Superior vena cava obstruction (SVCO) in palliative care
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Superior vena cava obstruction is an emergency and needs urgent medical attention. Help patients to get an early diagnosis and treatment by knowing who is at risk and the symptoms.
On this page:
What is superior vena cava obstruction?
Superior vena cava obstruction (SVCO) can happen when the superior vena cava (SVC) is blocked or compressed by a tumour.
The SVC is a large vein that carries blood from the upper body to the heart. Tumours can press on the SVC or cause a blood clot (thrombus), reducing the flow of blood. This causes pressure to build up in the head, neck and arms.
Patients most at risk of superior vena cava obstruction
SVCO is most common in patients with lung cancer but can also be caused by lymphoma and metastases from breast, bowel and other cancers.
Signs and symptoms of superior vena cava obstruction
The signs and symptoms of SVCO are caused by increased pressure in the head, neck and arms. The pressure can increase over days or weeks. Signs and symptoms include:
- headache or feeling of fullness in the head, made worse by bending or lying down
- breathlessness
- swollen veins in the neck and chest
- swelling of the face, neck, arms and hands
- changes to vision
- dizziness.
Symptoms can also include some or all of the following changes to their skin:
Change in the colour of their face
People with lighter skin tones may have redness in their face, and people with darker skin tones may have red or purple colouring in their face. The change in colour might be less obvious on darker skin tones, but may still be visible on close inspection.
Blue skin
On lighter skin tones this can be seen on the skin, lips or tongue. On darker skin tones, blue may be easier to see on the lips, tongue, gums, under the nails or around the eyes.
If you suspect superior vena cava obstruction
If you think a patient may have SVCO:
- contact their GP, hospital acute oncology team, palliative care team or specialist nurse immediately
- loosen clothing around their neck and arms
- make sure they're comfortable
- sit them up so their head is raised and support their upper arms on pillows, only if it does not cause discomfort or stress.
SVCO can be frightening and distressing for the patient and those around them. Explain what is happening and reassure them that help is coming.
Depending on the patient's needs and wishes, the medical team may assess them and arrange a CT scan to confirm the diagnosis. If treatment is appropriate, options may include:
- oxygen
- painkillers
- steroids
- anticoagulants (medicines to help stop the blood clotting)
- chemotherapy
- radiotherapy
- surgery to insert a stent (tube that keeps the blocked blood vessel open) in the SVC.
Useful resources
Scottish Palliative Care Guidelines: Superior Vena Cava Obstruction
Key points
- SVCO is a palliative care emergency that can affect people with cancer.
- Be aware of the common signs and symptoms.
- If you suspect SVCO, get help immediately. Know who to call in your area.
- SVCO can be very distressing for the patient and those around them.
- Stay calm and explain what’s happening to the patient and those important to them.
Let us know what you think
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Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
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