Superior vena cava obstruction

If SVCO is suspected, discuss this with an oncologist within 24 hours. The investigation of choice is a CTPA (CT Pulmonary Angiogram). SVCO is usually due to malignant involvement of upper mediastinal lymph nodes or a right upper lobe lung cancer; intraluminal thrombus may also be a feature.

Symptoms and signs: headache, breathlessness, swelling of face and arms, fixed raised JVP, dilated veins on chest wall
and around costal margin.

Initial treatment consists of dexamethasone 16mg daily orally if no contraindications are present aiming to reduce any oedema around the tumour. Gastroprotection should usually be used alongside steroid course.

Definitive treatment may include insertion of a vascular stent, radiotherapy or chemotherapy. If thrombus present, consider anticoagulation if no contraindications.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.