Superior vena cava obstruction in small-cell lung cancer

Le syndrome cave supérieur est l’expression clinique de la compression de la veine cave supérieure par un processus gênant le retour du sang veineux vers le cœur. Les étiologies sont nombreuses, actuellement dominées par les causes tumorales. Le diagnostic est clinique. La sévérité du tableau clinique dépend essentiellement de la rapidité d’installation du syndrome cave, pouvant être à l’origine d’un œdème laryngé ou cérébral mettant en jeu le pronostic vital. En dehors de ces deux situations qui nécessitent une prise en charge immédiate, une biopsie est nécessaire avant l’instauration de tout traitement. Celui-ci doit être multidisciplinaire, intégrant radiothérapie, chimiothérapie et traitement endovasculaire, et dépendra essentiellement de la sévérité des symptômes, du type et du stade tumoral, mais également de l’état général du patient.

Superior vena cava syndrome comprises various symptoms and signs resulting from the obstruction of the superior vena cava and resulting in reduced blood flow. Superior vena cava may occur secondary to a variety of conditions, but malignant etiologies are the most common. Usually, the diagnosis is based on a quite clear clinical presentation. Patient with acute presentation can develop life-threatening complications such as cerebral or laryngeal edema. In the absence of these two conditions, a histologic diagnosis should be obtained before the initiation of any therapy. Management of superior vena cava syndrome requires a multidisciplinary team. Therapeutic approaches include radiotherapy, chemotherapy and endovascular approach, and the choice of therapy will depend on the severity of the symptoms, the type and the stage of the tumor, but also the patient's general condition.

A 58-year-old man presents with a 2-week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. There is no history of syncope or dysphagia. He smoked cigarettes until 5 years ago. The physical examination reveals a heart rate of 105 beats per minute, a respiratory rate of 20 breaths per minute, and superficial vascular distention over the neck, chest, and upper abdomen. Stridor is not present. How should his case be evaluated and managed?

A 58-year-old man presents with progressive dyspnea on exertion and neck swelling. The physical examination reveals a heart rate of 105 beats per minute and superficial vascular distention over the neck, chest, and upper abdomen. How should his case be evaluated and managed?

Foreword

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.

Stage

A 58-year-old man presents with a 2-week history of progressive dyspnea on exertion, neck swelling, decreased appetite, and fatigue. There is no history of syncope or dysphagia. He smoked cigarettes until 5 years ago. The physical examination reveals a heart rate of 105 beats per minute, a respiratory rate of 20 breaths per minute, and superficial vascular distention over the neck, chest, and upper abdomen. Stridor is not present. How should his case be evaluated and managed?

The Clinical Problem

The superior vena cava syndrome, which occurs in approximately 15,000 persons in the United States each year, encompasses a . . .