Heart tumor

Heart tumor
Other names: Cardiac cancer, heart cancer, heart tumour
CT left atrial myxoma
SpecialtyOncology, cardiology
SymptomsNone, valvular heart disease, pericardial effusion, heart arrythmias, heart failure[1]
TypesPrimary: Myoxoma, lipoma, papillary fibroelastoma, rhabdomyoma, fibroma, angiosarcoma[1]
Secondary: Spread from melanoma, lymphoma, lung, breast, or esophagus cancer[1]
Diagnostic methodMedical imaging, biopsy[1]
Differential diagnosisInfectious endocarditis, thrombus[1]
TreatmentConservative, surgery, palliative care[1][2]
FrequencyUncommon (secondary 20-30 times more common than primary tumors)[3]

A heart tumor is a abnormal growth within the heart.[4] It may be benign or cancerous.[5] It can disrupt the electrical or mechanical activity of the heart.[3] Symptoms may vary from none, to valvular heart disease, pericardial effusion, heart arrythmias, and heart failure.[1]

They are divided into primary tumors, which are usually benign; and secondary tumors, which have typically spread from lung, skin, or breast cancer.[6] Primary tumors include myoxomas, lipomas, papillary fibroelastomas, rhabdomyomas, fibromas, and angiosarcomas.[1] About 90% of primary tumors are not cancerous.[1] Spread to the heart may occur from any cancer including lymphoma, breast, or esophagus cancer.[1] Diagnosis is typically by medical imaging.[5]

Treatment depends on the type of tumor.[1] Myxomas, angiosarcomas, and certain papillary fibroblastomas may be surgically removed.[1] Lipomas and rhabdomyomas rarely require intervention.[1] Cancerous tumors are generally treated with palliative care, which may include chemotherapy or radiation therapy.[2]

Primary tumors of the heart are uncommon.[3] They are found in less than 0.3% of people at the time of death.[1] Secondary heart tumors are 20-to-30 times more common than primary ones.[3] Outcomes with secondary tumors is generally poor.[2] Heart tumors have been described since at least 1835 by Albers.[7]

Signs and symptoms

People with heart tumours usually have non-specific symptoms, such as dyspnea (in particular, shortness of breath when lying down), thoracoabdominal pain (pain in the general area around the heart), fatigue, hemoptysis, nausea and vomiting, fever, weight loss, and night sweats. These symptoms mimic symptoms of other heart diseases, which can make diagnosis difficult.

Diagnosis

Micrograph of an atrial myxoma, the most common primary tumor of the heart.

In most cases, the diagnosis is based on clinical history, echocardiography, a CT scan or an MRI scan. Cardiac tumours are often first diagnosed after the patient has had a stroke, an embolism caused by detached tumour tissue.[8]

Classification

The WHO classification of tumors of soft tissue and bone apply to cancerous tumors of the heart.[4]

Primary

Main article: Primary tumors of the heart

Most heart tumors begin with myxomas, fibromas, rhabdomyomas, and hamartomas, although malignant sarcomas (such as angiosarcoma or cardiac sarcoma) have been known to occur. In a study of 12,487 autopsies performed in Hong Kong seven cardiac tumors were found, most of which were benign.[9] According to Mayo Clinic: "At Mayo Clinic, on average only one case of heart cancer is seen each year."[9] In a study conducted in the Hospital of the Medical University of Vienna 113 primary cardiac tumour cases were identified in a time period of 15 years with 11 being malignant. The mean survival in the latter group of patients was found to be 26.2 ± 9.8 months.[10]

Primary malignant cardiac tumors (PMCTs) are even rarer. The most recent published study about PMCTs used the Surveillance, Epidemiology and End-Results (SEER) Cancer Registry to study 497 patients with PMCTs who were diagnosed during 2000-2001 in the United States. Most cases were angiosarcomas (27.3%) with an incidence of 0.107 per 1,000,000 person-years and Non- Hodgkin's lymphomas [NHL] (26.9%), with an incidence of 0.108 per 1,000,000 person-years. The incidence rate of NHL increased significantly over the study period, but the incidence of cardiac angiosarcomas did not. The overall survival of NHL was found to be significantly better than angiosarcomas.[11]

Another previous study using the Surveillance, Epidemiology and End-Results (SEER) Cancer Registry from 1973–2011 found 551 cases of PMCTs, with an incidence of 34 cases per million persons. The study also found that the incidence has doubled over the past four decades. The associated mortality was very high, with only 46% of patients alive after one year. Sarcomas and mesotheliomas had the worst survival, while lymphomas had better survival. When compared with extracardiac tumors, PMCTs had worse survival.[12]

Secondary

Secondary or metastatic heart tumours are much more common than primary heart tumours, occurring even 100 times more often.[13] Every tumour in theory can metastasize to the heart with the only exception being tumours of the central nervous system.[14] Malignant melanomas frequently metastasize to the heart, and represent the tumour with the highest rate of cardiac metastases (in more than half of cases).[15]

Treatment

Primary

Benign

Most of these can be cured if the tumor can be completely removed. When a tumor is very large or there are multiple tumors, removing part of it that is not inside the heart walls can improve or eliminate symptoms. Some types can be followed with yearly echocardiograms instead of surgery if they are no longer causing symptoms.

Cancerous

Because they grow rapidly and invade important heart structures, they can be very difficult to treat. Unfortunately, most are not found until surgical removal is no longer possible. Chemotherapy and radiation therapy are sometimes used to try to slow tumor growth and improve symptoms (palliative care), but frequently they are ineffective for primary heart cancer.

