The key to managing superior vena cava (SVC) syndrome is to effectively treat the underlying cause; more than 60% of the cases are due to intrathoracic tumors.

Chest computed tomography (CT), ideally contrastedenhanced, is a crucial diagnostic tool in patients with suspected SVC syndrome.

Endovascular stenting is indicated in patients with severe symptoms or anticipated poor response to treatment.

Pericardial tamponade with hemodynamic compromise from a malignant pericardial effusion warrants emergent intervention, with percutaneous pericardial drainage with intrapericardial sclerosis as the procedure of choice.

The presence of a hemorrhagic effusion without history of antecedent trauma increases the risk of malignancy.

Pericardial fluid should be sent for cytology and/or flow cytometry when a malignant effusion is suspected.

Surgical pericardiotomy or pericardiectomy is considered in recurrent pericardial effusion or if pericardial biopsy is needed for diagnosis.

The diagnosis of spinal cord compression must be anticipated; once neurologic dysfunction develops, it is rarely reversible.

Back pain presenting in any patient with a current or past history of malignancy warrants further evaluation and documentation of a complete neurologic exam.

MRI of the entire spine axis is the gold standard imaging modality.

The most common location for epidural spinal cord compression is in the thoracic spine (60%).

Intravenous corticosteroids should be the initial treatment for SCCS until definitive treatment is possible.

Urgent surgery is indicated in patients with spinal instability, but radiation is the mainstay for most patients.

Rapid cell death results in a number of metabolic disturbances that define the syndrome of tumor lysis syndrome, including hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia (due to precipitation of calcium phosphate).

Aggressive IV hydration and management of electrolyte abnormalities are the key initial management.

Hemodialysis is an effective last resource.

Symptomatic hypercalcemia of malignancy or asymptomatic serum calcium concentration >14 mg/dL (3.5 mmol/L) warrants urgent intervention.

Aggressive IV hydration and diuretics are the initial management followed by bisphosphonates.

Hemodialysis can be considered in patients not responding to conservative treatment.