What is Cardiac Cancer (Heart Cancer)?
Heart tumors are not very common, and they can either originate in the heart (primary) or spread from other parts of the body (metastatic). Primary heart tumors are exceptionally rare, with only about 0.001 to 0.3% of autopsies showing them. These tumors can be grouped into three types: 1. harmless tumors present from birth; 2. harmless tumors that develop over time; and 3. damaging or harmful tumors. Most primary heart tumors, about 90%, are harmless. Myxoma is the most common primary heart tumor, contributing to just over half of all primary heart tumors. Damaging or harmful cardiac tumors are very uncommon, making up only 10% of all primary heart tumors. These often involve sarcomas, particularly angiosarcomas. It’s more common to have tumors from other parts of the body spread to the heart than to have primary heart tumors, but these are rarely removed with surgery.
What Causes Cardiac Cancer (Heart Cancer)?
Some heart tumors can arise due to genetic conditions or are part of genetic disorders. This can impact the advice given about the risks of inheriting such conditions and can guide treatment options.
For instances:
– Heart tumors known as cardiac rhabdomyomas are often linked to a condition known as tuberous sclerosis. This genetic condition is generally inherited and is defined by the growth of benign tumours in various organs.
– Cardiac fibromas, another type of heart tumor, can be associated with Gorlin syndrome. This is another inherited genetic disorder causing developmental problems and an increased risk of tumor growth.
– Heart tumors labeled as cardiac myxomas might be a part of the Carney complex, which is another inherited syndrome.
– Histiocytoid cardiomyopathy, a specific type of heart disease, sometimes appears in families, but the specific genetic changes causing this are not yet known.
Most heart sarcomas (a type of cancer) have genetic signatures similar to a kind of lung cancer known as pulmonary artery intimal sarcomas. These cancers commonly have changes in specific genes known as MDM2, PDGFRA, and CDKN2A. Another type of heart growth, known as papillary fibroelastomas, have occasionally been reported after certain heart procedures or chest radiation treatment.
Risk Factors and Frequency for Cardiac Cancer (Heart Cancer)
Primary cardiac tumors, tumors originating from the heart, are rather rare, occurring in only 0.001 to 0.3% of autopsy cases. Of these, almost 90% are benign, or non-cancerous. The most common of these benign tumors is a type called cardiac myxomas, which make up about 80% of all benign heart tumors.
Even though primary cardiac tumors are rare, secondary malignant heart disease, where cancer originates in another part of the body and then spreads to the heart, is considerably more common. Some estimates suggest it’s between 30 to 1,000 times more common.
- In a random autopsy series, the frequency of metastatic involvement, or spread of cancer to the heart, was found to be 0.4%.
- In patients who already have confirmed cancer elsewhere in their body, as many as 20% can see the cancer spread to the heart.
The cancer typically spreads to the heart either through direct extension of the tumor, or through the body’s venous or lymphatic system, or through arterial metastasis. The cancers that most commonly spread to the heart include lung, breast, esophagus, stomach, kidney cancers, melanoma, lymphoma, and leukemia.
Signs and Symptoms of Cardiac Cancer (Heart Cancer)
Cardiac tumors can cause a variety of symptoms, but these are often vague and subtle, which makes them hard to diagnose and treat promptly. The symptoms are usually related to problems in the heart itself, such as issues with the heart valves, fluid buildup around the heart, blocked blood flow within the heart, irregular heartbeat, and heart failure.
Interestingly, some heart tumors don’t cause any noticeable symptoms and are only found by chance during a medical exam or procedure. The specific symptoms a person experiences can depend on various factors, like the size and position of the tumor, as well as its growth speed and whether it is spreading into other tissues.
