ONCOLOGIC

EMERGENCIES

SUPERIOR VENA CAVA

SYNDROME

Signs and Symptoms

Signs and symptoms related to compression or
obstruction of the SVC caused by anterior
mediastinal mass:
Orthopneea
Headache
Facial swelling
Dizziness or fainting
Change in color, especialy sudden pallor

Clinical presentation
Physical examination may show:
Plethoric, edematous face and neck
Jugular venous distention
Papliedema
Pulsus paradoxus
Blood presure change
Pallor and even cardiorespiratory arrest with
postural changes
+/- traheal compression: cough, dyspneea, air
hungar, stridor, cyanosis

Superior Vena Cava Syndrome

Causes
Malignant tumors primary cause of SVCS
Non-Hodgkin lymphomas (lymphoblastic lymphoma)
Hodgkins disease
Acute lymphoblastic leukemia (T-cell phenotype)
Malignant teratoma
Thyroid cancer
Lung cancer
Neuroblastoma
Rhabdomyosarcoma

Superior Vena Cava Syndrome

Diagnosis
Diagnosis should be established by the least invasive
measures, because circulatory collapse or respiratory
failure may occure in patients receiving general
anesthesia or sedation.
Bone morrow aspiration, pleurocentesis,
pericardocentesis or limph node biopsy with local
anesthesia.
If the patient cannot tolerate anesthesia and a tissue
diagnosis is unobtainable, empiric therapy is
necessary.

Superior Vena Cava Syndrome

Treatment:
Radiation therapy has been the mainstay of
treatment
Chemotherapy
Steroids
Radiation therapy, chemotherapy or steroids
may rander the histologic diagnosis
uninterpretable within 48 hours.

SPINAL CORD COMPRESSION

Epidemiology
5-10% adult cancer patients
3-5% of children solid malignant tumors
Common tumor types:
- Adults: breast, lung, prostate, lymphoma, renal,
melanoma, sarcoma
- Children: Ewing sarcoma, neuroblastoma,
osteosarcoma, RMS, Hodgkins disease, soft tissue
sarcoma germ cell tumors

Pathogenesis
Hematogenous:
- extension via venous foramina to epidural space
Direct extension:
- extension via intervertebral foramina
Venous obstruction
White matter edema
Axonal swelling
Myelin brakedown
Decrease blood flow in to the compressed section
and caudaly

Presentation
Pain:
- beck pain , localized or radicular
- agravated by movement, neck flexion
Motor symptoms
Sensory symptoms
Sphyncter dysfunction

Diagnosis
Plan X-rays (30% abnormal)
Bone scan less helpful in identifying
the cause of the compression
MRI - the imagine modality of choice
CSF - provide nonspecific information

Management

Corticosteroids
Surgery
Radiation treatment
Chemotherapy

Treatment
Corticosteroids:
- improve outcome
- Dexamethazone :1 mg/kg
Surgery:
Laminectomy ( removal of the posterior arch of the spinal
canal)
- if primary tumor unknown
- can not rezect anterior or vertebral body disease
- progressive kyphosis and neuro- deficits
Surgically treated children develop kyphosis requiring
further treatment

Treatment
Radiation therapy:
- none superior over the other
- used in radiosensitive tumors in which the diagnosis
is known
Chemotherapy:
- may be considered for chemo-sensitive tumors
- NHL, neuroblastoma, Ewing tumor, germ cell
tumors
Surgery is not superior to medical treatment in chemosensitive tumors

Conclusions
Do not ignore beck pain!
Early diagnosis and treatment are essential
Prognosis of neurologic recovery:
- patients who are ambulatory at diagnosis usualy
remain ambulatory
- patient who are not ambulatory: 50% regain the
ability to ambulate
- children who are not ambulatory at diagnosis fare
better than do adults

INCREASED INTRACRANIAL
PRESSURE

Causes
Brain tumors
- infratentorial tumors block the third or
fourth ventricle
- Astrocytomas
- Medulloblastomas
- Craniopharingioma, germinomas,
optic gliomas, pituitary tumors

Clinical presentation
Varies according to age:
Infant:
- personality changes,
- lethargy
- loss of previously acquired motor skills
- seizures
- Increased in head circumference
Older children/adults:
- Headache: recurrent, with/without vomiting on arising in the
morning
- diplopia, ataxia, hemiparesis, speech disturbance, neck
stiffness, lethargy, coma

Management
Intake: 75% maintenance
Dexamethasone: 0,5- 1 mg/kg
CT scan of the brain to determine the cause
Diuretics: mannitol 20%: 1-2g/kg
Acetazolamide: 5 mg/kg reduce CSF
production
Antiseizure treatment or prophylaxis
Surgical resection of the tumor