Tumor Compression Syndromes

Basics

Description

  • Complications arising from the compression of neural or vascular structures by solid tumors or their direct infiltration of such structures
  • Spinal cord compression:
    • Affects >20,000 patients each year
    • Occurs in 5–14% of cancer patients
    • More than 90% of cases are metastases from lung, breast, prostate cancer, multiple myeloma, Hodgkins, and non-Hodgkins lymphoma
    • In children sarcomas and neuroblastomas are the most frequent causes
    • Vertebral metastases are far more common than epidural spinal cord compression (ESCC)
    • Approximately 20% of cases of ESCC represent the initial manifestation of malignancy
  • Other neurologic tumor compression:
    • Brachial plexus
    • Recurrent laryngeal nerve compression by mediastinal lymph nodes
  • Superior vena cava (SVC) syndrome:
    • Obstruction of returning blood flow in the SVC by compression, infiltration, or thrombosis
    • Venous hypertension within the area ordinarily drained by the SVC
    • In severe cases, gradual elevation of the intracranial pressure (ICP), with altered mental status and coma
    • 60–85% caused by malignancy

Etiology

  • Spinal cord compression:
    • Prostate cancer
    • Breast cancer
    • Lung cancer
    • Renal cell carcinoma
    • Multiple myeloma
    • Melanoma
    • Thyroid cancer
    • Lymphoma
    • Sarcoma
  • Brachial plexus compression:
    • 0.4% of cancers
    • 2–5% of those who receive radiation treatment
    • Lung cancer
    • Breast cancer
  • SVC syndrome from tumor compression:
    • Lung cancer (most common):
      • Non–small-cell lung cancer primarily (50%)
      • Small-cell lung cancer (25%)
    • Non-Hodgkins lymphoma (10%)
    • Incidence due to thrombosis rising due to use of intravascular devices such as catheters and pacemakers
    • Postirradiation fibrosis
    • Lymphoma
    • Breast cancer
    • Testicular cancer
    • See Differential Diagnosis for nonmalignant etiologies of the SVC syndrome

Pediatric Considerations
In children with spinal cord compression, common causes are sarcoma, neuroblastoma, germ cell tumors, and lymphoma

There's more to see -- the rest of this topic is available only to subscribers.