Secondary

In most cases, people with heart metastases have advanced tumour disease, with the heart being only one of the many places involved in the generalised tumour spread. At that stage of the disease, the patients will have already undergone extensive chemotherapy, radiation therapy or surgical procedures. Cardiac treatment is usually confined to palliative measures.[14]

Notable cases

  • Henry VIII's first wife Catherine of Aragon's death is believed to have resulted from heart cancer.
  • Eric Carr, American musician; drummer of the rock band Kiss, died of heart cancer.[16]
  • John Brim, American blues musician and original writer of "Ice Cream Man", later covered by Van Halen.
  • Alexander Belov, Soviet basketball player.[17]
  • Mimi Lerner, Polish-American mezzo-soprano, died of heart cancer.
  • Ondřej Buchtela, Czech professional ice hockey defenceman, died of heart cancer.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Rodriguez Ziccardi, M; Tariq, MA; Limaiem, F (January 2020). "Cardiac Cancer". PMID 30725829. {{cite journal}}: Cite journal requires |journal= (help)
  2. 1 2 3 "Cardiac Tumors - Cardiovascular Disorders". Merck Manuals Professional Edition. Archived from the original on 25 January 2021. Retrieved 19 February 2021.
  3. 1 2 3 4 WHO Classification of Tumours Editorial Board (2021). "3. Tumours of the heart: introduction". Thoracic Tumours. Vol. 5 (5th ed.). Lyon (France): World Health Organization. pp. 228–229. ISBN 978-92-832-4506-3. Archived from the original on 2022-05-14. Retrieved 2022-07-22.
  4. 1 2 Romero, Maria; Virmani, Renu (2020). "74. Heart tumors". In Raja, Shahzad G. (ed.). Cardiac Surgery: A Complete Guide. Switzerland: Springer. pp. 673–690. ISBN 978-3-030-24176-6. Archived from the original on 2022-02-12. Retrieved 2022-02-12.
  5. 1 2 "Overview of Heart Tumors - Heart and Blood Vessel Disorders". Merck Manuals Consumer Version. Archived from the original on 28 February 2021. Retrieved 19 February 2021.
  6. ↑ Maleszewski, Joseph J.; Basso, Cristina; Bois, Melanie C.; Glass, Carolyn; Klarich, Kyle W.; Leduc, Charles; Padera, Robert F.; Tavora, Fabio (April 2022). "The 2021 WHO Classification of Tumors of the Heart". Journal of Thoracic Oncology: Official Publication of the International Association for the Study of Lung Cancer. 17 (4): 510–518. doi:10.1016/j.jtho.2021.10.021. ISSN 1556-1380. PMID 34774791. Archived from the original on 2022-07-24. Retrieved 2022-07-24.
  7. ↑ Burke, Allen; Virmani, Renu (1996). Tumors of the Heart and Great Vessels. Armed Forces Institute of Pathology. p. 1. ISBN 978-1-881041-20-7. Archived from the original on 2021-08-28. Retrieved 2021-02-19.
  8. ↑ Hoffmeier A, Sindermann JR, Scheld HH, Martens S (March 2014). "Cardiac tumors--diagnosis and surgical treatment". Deutsches Ärzteblatt International. 111 (12): 205–11. doi:10.3238/arztebl.2014.0205. PMC 3983698. PMID 24717305.
  9. 1 2 Moynihan TJ (2015-03-25). "Heart cancer: Is there such a thing?". MayoClinic.com. Archived from the original on 2015-05-09. Retrieved 2015-06-01.
  10. ↑ Habertheuer A, Laufer G, Wiedemann D, Andreas M, Ehrlich M, Rath C, Kocher A (April 2015). "Primary cardiac tumors on the verge of oblivion: a European experience over 15 years". Journal of Cardiothoracic Surgery. 10: 56. doi:10.1186/s13019-015-0255-4. PMC 4423145. PMID 25928192.
  11. ↑ Saad AM, Abushouk AI, Al-Husseini MJ, Salahia S, Alrefai A, Afifi AM, Abdel-Daim MM (December 2017). "Characteristics, survival and incidence rates and trends of primary cardiac malignancies in the United States". Cardiovascular Pathology. 33: 27–31. doi:10.1016/j.carpath.2017.12.001. PMID 29414429.
  12. ↑ Oliveira GH, Al-Kindi SG, Hoimes C, Park SJ (December 2015). "Characteristics and Survival of Malignant Cardiac Tumors: A 40-Year Analysis of >500 Patients". Circulation. 132 (25): 2395–402. doi:10.1161/CIRCULATIONAHA.115.016418. PMID 26467256.
  13. ↑ Burke A, Virmani R. Tumors of the Cardiovascular System, Atlas of Tumour Pathology, 3rd Series, Fascicle 16. Washington, DC: Armed Forces Institute of Pathology 1996
  14. 1 2 Reynen, K. (2004-03-01). "Metastases to the heart". Annals of Oncology. 15 (3): 375–381. doi:10.1093/annonc/mdh086. ISSN 0923-7534. PMID 14998838.
  15. ↑ Glancy, D.Luke; Roberts, William C. (1968-04-01). "The heart in malignant melanoma: A study of 70 autopsy cases". The American Journal of Cardiology. 21 (4): 555–571. doi:10.1016/0002-9149(68)90289-0. ISSN 0002-9149. PMID 5650736.
  16. ↑ Wilkening, Matthew. "The Day Kiss Drummer Eric Carr Died". Ultimate Classic Rock. Archived from the original on 2020-06-05. Retrieved 2020-06-13.
  17. ↑ "The Free Lance-Star - Google News Archive Search". news.google.com. Archived from the original on 2020-06-13. Retrieved 2020-06-13.
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