to chemotherapy, radiation therapy may be given.


Chemotherapy

Chemotherapy is the treatment of choice for sensitive tumors such as lymphoma or small cell lung cancer. The presence of superior vena cava syndrome should not change the treatment approach. The rapid start of chemotherapy can result in complete and partial response rates of superior vena cava syndrome of more than 80% in small cell lung cancer.


Thrombolysis (Breaking Up Blood Clots)

Superior vena cava syndrome may come about when a thrombus (blood clot) forms in a partially blocked vein. Patients who have blood clots may need treatment to dissolve or remove the blood clot.


Stent Placement

A stent may be used to open up the blocked vein. A stent is a tube like device that is inserted into the blocked area of a vein to allow blood to pass through. This may help about 90% or more of patients. Sometimes, patients may also receive an anticoagulant to keep more blood clots from forming.


Surgery

Surgical bypass of a blocked superior vena cava is used more often for patients without cancer, although it is used sometimes for cancer patients with blockages caused by cancer.


Social Considerations

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Patients and family members are often frightened and anxious because of the symptoms of superior vena cava syndrome, particularly swelling, trouble swallowing, coughing, and hoarseness. Patients and their families should receive information about the cause of symptoms and their short-term treatment. When aggressive treatment is refused because of terminal cancer, patients and family members can be taught to treat symptoms.

Because most adult patients who develop superior vena cava syndrome have lung cancer, the type of treatment and care prescribed should take into account the patient's prognosis and other symptoms caused by the cancer.


Superior Vena Cava Syndrome Occurring in Children

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Superior vena cava syndrome refers to blockage of the superior vena cava, while the squeezing of the trachea (windpipe) is called superior mediastinal syndrome. Since superior mediastinal syndrome and the resulting breathing problems frequently occur in children with superior vena cava syndrome, the two syndromes are considered to be the same in children. In adults, the windpipe is fairly rigid, but in children it is softer and more likely to be squeezed shut. Also, the diameter of a child's windpipe is smaller, so any amount of swelling can cause breathing problems. Therefore, superior vena cava syndrome is different from the syndrome in adults and is a serious medical emergency.

The most common symptoms in children are similar to those in adults and include coughing, hoarseness, difficulty breathing, and chest pain. Other less common but more serious symptoms include anxiety, confusion, tiredness, headache, vision problems, a sense of fullness in the ears, and, especially, fainting.

Superior vena cava syndrome is rare in children and appears in 12% of children with cancer in the chest. The cause, diagnosis, and treatment of superior vena cava syndrome in children is not the same as it is in adults. While the most common cause of superior vena cava syndrome in adults is lung cancer, in children it is non-Hodgkin's lymphoma. As with adults, a frequent noncancerous cause is a blood clot associated with an intravenous catheter.

A physical examination, chest x-ray, and medical history are usually all that are needed to determine the diagnosis of superior vena cava syndrome. If lymphoma or another cancer is suspected, a biopsy is helpful for the diagnosis, but may be too dangerous for the child. Children with superior vena cava syndrome do not tolerate general anesthesia well because of its effect on the heart and lungs.

When cancer is the cause of superior vena cava syndrome, the situation may be a medical emergency, with no time to diagnose the cancer with tissue. In most cases, the best approach is to start treatment before a definite diagnosis is made. Radiation therapy is usually used to treat the tumor. After radiation therapy, breathing may become more difficult because of the rapid swelling that narrows the windpipe. In these situations, it may be necessary to give a drug that reduces swelling.

Along with radiation, chemotherapy with steroids, cyclophosphamide, or both with other drugs may be used. If the tumor does not respond, it may not be cancerous. If necessary, surgery may be performed.


Questions or Comments About This Summary

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If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.


To Learn More

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Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office
  • Suite 3036A
  • 6116 Executive Boulevard, MSC8322
  • Bethesda, MD 20892-8322


About PDQ®

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PDQ® is a comprehensive cancer database available on NCI's Web site.

PDQ® is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ® is available online at NCI's Web site. PDQ® is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ® contains cancer information summaries.

The PDQ® database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ® cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ® also contains information on clinical trials.

Some patients have symptoms caused by cancer treatment or by the cancer itself. Patients who have symptoms related to cancer treatment may want to take part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During supportive care clinical trials, information is collected about new treatment methods, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ® and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ®. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


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