- Issues with heart valves
- Fluid buildup around the heart
- Blocked blood flow within the heart
- Irregular heartbeat
- Heart failure
- Size and position of the tumor
- Speed of tumor growth
- Whether the tumor is spreading
Testing for Cardiac Cancer (Heart Cancer)
If your doctor suspects you have a growth in your heart (a cardiac mass), they will probably use several types of imaging tests to get a better look at it. These tests help your doctor figure out how big the mass is, where it is, and whether it’s causing trouble with other structures in your heart. Even with all these tests, though, the only sure way to identify the tumor is to remove it and examine it under a microscope.
Here’s a quick run-down of some of the tests your doctor might use:
Echocardiogram: This is an ultrasound of your heart, and it’s often the first test used to diagnose a cardiac mass. It’s good at picking up these kinds of growths, and it can be done easily at your bedside. If this test does pick up a mass, your doctor might use a more detailed version of it, called a transesophageal echocardiogram, to get a closer look. This can provide more information about how big the tumor is, whether it moves, where it is located, and whether it’s creating problems with your heart valves or other heart structures. If it’s hard to see the tumor on this test, your doctor might add a special dye to make it show up more clearly.
Cardiac MRI: This is a special type of MRI that looks specifically at your heart. It’s great for figuring out a tumor’s size and location, and it can also help your doctor plan for surgery to remove it if necessary. This test can give some clues about what the mass is made of, and it can also tell the difference between a tumor and a blood clot.
CT Scan: This test uses x-rays to create detailed images of your heart. It can help your doctor assess the size of the cardiac mass and the surrounding structures. It can also show if the mass contains calcium, and it can pick up small masses that might be missed on other tests.
Left Heart Catheterization with Coronary Angiogram: This procedure involves threading a thin, flexible tube (a catheter) through your blood vessels to your heart. It can help your doctor figure out how the tumor is affecting your heart’s blood supply and its surrounding structures. Your doctor can also use this test to see how far the tumor extends into the chamber of your heart.
While these tests can provide a lot of information, the only way for your doctor to be certain about what kind of tumor it is, is to examine it under a microscope, a process called histological evaluation. This typically involves taking a small piece of the tumor (a biopsy), which can be risky and is usually done only in hospitals where doctors have a lot of experience with these procedures. It’s easier and safer to biopsy tumors on the right side of the heart, because biopsying a tumor on the left side has more risks. To increase the success rate, doctors can use imaging to guide the biopsy. They can also examine fluid from around your heart to try to figure out what kind of tumor it is. If possible, doctors generally prefer to surgically remove the tumor and then look at it under a microscope.
Treatment Options for Cardiac Cancer (Heart Cancer)
Cardiac tumors, or lumps in your heart, come in different types. Some are benign (not harmful in effect) while others can be malignant (cancerous). Below is a description of several types of heart tumors and how they are managed:
Myxoma: This benign tumor needs to be surgically removed due to its high risk of breaking apart and causing harmful effects in your body. Doctors make sure to remove all of the tumor during surgery to avoid it coming back.
Lipomas: Lipomas are another type of benign tumor. However, if they are not causing any symptoms or heart rhythm abnormalities, there is no need for medical intervention or surgery.
Papillary Fibroelastoma: These benign tumors are found on the left side of your heart. If there’s a large, moving lump or evidence that small parts have broken off, surgery is needed to remove the tumor.
Rhabdomyoma: These benign heart tumors usually shrink on their own after birth, meaning they rarely need to be removed. However, if they cause a blockage or heart rhythm issues, surgery may be necessary.
Fibroma: These are another type of benign tumor. If possible, it’s generally recommended to surgically remove the entire tumor.
Cardiac Sarcomas: These are malignant tumors that have a poor outlook. Research has found that survival might be improved if the tumor is completely removed.
Secondary heart tumors are those that started elsewhere in the body but have spread (metastasized) to the heart. The treatment for these usually involves treating the primary cancer. However, they often indicate a poor outlook. If they cause fluid build-up around your heart, this can be drained. If the fluid keeps coming back, a small hole (pericardial window) can be made to allow it to drain more easily.
