There are a number of frequently encountered situations, sometimes known as ‘palliative care emergencies’, where interventions at an early stage can result in reducing disability even in the end stages of life. Superior vena cava obstruction (SVCO) occurs when this large vessel is partially occluded due to tumour growth affecting the vessel, tumour pressure against the vessel, thrombosis or inflammation (Figure 24.1). About 70% of the incidence of SVCO is in patients with lung cancer. Other tumours include lymphomas with mediastinal disease, or metastatic spread from testicular, breast, bowel or oesophageal cancers. It may also be a complication for patients with central line catheters like Hickman lines or apheresis or dialysis lines (Macmillan Cancer Support, 2013). SVCO can sometimes be the presenting problem for the patient, so care is needed before conclusions are drawn or anything is said about possible causes.
Emergencies: superior vena cava obstruction
Palliative care emergencies
Causes
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