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Answer 2
  1. SCLC. This patient has signs and symptoms of superior vena cava syndrome (SVCS), a clinical diagnosis defined as a partial or total obstruction of the superior vena cava by tumor invasion, external compression, or thrombus formation. SVCS is most commonly associated with swelling of the face and upper limbs, cough, chest pain, and venous distension of the neck.8,9 Although there are benign etiologies of SVCS, malignancy remains the most common cause. Approximately 80% of cases are due to bronchogenic carcinoma, with the majority of such cases caused by SCLC. SCLC commonly occurs in the hilar regions, and smoking is the primary risk factor in 90% of cases.10

    8. Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest 1993;103(4 Suppl):394S–7S.

    9. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes [published erratum appears in N Engl J Med 2008;358:1083]. N Engl J Med 2007;356:1862–9.

    10. Neary J, Lai J. Superior vena cava syndrome in small-cell carcinoma of the lung: case report and literature review. U Toronto Med J 2004;81:222–9. Available at www.utmj.org/issues/81.3/Clinico_Correlation_81-222.pdf. Accessed 20 Oct 2008.

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