Clinical Approach Defined for Superior Vena Cava Syndrome

New Haven, Conn. — Yale Cancer Center physicians have presented clinical recommendations for the diagnosis and subsequent treatment of superior vena cava syndrome in this week’s issue of the New England Journal of Medicine.

The article in Clinical Practice dispels misconceptions related to superior vena cava syndrome, provides clinical management evidence, and presents a case study for review.

Lead author Lynn D. Wilson, M.D., MPH, Professor, Clinical Director, and Vice Chairman of the Department of Therapeutic Radiology at Yale School of Medicine, urges physicians evaluating patients who present with superior vena cava syndrome to evaluate the patient in a multidisciplinary fashion.

“The superior vena cava syndrome is often clinically striking, but rarely requires emergency intervention,” Wilson said. “The majority of cases are due to a malignant condition and treatment planning should be multidisciplinary with input from medical, radiation, and surgical oncologists.”

Superior vena cava syndrome occurs in approximately 15,000 people in the United States each year, and 65 percent of the cases are caused by malignancies. Of the cases caused by cancer, 72 percent result from lung cancer, 12 percent from lymphoma, nine percent from metastatic cancers, and seven percent from other cancer types. The most common symptom of superior vena cava syndrome is facial edema, which is present in 82 percent of the cases. Arm edema and distended neck and chest veins are also common clinical presentations.

Review of the literature and case studies presented at Yale Cancer Center led the authors to carefully evaluate the management of superior vena cava syndrome. Their findings strongly encouraged the careful evaluation of the patient and, if a malignancy is found, proper staging and treatment planning for the treatment of the cancer. “In the vast majority of patients, definitive treatment of their cancer leads to the relief of the symptoms associated with superior vena cava syndrome. Deterring from a multidisciplinary management plan, and focusing only on the effects of the syndrome, should be discouraged,” Wilson said.

Study co-authors included Dr. Frank C. Detterbeck, Professor of Thoracic Surgery at Yale School of Medicine, and Dr. Joachim Yahalom, Professor of Radiation Oncology at Weill Cornell Medical College and Attending Physician at Memorial Sloan Kettering Cancer Center.

Yale Cancer Center is one of a select network of 39 comprehensive cancer centers in the country designated by the National Cancer Institute and the only one in Southern New England. The Center harnesses the scientific resources of Yale University School of Medicine, Yale-New Haven Hospital, and Yale University. For more information visit the Yale Cancer Center web site.