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Cardiopulmonary Syndromes (PDQ®)

Patient Version
Last Modified: 08/19/2011

Superior Vena Cava Syndrome

Key Points for This Section


Superior vena cava syndrome (SVCS) is a group of symptoms that occur when the superior vena cava is partly blocked.

The superior vena cava is a major vein that leads to the heart. The heart is divided into four parts. The right and left atrium make up the top parts of the heart and the right and left ventricle make up the bottom parts of the heart. The right atrium of the heart receives blood from two major veins:

  • The superior vena cava returns blood from the upper body to the heart.
  • The inferior vena cava returns blood from the lower body to the heart.

Different conditions can slow the flow of blood through the superior vena cava. These include a tumor in the chest, nearby lymph nodes that are swollen (from cancer), or a blood clot in the superior vena cava. The vein may become completely blocked. Sometimes, smaller veins in the area become larger and take over for the superior vena cava if it is blocked, but this takes time. Superior vena cava syndrome (SVCS) is the group of symptoms that occur when this vein is partly blocked.

SVCS is usually caused by cancer.

Superior vena cava syndrome (SVCS) is usually caused by cancer. In adults, SVCS is most common in the following types of cancer:

Less common causes of SVCS include:

Common symptoms of SVCS include breathing problems and coughing.

The symptoms of SVCS are more severe if the vein becomes blocked quickly. This is because the other veins in the area do not have time to widen and take over the blood flow that cannot pass through the superior vena cava.

The most common symptoms are:

  • Trouble breathing.
  • Coughing.
  • Swelling in the face, neck, upper body, or arms.

Less common symptoms include the following:

  • Hoarse voice.
  • Trouble swallowing or talking.
  • Coughing up blood.
  • Swollen veins in the chest or neck.
  • Chest pain.
  • Reddish skin color.

Tests are done to find and diagnose the blockage.

The following tests may be done to diagnose SVCS and find the blockage:

  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A CT scan of the chest will be done to diagnose SVCS.

  • Venography: A procedure to x-ray veins. A contrast dye is injected into the veins to outline them on the x-rays.

  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

  • Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

It is important to find out the cause of SVCS before starting treatment. The type of cancer can affect the type of treatment needed. Unless the airway is blocked or the brain is swelling, waiting to start treatment while a diagnosis is made usually causes no problem in adults. If doctors think lung cancer is causing the problem, a sputum sample may be taken and a biopsy may be done.

Treatment for SVCS caused by cancer depends on the cause, symptoms, and prognosis.

Treatment for SCVS caused by cancer depends on the following:

  • The type of cancer.
  • The cause of the blockage.
  • How severe the symptoms are.
  • The prognosis (chance of recovery).
  • Whether treatment is to cure, control, or relieve the symptoms of cancer.
  • The patient's wishes.

Treatment may include the following:

  • Watchful waiting

    Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless symptoms appear or change. A patient who has good blood flow through smaller veins in the area and mild symptoms may not need treatment.

    The following may be used to relieve symptoms and keep the patient comfortable:

    • Keeping the upper body raised higher than the lower body.
    • Corticosteroids (drugs that reduce swelling).
    • Diuretics (drugs that make excess fluid pass from the body in urine). Patients taking diuretics are closely watched because these drugs can cause dehydration (loss of too much fluid from the body).

  • Chemotherapy

    Chemotherapy is the usual treatment for tumors that respond to anticancer drugs, including small cell lung cancer and lymphoma. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

  • Radiation therapy

    If the blockage of the superior vena cava is caused by a tumor that does not usually respond to chemotherapy, radiation therapy may be given. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

  • Thrombolysis

    SVCS may occur when a thrombus (blood clot) forms in a partly blocked vein. Thrombolysis is a way to break up and remove blood clots. This may done by a thrombectomy. Thrombectomy is surgery to remove the blood clot or the use of a device inserted into the vein to remove the blood clot. This may be done with or without the use of drugs to break up the clot.

