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SVCO SCLC Chemotherapy — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesSVCO SCLC ChemotherapySCE Medical Oncology

A 55-year-old woman with cancer develops superior vena cava obstruction from mediastinal lymphadenopathy. She has a tissue diagnosis of SCLC. She is haemodynamically stable with facial swelling and dyspnoea. What is the definitive treatment?

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Correct answer: E — Start systemic chemotherapy urgently (SCLC is highly chemosensitive and often produces rapid SVCO resolution) — SVC stenting is reserved for severe symptoms/haemodynamic compromise or if the histology is unknown and tissue is needed

In SVCO from SCLC (a chemosensitive tumour), systemic chemotherapy is the definitive treatment and often produces rapid improvement within days. SVC stenting is reserved for: (1) severe/life-threatening symptoms not responding to steroids/initial chemotherapy, (2) histology unknown and tissue biopsy needed (stenting provides immediate relief while awaiting diagnosis), (3) chemoresistant tumours. Dexamethasone 16 mg/day provides symptomatic bridging. Head-of-bed elevation and supplemental oxygen are supportive measures. Anticoagulation is considered if concurrent SVC thrombus is present.

Reference: ESMO 2024 Oncological Emergencies; NICE NG122