Tumor Compression Syndromes

Tumor Compression Syndromes is a topic covered in the 5-Minute Emergency Consult.

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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 over 20,000 patients each year
    • Occurs in 5–14% of cancer patients
    • More than 50% of cases are metastases from lung, breast, or prostate cancer.
    • 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):
      • Small cell lung cancer primarily
  • Postirradiation fibrosis
  • Lymphoma
  • Breast cancer
  • Testicular cancer
  • See “Differential Diagnosis” for non malignant etiologies of the SVC syndrome.

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

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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 over 20,000 patients each year
    • Occurs in 5–14% of cancer patients
    • More than 50% of cases are metastases from lung, breast, or prostate cancer.
    • 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):
      • Small cell lung cancer primarily
  • Postirradiation fibrosis
  • Lymphoma
  • Breast cancer
  • Testicular cancer
  • See “Differential Diagnosis” for non malignant etiologies of the SVC syndrome.

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

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