  • Stent placement

    If the superior vena cava is partly blocked by the tumor, an expandable stent (tube) may be placed inside the superior vena cava to help keep it open and allow blood to pass through. This helps most patients. Drugs to keep more blood clots from forming may also be used.

  • Surgery

    Surgery to bypass (go around) the blocked part of the vein is sometimes used for cancer patients, but is used more often for patients without cancer.

Palliative care may be given to relieve symptoms in patients with SVCS.

Superior vena cava syndrome is serious and the symptoms can be upsetting for the patient and family. It is important that patients and family members ask questions about superior vena cava syndrome and how to treat it. This can help relieve anxiety about symptoms such as swelling, trouble swallowing, coughing, and hoarseness.

Patients with advanced cancer sometimes decide not to have any serious treatment. Palliative treatment can help keep patients comfortable by relieving symptoms to improve their quality of life.



Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
advanced cancer (ad-VANST KAN-ser)
Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.
anxiety (ang-ZY-eh-tee)
Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.
biopsy (BY-op-see)
The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood clot (blud klot)
A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
bypass (BY-pas)
A surgical procedure in which the doctor creates a new pathway for the flow of body fluids.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
catheter (KA-theh-ter)
A flexible tube used to deliver fluids into or withdraw fluids from the body.
cavity (KA-vih-tee)
A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id)
The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chest x-ray (chest EX-ray)
An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
colon cancer (KOH-lun KAN-ser)
Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
contrast material (KON-trast muh-TEER-ee-ul)
A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
corticosteroid (KOR-tih-koh-STAYR-oyd)
Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland). They are also made in the laboratory. Corticosteroids have many different effects in the body, and are used to treat many different conditions. They may be used as hormone replacement, to suppress the immune system, and to treat some side effects of cancer and its treatment. Corticosteroids are also used to treat certain lymphomas and lymphoid leukemias.
CT scan (… skan)
A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cure (kyoor)
To heal or restore health; a treatment to restore health.
dehydration (dee-hy-DRAY-shun)
A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.
device (dee-VISE)
An object that has a specific use. In medicine, wheelchairs, pumps, and artificial limbs are examples of devices.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diuretic (DY-yuh-REH-tik)
A drug that increases the production of urine.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
esophageal cancer (ee-SAH-fuh-JEE-ul KAN-ser)
Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
germ cell tumor (jerm sel TOO-mer)
A type of tumor that begins in the cells that give rise to sperm or eggs. Germ cell tumors can occur almost anywhere in the body and can be either benign or malignant.
Hodgkin lymphoma (HOJ-kin lim-FOH-muh)
A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.
immune system (ih-MYOON SIS-tem)
The complex group of organs and cells that defends the body against infections and other diseases.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
inferior vena cava (in-FEER-ee-er VEE-nuh KAY-vuh)
A large vein that empties into the heart. It carries blood from the legs and feet and from organs in the abdomen and pelvis.
injection (in-JEK-shun)
Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
intravenous (IN-truh-VEE-nus)
Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.
Kaposi sarcoma (kuh-POH-zee sar-KOH-muh)
A type of cancer characterized by the abnormal growth of blood vessels that develop into skin lesions or occur internally.
lung cancer (lung KAN-ser)
Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
lymph node (limf node)
A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymphoma (lim-FOH-muh)
Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.
metastatic (meh-tuh-STA-tik)
Having to do with metastasis, which is the spread of cancer from the primary site (place where it started) to other places in the body.
monitor (MAH-nih-ter)
In medicine, to regularly watch and check a person or condition to see if there is any change. Also refers to a device that records and/or displays patient data, such as for an electrocardiogram (EKG).
