Clinically , the patient has an SVCO. At this time, the increase dose
of morphine per se is unlikely to be helpful if the underlying SVCO is not
managed. A blanket increase of Morphine should not be done at this point.
Superior Vena Cava Obstruction (SVCO)
Malignant mediastinal lymphadenopathy can result in SVCO. The most common cause
is lung cancers (causing 60-70% of malignant SVCOs) especially small cell lung
cancer. Other causes of malignant SVCO include breast cancer, lymphoma and germ
cell tumor.
Patients present with facial and neck swelling, dyspnea, headaches, chest wall
distension and occasionally syncope. SVCO is a palliative care urgency and requires
prompt attention.
Treatment depends on anticipated life expectancy:
Hours to days: These patients may be too ill to tolerate most interventions.
Consider oral steroids to decrease lymphadenopathy, symptomatic management
of dyspnea, headaches etc.
Days to weeks or more: Patients with lymphoma or small cell lung cancer
are often treated with palliative chemotherapy. Patients with non-small cell
lung cancer are palliated with radiation therapy (RT) with or without stent
placement during or after RT. Patients with lymphoma and germ cell tumor may
be candidates for curative RT.
Mr. Silver was treated with an accelerated course of radiation therapy and
continued on the Decadron with significant improvement in his breathlessness.
