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 >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

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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 >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

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