MRI
A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
non-Hodgkin lymphoma (non-HOJ-kin lim-FOH-muh)
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
pacemaker (PAYS-may-ker)
An electronic device that is implanted in the body to monitor heart rate and rhythm. It gives the heart electrical stimulation when it does not beat normally. It runs on batteries and has long, thin wires that connect it to the heart. Also called artificial pacemaker and cardiac pacemaker.
palliative therapy (PA-lee-uh-tiv THAYR-uh-pee)
Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.
prognosis (prog-NO-sis)
The likely outcome or course of a disease; the chance of recovery or recurrence.
quality of life (KWAH-lih-tee ... life)
The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.
radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
recover (ree-KUH-ver)
To become well and healthy again.
regional chemotherapy (REE-juh-nul KEE-moh-THAYR-uh-pee)
Treatment with anticancer drugs directed to a specific area of the body.
response (reh-SPONTS)
In medicine, an improvement related to treatment.
sarcoidosis (SAR-koy-DOH-sis)
An inflammatory disease marked by the formation of granulomas (small nodules of immune cells) in the lungs, lymph nodes, and other organs. Sarcoidosis may be acute and go away by itself, or it may be chronic and progressive. Also called sarcoid.
small cell lung cancer (... sel lung KAN-ser)
An aggressive (fast-growing) cancer that forms in tissues of the lung and can spread to other parts of the body. The cancer cells look small and oval-shaped when looked at under a microscope.
sonogram (SAH-noh-gram)
A computer picture of areas inside the body created by bouncing high-energy sound waves (ultrasound) off internal tissues or organs. Also called ultrasonogram.
sputum (SPYOO-tum)
Mucus and other matter brought up from the lungs by coughing.
stage (stayj)
The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stent (stent)
A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to keep the structure open.
superior vena cava (soo-PEER-ee-er VEE-nuh KAY-vuh)
The large vein that carries blood from the head, neck, arms, and chest to the heart.
superior vena cava syndrome (soo-PEER-ee-er VEE-nuh KAY-vuh SIN-drome)
A condition in which a tumor presses against the superior vena cava (the large vein that carries blood from the head, neck, arms, and chest to the heart). This pressure blocks blood flow to the heart and may cause coughing, difficulty in breathing, and swelling of the face, neck, and upper arms.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
syndrome (SIN-drome)
A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.
systemic chemotherapy (sis-TEH-mik KEE-moh-THAYR-uh-pee)
Treatment with anticancer drugs that travel through the blood to cells all over the body.
thrombectomy (throm-BEK-toh-mee)
Surgery to remove a thrombus (blood clot) from a blood vessel.
thrombolysis (throm-BOL-ih-sis)
The process of breaking up a thrombus (blood clot) that is blocking blood flow. The blood clot may be dissolved using drugs delivered through a catheter (tube) into the clot.
thrombus (THROM-bus)
A blood clot that forms on the wall of a blood vessel or in the heart when blood platelets, proteins, and cells stick together. A thrombus may block the flow of blood.
thymus (THY-mus)
An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.
thyroid cancer (THY-royd KAN-ser)
Cancer that forms in the thyroid gland (an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight). Four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic thyroid cancer. The four types are based on how the cancer cells look under a microscope.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
tuberculosis (too-BER-kyoo-LOH-sis)
A disease caused by a specific type of bacteria that spreads from one person to another through the air. Tuberculosis can affect many parts of the body, but most often affects the lungs. A person may not have symptoms of tuberculosis for years, but they may appear when the patient becomes ill with a serious condition like diabetes, AIDS, or cancer. Tuberculosis can usually be treated and cured with antibiotics. Also called TB.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
ultrasound (UL-truh-SOWND)
A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
urine (YOOR-in)
Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
vein (vayn)
A blood vessel that carries blood to the heart from tissues and organs in the body.
venography (veh-NAH-gruh-fee)
A procedure in which an x-ray of the veins is taken after a special dye is injected into the bone marrow or veins.
ventricle (VEN-trih-kul)
A fluid-filled cavity in the heart or brain.
watchful waiting (WACH-ful WAY-ting)
Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.