Superior Vena Cava Syndrome in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Superior Vena Cava Syndrome (SVCS) occurs when a person’s superior vena cava is partially blocked or compressed. The superior vena cava is a major vein in a person’s body. It carries blood from the head, neck, upper chest, and arms to the heart. Cancer is usually the main cause of SVCS.
More than 90% of cases of superior vena cava obstruction (SVCO) are caused by cancer – most commonly bronchogenic carcinoma, typically a tumour outside the vessel compressing the vessel wall – but it can, sometimes, have a benign cause.
SVCS is rare in children. However, SVCS in children can be life threatening. If your child has signs of SVCS, it is important to contact your child’s health care team immediately.
A child’s trachea is smaller and softer than an adult’s trachea. This means that it can swell or become constricted quickly, causing breathing problems.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
SVCS is a group of symptoms that usually develop slowly. Because SVCS can cause serious breathing problems, it is an emergency. If you experience any of the symptoms listed below, contact your doctor immediately. Although SVCS is serious and causes symptoms that may be frightening, treatment works well for most people.
Common symptoms of SVCS include:
- Difficulty breathing or shortness of breath
- Swelling of the face, neck, upper body, and arms
Rare symptoms of SVCS include:
- Bluish skin from too little oxygen
- Chest pain
- Coughing up blood from the lungs and throat
- Difficulty swallowing
- Quicker breathing
- Fluid build-up in the arms
- Horner’s syndrome, which includes a constricted pupil, sagging eyelid, and lack of sweat on one side of the face
- Swelling of the veins in the chest and neck
- Vocal cord paralysis
Common Childhood SVCS symptoms are similar to the symptoms that adults experience and may include:
- Chest pain
- Difficulty breathing
SVCS may develop quickly, completely blocking the airway. When this occurs, a person may need a ventilator to help with breathing until the blockage is treated. More commonly, if the blockage develops slowly, other veins may enlarge to carry extra blood. In these situations, the symptoms may be milder.
SVCS is more common for people who have lung cancer, Non-Hodgkin Lymphoma, or cancers that spread to the chest.
However, there are different ways cancer can cause SVCS:
- A tumour in the chest may press on the superior vena cava
- A tumour may grow into the superior vena cava, causing a blockage
- If cancer spreads to the lymph nodes surrounding the superior vena cava, the lymph nodes may enlarge and press on or block the vein
- A blood clot in the vein, caused by a pacemaker wire or an intravenous catheter, which is a flexible tube placed in a vein to take out or put in fluids
The following tests will help your doctor diagnose SVCS:
- Chest x-ray
- Computerised Tomography (CT) scan
- Magnetic Resonance Imaging (MRI)
- Venography, which is an x-ray done after injecting a special dye into the patient’s vein
Sometimes, people with SVCS may not need treatment until SVCS is diagnosed. Or, they may not need treatment right away. This depends on whether the symptoms are mild, the trachea is not blocked, and blood is flowing well through other veins in the chest.
Other short-term treatments can help reduce symptoms of SVCS, including:
- Raising the patient’s head
- Giving corticosteroids, which are medications that reduce swelling
- Using diuretics, which are medications that eliminate excess fluid from the body by increasing urination
- Thrombolysis, a treatment to break up a blot clot in the vein
- Stent placement, which is the insertion of a tube-like device into the blocked area of the vein to allow blood to pass through
- Surgery to bypass a blockage