LWBK1006-39 LWW-Govindan-Review December 12, 2011 20:30
506 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology ReviewANSWERS
Answer 39.1. The answer is A.
Malignant disease is the most common cause of SVC syndrome. Among
the malignancies, the most common is small cell lung cancer, followed by
squamous cell lung cancer and lymphoma in most series. Diffuse large
B-cell lymphoma and lymphoblastic lymphoma are the most common
among lymphomas that cause SVC syndrome. Although Hodgkin’s dis-
ease frequently involves mediastinum, it rarely causes SVC syndrome.
Breast cancer is the most common metastatic cancer that causes SVC syn-
drome. Nonmalignant condition causing SVC syndrome is increasingly
becoming more common because of the use of vascular devices, which
can result in SVC thrombosis.Answer 39.2. The answer is C.
Studies have shown that both radiation therapy and chemotherapy are
equally effective in relieving symptoms in small cell lung cancer and lym-
phoma. Surgery is not a good option for this patient with extensive-stage
small cell lung cancer, and an SVC stent may be used in case of lack of
response or relapsed obstruction after initial therapy. Although radiation
could be used for immediate symptomatic relief, combination chemother-
apy is also very effective and preferable as initial therapy, avoiding the
large radiation field and also addressing the metastatic lesions.Answer 39.3. The answer is D.
The SVC extends from the junction of the right and left innominate veins
to the right atrium and is completely encircled by lymph node chains
draining from the right thoracic cavity and lower part of the left thorax.
Approximately 80% of the tumors causing SVC syndrome are located in
the right lung. In the absence of mediastinal lymph node enlargement, the
most likely cause of the SVC is direct extension from the centrally located
right-sided tumor.Answer 39.4. The answer is A.
Absence of venous pulsations within the center of the optic disk is usually
one of the earliest signs of increased intracranial pressure, with blurring
of the optic disk and hemorrhage occurring at later stages. The Foster-
Kennedy syndrome, characterized by ipsilateral optic atrophy and con-
tralateral papilledema, is rarely seen late event.Answer 39.5. The answer is B.
Although most patients with malignant spinal cord compression (MSCC)
have a history of malignancy, approximately 20% develop this complica-
tion at the initial presentation. Breast cancer is a common cause of MSCC
during the course of the disease, but this manifestation rarely occurs at
presentation. Colon cancer is an uncommon cause of MSCC, and prostate