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Superior vena cava obstruction — SCE Respiratory MCQ

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HardLung cancerSuperior vena cava obstructionSCE Respiratory

A 58-year-old woman with known lung cancer develops facial swelling, distended neck veins and dyspnoea. CT shows superior vena cava compression from bulky right paratracheal lymphadenopathy, with patent airway and no stridor. Oxygen saturation is 95% on air and she is haemodynamically stable. Histology is not yet confirmed. What is the most appropriate management?

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Correct answer: A — Urgent tissue diagnosis and oncology-led treatment planning

Stable malignant SVC obstruction usually needs urgent tissue diagnosis because treatment depends on histology and molecular subtype. Immediate radiotherapy can compromise diagnostic yield and is reserved for severe compromise or established indications. Endovascular stenting is considered for severe symptoms but does not replace histological planning.

Reference: NICE NG122 Lung cancer; National Optimal Lung Cancer Pathway