What else can Cardiac Cancer (Heart Cancer) be?
When a doctor is trying to figure out the cause of a heart mass, there are other more common issues they may consider. These include blood clots (thrombus) or infections (vegetations). The patient’s overall health and symptoms are crucial in figuring out the cause of the heart mass.
If a patient has things like heart implants or artificial heart parts and also has an infection, doctors may suspect these infectious growths (vegetations) as the cause.
Patients with cancer who also have heart failure symptoms might not necessarily have a heart tumor. These symptoms could be related to heart damage from chemotherapy treatments. This possibility needs to be checked before a doctor can determine if the cancer has spread to the heart.
Diseases caused by infections can also cause masses or fluid buildup inside the heart and around the heart sack (pericardial masses or effusion). In these cases, testing for germs (microbiological assessment) is needed.
What to expect with Cardiac Cancer (Heart Cancer)
The outcome for different heart tumors greatly depends on their type and their interference with heart function.
Benign (non-cancerous) heart tumors generally have the best prognosis, unless they cause multiple embolizations, which are blockages in the blood vessels. This can be particularly severe if it happens throughout the body, as it could lead to multiple strokes, resulting in various neurological challenges and physical limitations. There might be problems too if the tumor interferes with the heart’s electrical signaling system, as this can cause irregular heart rhythms, which can be dangerous, or problems with the heart valves, leading to fainting or symptoms of heart failure.
Malignant (cancerous) tumors, especially those formed in the heart, generally have the worst prognosis. A patient’s survival beyond the first year of diagnosis is generally low, especially if the tumor is not surgically removed.
Metastatic heart tumors, which are tumors that have spread to the heart from another part of the body, have a poor prognosis. This is primarily because the original tumor is likely to be advanced, with possible spread to different areas. Also, this type of tumor can interfere with the heart’s mechanical workings.
Possible Complications When Diagnosed with Cardiac Cancer (Heart Cancer)
The complications of heart tumors are primarily related to the physical disruptions they can cause within the heart.
One common issue is when fragments break off from the tumor, creating blockages known as embolisms that can lead to strokes. This can appear initially as a stroke, and then upon further medical investigation, the heart tumor can be discovered.
Another problem happens when the tumor is located next to the heart’s valves, disrupting their function and causing disorders like obstruction or insufficiency (where the valve doesn’t open or close fully). If the tumor blocks the flow of blood, it can cause sudden fainting episodes as the brain and heart are deprived of necessary oxygen. This could also set off rapid, erratic heart rhythms, known as tachyarrhythmias.
If the tumor is situated next to the epicardium or myocardium which are parts of the heart’s electrical conduction system, it can lead to abnormal electrical signals and conditions like atrioventricular block, complete heart block, or rapid, irregular heart rhythms known as ventricular tachyarrhythmias.
When the membrane around the heart, known as pericardium, is affected by the tumor, it can lead to a build-up of fluid called pericardial effusion. This can disrupt normal heart function, leading to symptoms such as low blood pressure, shortness of breath, and in severe cases, a dangerous condition called cardiac tamponade where fluid compresses the heart.
Possible complications include:
- Embolisms leading to strokes
- Heart valve disorders like obstruction or insufficiency
- Sudden fainting due to blocked blood flow
- Rapid, irregular heart rhythms (tachyarrhythmias)
- Electrical abnormalities such as atrioventricular block, complete heart block, or ventricular tachyarrhythmias
- Build-up of fluid around the heart (pericardial effusion) causing low blood pressure, shortness of breath, and potentially, cardiac tamponade
Preventing Cardiac Cancer (Heart Cancer)
Patients who have been diagnosed with heart masses need comprehensive tests. These tests are crucial to find out the exact cause and take the necessary steps to prevent any worsening of their heart condition.
Heart masses are unusual growths that may stay within the heart’s tissues. Once these are removed, it can stop any potential problems related to the mass interfering with how the heart works.