Version July 2025
CT: computed tomography; GCT: germ cell tumor; NHL: non-Hodgkin lymphoma; NSCLC: non-small cell lung carcinoma; PET: positron emission tomography; RT: radiation therapy; SCLC: small cell lung carcinoma; SVC: superior vena cava.
* Systemic anticoagulation with intravenous heparin is initiated provided there are no contraindications. Transition to oral anticoagulation, which is continued for up to 9 months or indefinitely for patients with a hypercoagulable state related to malignancy.
¶ Endovascular intervention includes catheter-based venography with endovenous mechanical thrombectomy or thrombolysis if thrombus is present, and angioplasty and stenting, as needed for significant stenotic lesions. Stents are used with caution early in the treatment of low-grade lesions over concern for possible stent migration as a result of tumor shrinkage after oncologic therapy. Following intervention, antiplatelet therapy is provided using aspirin with or without clopidogrel depending on whether a stent was placed, and with or without concomitant anticoagulation depending on whether thrombus was present.
Δ Approximately 60% of patients with SVC syndrome present without a pre-existing diagnosis of cancer. In such cases, if the imaging studies are consistent with a malignancy, a histologic diagnosis is required prior to initiating specific antitumor therapy. Some patients with a pre-existing cancer diagnosis may also benefit from repeat biopsy in the setting of tumor progression.
◊ Further imaging, including CT abdomen/pelvis, PET, or other imaging studies may be necessary to complete staging, depending on the likely primary.
§ Selected patients with thymoma/thymic carcinoma or residual mass after the treatment of GCT may benefit from surgical resection. RT is appropriate for radiosensitive tumors.
