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Superior vena cava obstruction — SCE Acute Medicine MCQ

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ModerateCancer and Palliative CareSuperior vena cava obstructionSCE Acute Medicine

A 65-year-old smoker presents with facial swelling, dyspnoea and distended chest wall veins. Symptoms are worse when bending forward. Chest radiograph shows a right hilar mass and widened mediastinum. He has no stridor and oxygen saturation is 95% on air. What is the most appropriate next step in management?

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Correct answer: B — Urgent CT chest and tissue diagnosis with oncology involvement

SVCO from suspected lung cancer requires urgent imaging, tissue diagnosis and oncology planning if the patient is stable. Immediate empirical radiotherapy can compromise diagnosis and is reserved for life-threatening compromise when tissue cannot be obtained promptly. Diuretics do not treat the obstruction. The pearl is that airway or cerebral compromise changes the urgency and may justify emergency steroids or stenting.

Reference: NICE NG122 lung cancer; oncological emergency guidance