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Heart Cancers: Complex Carcinomas

✍️Rem Ehab Abdelkader | MD Candidate & Human Rights Trainer at IFMSA

 

What is Heart Cancer? 🫀

Cardiac cancers is when there is excessive cellular growth that develop within the tissue of the heart.

These can be grouped into two categories: primary and secondary tumours. Primary tumours arise from the cardiac tissue, whereas secondary heart tumours (metastatic tumours) develop when cancer spreads to the heart tissue from a tumour elsewhere in the body. Heart tumours can be benign (noncancerous) or malignant (cancerous). About 75- 95% of primary heart tumours are benign. These tumours don't pose a risk but may lead to unfavourable symptoms according to where they are located within the heart chambers. On the other hand, malignant cancers pose greater risk and reduced survival rate.

 

Where can heart tumours form?❤️‍🩹

Heart tumours can occur anywhere in the heart.

For example, heart tumours can proliferate in the:

  • Endocardium (the tissue that internally lines the heart chambers)

  • Myocardium (the smooth muscle)

  • Heart valves (the valves that control the blood flow around the heart chambers)

  • Pericardium (the external lining of the heart)


 

What are the types of primary heart tumours? 🥼

A lot of our knowledge about heart tumours comes from autopsy and case studies.

Types of malignant cardiac cancer include:

Sarcoma

This is the most common malignant heart tumour. Sarcomas are tumours that arise from muscle tissue. Cardiac sarcomas include; cardiac angiosarcoma which includes abnormal blood vessels and forms mainly in the right atrium, and cardiac rhabdomyosarcoma which also typically present in the right atrium and mainly affects children.

Pericardial Mesothelioma

Primary Lymphoma

Types of benign primary tumours include:

Myxoma

Myxoma makes up nearly half of all heart tumours. Most myxomas develop in the left atrium. This requires prompt surgical removal to avoid complications such as embolism (when a tissue fragment breaks off into the bloodstream and block small blood vessels).

Papillary Fibroelastoma



 

What are the symptoms of cardiac tumours and how do we diagnose them? 🩺

The clinical symptoms of cardiac tumours are difficult to identify and often take a long time to manifest. This delays diagnosis and surgical management.

The clinical manifestations depend on tumour size, location, growth rate, and invasiveness in the cardiac tissue. They can manifest as symptoms related to the heart such as; dysfunction of the heart values, irregular heartbeat, blood flow obstruction, blood pooling and congestive heart failure. Patients with any of these cardiac symptoms mainly complain of shortness of breath, bluish discoloration of fingertips or tongue, acute chest pain or swollen limbs.


When a patient presents with any of these symptoms, a cardiologist evaluates them using an echocardiogram/EKG, cardiac MRI, and a CT scan. The EKG can be done as a bedside procedure and identifies most cardiac tumours. The EKG and cardiac MRI won't detect a heart thrombus, which is a collection of fibrin cells and blood clots and is not a tumour.

 

What is the treatment of cardiac tumours? 💊

Early detection of cardiac tumours has a significant effect on planning the intervention plan.

The conservative treatment of cardiac tumours is typically limited to small, stationary masses, such as lipomas, and papillary fibroelastomas which usually advance slowly and are monitored for growth or symptom development using serial echocardiography. The overall prognosis of benign tumours is generally good, especially in asymptomatic patients.


Management of malignant primary tumours should ideally combine complete surgical removal of cancerous tissue and chemoradiotherapy to reduce the risk of recurrence. Low-dose radiotherapy used before or after surgical intervention is particularly helpful in cardiac sarcomas.

 
COntent Editor on a lilac background

Edited by: Olivia Laughton | Content Editor | BSc Microbiology, University of Leeds


 

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