Superior Vena Cava Syndrome

Legendary actor Sherman Hemsley died from a lung cancer complication called superior vena cava syndrome (SVCS).

But what is it?

According to the National Cancer Institute, superior vena cava syndrome is a group of symptoms that occur when the superior vena cava, a major vein that leads to the heart, is partly blocked.

Your Heart: A Quick 101

The heart is divided into four parts. The right and left atrium make up the top parts of the heart and the right and left ventricle make up the bottom parts of the heart. The right atrium of the heart receives blood from two major veins: The superior vena cava, which returns blood from the upper body to the heart, and the inferior vena cava, which returns blood from the lower body to the heart.

Different conditions can slow the flow of blood through the superior vena cava. These include a tumor in the chest, nearby lymph nodes that are swollen (from cancer), or a blood clot in the superior vena cava. The vein may become completely blocked. Sometimes, smaller veins in the area become larger and take over for the superior vena cava if it is blocked, but this takes time.

Superior Vena Cava Syndrome: What Is It?

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Superior vena cava syndrome (SVCS) is the group of symptoms that occur when this vein is partly blocked, and is usually caused by cancer. In adults, SVCS is most common in the following types of cancer:

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• Lung cancer.
• Non-Hodgkin lymphoma (NHL).

However, less common causes of SVCS include:

• A blood clot that forms during the use of an intravenouscatheter (flexible tube used to put fluids into or take blood out of a vein) in the superior vena cava. A clot may also be caused by pacemaker wires.
• Infection or cancer in the chest that causes affected tissues to become thick and hard.
• Other cancers, including metastaticbreast cancer, metastatic germ cell tumors, colon cancer, esophageal cancer, Kaposi sarcoma, Hodgkin lymphoma, thymus cancer, and thyroid cancer.
• Behcet syndrome (a disease of the immune system).
• Sarcoidosis (a disease of the lymph nodes that acts like tuberculosis).

What Are Common Superior Vena Cava Syndrome Symptoms?

Common symptoms of SVCS include breathing problems and coughing. The symptoms of SVCS are more severe if the vein becomes blocked quickly. This is because the other veins in the area do not have time to widen and take over the blood flow that cannot pass through the superior vena cava.

The most common symptoms are:

• Trouble breathing
• Coughing
• Swelling in the face, neck, upper body, or arms

Less common symptoms include:

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• Hoarse voice
• Trouble swallowing or talking
• Coughing up blood
• Swollen veins in the chest or neck
• Chest pain
• Reddish skin color

How Is Superior Vena Cava Syndrome Diagnosed?

Tests are done to find and diagnose the blockage issues. The following tests may be done to diagnose SVCS and find the blockage:

• Chest x-ray
• CT scan (CAT scan)
• Venography
• MRI (magnetic resonance imaging)
• Ultrasound

How Is Superior Vena Cava Syndrome Treated?

It is important to find out the cause of SVCS before starting treatment. The type of cancer can affect the type of treatment needed. Unless the airway is blocked or the brain is swelling, waiting to start treatment while a diagnosis is made usually causes no problem in adults. If doctors think lung cancer is causing the problem, a sputum sample may be taken and a biopsy may be done.

Treatment for SCVS caused by cancer depends on the following:

• The type of cancer.
• The cause of the blockage.
• How severe the symptoms are.
• The prognosis (chance of recovery).
• Whether treatment is to cure, control, or relieve the symptoms of cancer.
• The patient’s wishes.

An Alternative Treatment: Watchful Waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless symptoms appear or change. A patient who has good blood flow through smaller veins in the area and mild symptoms may not need treatment.