Superior vena cava syndrome (SVCS) is a relatively common occurrence in the oncology patient. Nurse practitioners should keep a high index of suspicion for the development of this condition. Early detection of signs and symptoms can lead to a more favorable patient response. Diagnostics and referral to an oncologist should be initiated immediately. Biopsy of a suspected lesion is now the standard of care. The standard of treatment remains localized radiation therapy and chemotherapy as appropriate. SVCS may be an oncological emergency, and it may be the presenting symptom of a malignancy. Identification of this potentially fatal circumstance may greatly improve the patient's outcome.