Superior vena cava syndrome medical therapy: Difference between revisions
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Short-term palliation of a symptomatic patient who does not want aggressive treatment may be achieved by elevating the head and using [[corticosteroid]]s and [[diuresis]]. There are no definitive studies that prove the effectiveness of [[steroids]], although they are potentially useful to treat respiratory compromise. [[Diuretic]]s may give symptomatic relief of [[edema]] but can ultimately cause systemic complications, such as [[hypernatremia]]. | Short-term palliation of a symptomatic patient who does not want aggressive treatment may be achieved by elevating the head and using [[corticosteroid]]s and [[diuresis]]. There are no definitive studies that prove the effectiveness of [[steroids]], although they are potentially useful to treat respiratory compromise. [[Diuretic]]s may give symptomatic relief of [[edema]] but can ultimately cause systemic complications, such as [[hypernatremia]]. | ||
Palliative measures include | Palliative measures include: | ||
* | * Glucocorticoids ([[Dexametasone]] 4mg q6), although risk is that it will obliterate existing histology in case first biopsy is insufficient | ||
* Head elevation to decrease hydrostatic pressure and cerebral edema | * Head elevation to decrease hydrostatic pressure and cerebral edema | ||
* Remove indwelling catheter (if secondary to thrombosis) | * Remove indwelling catheter (if secondary to thrombosis) |
Revision as of 21:20, 13 January 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Superior vena cava syndrome is a medical emergency and requires prompt treatment. The treatment of SVCS depends on the etiology of the obstruction, the severity of the symptoms, the prognosis of the patient, and patient preferences and goals for therapy.[1]
Medical Therapy
Patients with sufficient collateral blood flow and minimal symptoms may not need treatment. If the lesion is above the azygous vein or if the onset of SVC occlusion is slow enough to allow sufficient collateral circulation, the symptoms and signs may stabilize and the patient may be comfortable enough to forgo further therapy.
Palliative Therapy
Short-term palliation of a symptomatic patient who does not want aggressive treatment may be achieved by elevating the head and using corticosteroids and diuresis. There are no definitive studies that prove the effectiveness of steroids, although they are potentially useful to treat respiratory compromise. Diuretics may give symptomatic relief of edema but can ultimately cause systemic complications, such as hypernatremia.
Palliative measures include:
- Glucocorticoids (Dexametasone 4mg q6), although risk is that it will obliterate existing histology in case first biopsy is insufficient
- Head elevation to decrease hydrostatic pressure and cerebral edema
- Remove indwelling catheter (if secondary to thrombosis)
- Consider loop diuretics (thiazide diuretics)
- Anticoagulation benefit not clear, although some recommend thrombolysis followed by anticoagulation
Chemotherapy
Chemotherapy is the treatment of choice for sensitive tumors such as lymphoma or small cell lung cancer. SVCS does not appear to be an independent prognostic factor, and its presence should not change the treatment approach. Rapid initiation of chemotherapy can result in complete and partial response rates of the SVCS of more than 80% in small cell lung cancer patients.
Thrombolysis
It has been suggested that SVCS arises when a thrombus forms in a partially occluded vein. In patients with a documented thrombus in the SVC, treatment may include thrombectomy, with or without tissue plasminogen activator or other thrombolytic agents such as streptokinase or urokinase.
- Patients and family members are often frightened and anxious because of the symptoms produced by SVCS, particularly swelling, dysphagia, coughing, and hoarseness. It is important to provide information to patients and family members on the cause of the symptoms and on short-term measures for palliation, especially during the diagnostic period. When aggressive treatment is declined because of the terminal nature of the underlying disease, it may be necessary to teach symptom management approaches to patients and family members.
- Because most adult patients who develop SVCS have lung cancer, the treatment and psychologic support measures that are developed for SVCS should take into account the patient’s prognosis and psychologic condition and other symptoms caused by the malignancy.
References
- ↑ Superior vena cava syndrome. Canadian Society of Cancer. http://www.cancer.gov/about-cancer/treatment/side-effects/cardiopulmonary-hp-pdq#link/_117_toc Accessed on January 13, 2016