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Superior vena cava syndrome — ABIM Board MCQ

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HardHematology/OncologySuperior vena cava syndromeABIM Board

A 60-year-old man has facial swelling, orthopnea, and dilated chest-wall veins. CT shows a mediastinal mass compressing the superior vena cava. He is oxygenating normally, has no stridor, laryngeal edema, syncope, or neurologic deficit, and has not yet had a biopsy. What is the most appropriate next step?

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Correct answer: B — Obtain tissue diagnosis and staging before selecting tumor-directed therapy

The best answer is “Obtain tissue diagnosis and staging before selecting tumor-directed therapy”. In the absence of airway compromise or cerebral edema, SVC syndrome usually permits diagnostic clarification. Histology matters because small-cell carcinoma, lymphoma, non-small-cell carcinoma, and nonmalignant thrombosis require different treatment. Supportive positioning and symptom management continue while the least risky biopsy is arranged. Empiric radiation can obscure diagnosis and is reserved for a true emergency in which tissue cannot first be obtained.

Reference: NCI PDQ: Cardiopulmonary Syndromes—Superior Vena Cava Syndrome: https://www.cancer.gov/about-cancer/treatment/side-effects/cardiopulmonary-hp-pdq