Diagnostic and therapeutic management of superior vena cava syndrome

Background: Superior vena cava syndrome (SVCS) is the clinical expression o f obstruction of blood now through the superior caval vein. In more than 80 % of patients this complication is due to a malignant tumor, and in 60% of cases the first symptom of this tumor. Diagnosis and Treatment: If the clinical course of SVCS represents an absol ute emergency, irradiation may have to be started immediately, even before the histologic diagnosis is established Alternatively, expandable metallic stents have been used with considerable success for treatment of vena caval obstruction since patients respond immediately after stent implantation. F or diagnosis, a chest X-ray and a CT scan should be performed. Chemotherapy is the treatment of choice for high-grade lymphomas, germ cell tumors and small-cell lung cancer since this modality is mon effective than radiothera py response rate: 80%). For less chemotherapy responsive tumors radiotherap y is the primary treatment. Successful experience with thrombolytic agents is limited to treatment of catheter-induced SVCS, in contrast, only 20% of patients respond to thrombolytic therapy in the absence of a central cathet er. Surgical resection of SVCS associated tumors has not improved survival rates and should be avoided.