Symptoms - Face and Neck Swelling

If you have lung cancer, you know it can cause many symptoms. One possible symptom is swelling of the face and neck. This may be the result of a condition called superior vena cava syndrome (SVCS) that can occur with lung cancer.^1-4

What is the superior vena cava?

To understand SVCS, it is helpful to know your way around the inside of your chest. You can think of your chest’s blood vessels as streets and highways on a road map.^1,2

Your blood is like traffic, traveling to and from your heart. One-way streets and highways carrying traffic to the heart and lungs are veins. All veins meet at a superhighway – your superior vena cava (SVC). This large vein leads to your heart, then lungs, where traffic can get fuel (oxygen).^1,2,5

Once the traffic is all fueled up, it heads back out of the heart. It passes through the other superhighway (aorta) to the other one-way streets and highways (arteries). These lead back to all the places in your body.^1,2

How can lung cancer cause superior vena cava syndrome?

Your SVC runs alongside the right lung and other structures in your inner chest. It is so close that lung tumors can form roadblocks in or around your SVC. This can slow blood flow, which can lead to other roadblocks like blood clots.^1,2,5,6

Over time, your body can create detours to the unblocked area of the SVC. It simply uses smaller veins and arteries. But those blood vessels are not used to the new amount of blood running through them, and they swell. Blood can back up into your head and neck. This may lead to visible face and neck swelling.^1,5,6

Besides swelling of your face and neck, you may notice:^1-5,7

• Swelling in your arms and/or chest
• Chest pain
• Breathing problems (shortness of breath or cough)
• Swallowing problems
• Voice hoarseness
• Trouble thinking clearly
• Headaches
• Worsening symptoms when you bend over or lie flat

Who develops superior vena cava syndrome?

According to a 2024 study review, SVCS only happens to about 2 to 4 people out of 100 with lung cancer. Most are between 40 and 60 years old, and more are men than women. The number of people with SVCS varies with the type of lung cancer:^1,2,5

• 60 percent do not know they have cancer before swelling starts.
• 60 to 85 percent have a cancer tumor in their inner chest.
• 50 percent have non-small cell lung cancer.
• 22 to 35 percent have fast-growing small-cell lung cancer.
• 15 to 40 percent do not have a tumor. A blood clot, implanted device, or an infection may be causing their symptoms.

How is SVCS diagnosed?

First, your doctor may take an X-ray of your inner chest. If you have SVCS, your X-ray may show a mass. If it does, your doctor may take a sample of that mass and examine it. This is called a biopsy.^1,5,6

If the mass is cancerous, your doctor may request a contrast enhanced computed tomography (CECT) scan. This creates more detailed images of your inner chest. They use a special dye to highlight what is going on with your veins and SVC. The CECT results help them decide what action to take next.^1-5,7

Doctors may also make a vivid picture of just your veins (venogram). In a venogram, they inject dye into your veins to show the exact size and location of the tumor.^1,5

How is SVCS treated?

Doctors “grade” your symptoms to decide what level of treatment you need. For example:^1,2,5

• Grade 0: No symptoms, but blockage on X-ray
• Grade 1: Mild symptoms like head and neck swelling and blue skin
• Grade 2: Moderate symptoms like head, neck, and possibly arm and chest swelling, trouble swallowing, cough, and trouble moving your head
• Grade 3: Severe symptoms like trouble breathing and thinking, fainting, and low blood pressure
• Grade 4: Life-threatening symptoms like brain swelling, difficulty breathing, and fainting
• Grade 5: Fatal symptoms

If slowed blood has caused a blood clot, your doctor may give you drugs to try to dissolve the clot right away.^1,2,4,5,7

If they find cancer, your doctor may order chemotherapy and radiation to shrink and kill cancer cells. These treatment methods are very effective. But faster-acting treatments can resolve symptoms of SVCS sooner. Your doctor may guide a tiny tube (catheter) into the area above your SVC blockage. This opens the vein. While in there, they can place a little device called a stent in the vein to hold it open.^1-5

With stenting, most symptoms resolve within 72 hours. A 2022 review of 54 studies showed that stenting worked with few complications.^1,2,6

What is the takeaway?

Swelling in your face or neck can be signs of superior vena cava syndrome, a possible complication of lung cancer. If you have swelling or any other symptoms listed above, talk to your doctor right away.