Emergencies in Malignacy

Hery Agung S.A

1. Superior Vena Cava Syndromme (SVCS)

2. Febrile Neutropenia

Superior Vena Cava

Syndromme
A group of symptoms
Direct obstruction of the Superior Vena

Cava
By malignancies (bronchogenic carcinoma,
mediastinal lymphadenopathy, right upper
lobe lung cancer)
Others (tuberculosis, stenosis, thrombosis
=> rare)

Etiologies
Lung Cancer, NHL
Metastatic breast cancer, HL, thymus Ca,

Thyroid Ca, Esophageal Ca

Thrombosis
Infection
Sarcoidosis

Common symptom and sign

Dyspneu
Coughing
Swelling in the face, neck, upper body, arms
Pembertons sign
Horase voice
Disphagia
Swollen veins in chest or neck
Reddish skin color

Examination
CT scan Thoraks
Venograf
Chest X-Ray
MRI, PET, USG

Treatment
Depends on etiologies
Relieve the symptom
Sometimes urgencies (theraphy can be

delayed until Dx is clear if the patient is

stable)

Modalities
Radiotheraphy
Chemotherapy
Endovaxcular theraphy
Corticosteroid

Radiotheraphy
Fast relieve (below 72 hours)
70-90% free from symptom for 2 weeks
Reccurence: 10-19%
Tailor-made dose (depends on individual

and the malignancies)

Chemotheraphy
Alternative theraphy for chemo-sensitive

case

Endovascular
Complete resolution 68-100% in metalic

stent
Reccurebce: 4-45%
Complication: Stent misplacement (10%),
stent migration (5%), stent occlution (10%),
aritmia

Corticosteroid
Maybe helpful in lymphoma or thymoma (or

othersteroid-responsive malignancies)
Not recommended to SVCS due to lung
cancer or other cause
Decrease the inflmmatory response to
tumor invasion and edema surrounding the
tumor

Febrile Neutropenia
oral temperature >38.5C or two

consecutive readings of >38.0C for 2 h and

an absolute neutrophil count <0.5 10 9/l, or
expected to fall below 0.5 109/l

Mortality
Overall mortality rates are 5% in patients

with solid tumours (1% in low risk patients)

and as high as 11% in some haematological
malignancies
18% in Gram-negative and 5% in Grampositive bacteraemia
Mortality varies according to the MASCC
prognostic index

MASCC Scoring Index

References
Michael S Beeson, SVCS, in emergency Medicine available

from emedicine.medscape.com/article/760301-clinical
McCurdy MY, Shanholtz CB, Superior Vena Cava Syndrome,
available from pulmccm.org/2012/review-articles/camcerrelated-medical-emergencies-superior-vena-cavasyndrome/
Anonym, Superior Vena Cava Syndrome, available from
www.cancer.gov
/cancertopics/pdq/supportivecare/cardiopulmonary/Patient/
page5#Keypoint15
J. de Naurois, Novitzky-Basso, M. J. Gill, et al, Management
of febrile neutropenia: ESMO Clinical Practice Guidelines,
Annals of Oncology 21 (Supplement 5): v252v256, 2010

NCCN, Prevention and treatment of cancer

related Infection, 2009, available from

www.oralcancerfoundation.org/treatment/pd
f/infections-NCCN.pdf
Rachmat S, Iman S,Panji I, et al, Hematologi
dan onkologi medik, 2008, Sub Bagian HOM
dan PII bag IPD FKUNPAD, p,320-2