Cardiac Tumors and Cancers

Cardiac tumors are abnormal growths of tissue located in the heart. Primary cardiac tumors—tumors that arise in the heart itself—may be either benign or malignant. Secondary (or metastatic) cardiac tumors are malignant cancers that spread to the heart from another location. 

Primary cardiac tumors are quite uncommon; metastatic cancer affecting the heart is much more common. The significance of a cardiac tumor can range from being a mere “incidental finding” that has little significance to a severe, life-threatening medical crisis.

The large majority of primary cardiac tumors are benign, and many times these benign tumors cause no symptoms. Often, therefore, benign cardiac tumors are identified only when the heart is being evaluated for some other reason. When benign cardiac tumors do cause symptoms, those symptoms are usually related to the location of the tumor within the heart, rather than to the specific type of tumor that is causing them.

Primary cardiac cancer (a malignant tumor arising in the heart) is rare. When it does occur, it tends to be aggressive cancer that is very difficult to treat effectively and is often fatal.

Metastatic cancer of the heart is a fairly frequent event. When cancer spreads to the heart, that usually indicates that the cancer is widespread, and treatment tends to be quite difficult.

Symptoms

Tumors in the heart can cause symptoms in several different ways:

  • A cardiac tumor can partially obstruct blood flow through the heart itself, leading to a reduction in the amount of blood the heart can pump into the circulation. This obstruction to blood flow can produce symptoms similar to those of heart failure.
  • A cardiac tumor can interfere with the normal functioning of heart valves, leading to symptoms of valvular stenosis (narrowing) or regurgitation (leaking).
  • A tumor can cause the formation of blood clots within the heart. These clots can embolize (break off and travel to other parts of the body), causing a stroke, pulmonary embolus, kidney damage, or damage to other organs.
  • Cardiac tumors can invade the cardiac muscle, leading to heart failure, cardiac arrhythmias, or pericardial effusion and tamponade.
  • As with almost any type of tumor, tumors originating in the heart can produce generalized symptoms that do not necessarily suggest a heart problem, such as weight loss, poor appetite, weakness, and fatigue.

The location of where a cardiac tumor is located within the heart partially determines the type of symptoms that are most likely to result. Here are the symptoms most commonly associated with tumors in specific locations:

  • Tumors of the right atrium tend to obstruct blood flow through the right side of the heart and produce symptoms that are similar to those of tricuspid valve stenosis, including severe edema (swelling), ascites (fluid accumulation in the abdomen), liver enlargement, and fatigue. Clots that form on a right atrial tumor can cause even more obstruction and can lead to pulmonary embolus.
  • Tumors of the right ventricle can produce obstruction to blood flow that mimics right-sided heart failure, pulmonic valve stenosis, or restrictive cardiomyopathy.
  • Tumors of the left atrium often interfere with the normal functioning of the mitral valve and may mimic either mitral stenosis or mitral regurgitation. They also commonly produce blood clots that embolize into the general circulation, causing strokes and other organ problems. 
  • Tumors of the left ventricle tend to produce cardiac arrhythmias, especially heart block and ventricular tachycardia or ventricular fibrillation. As with left atrial tumors, they may also cause embolization of blood clots into the general circulation. Further, they can obstruct blood flow out of the left ventricle, producing symptoms similar to aortic stenosis.
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    Diagnosis

    Most commonly, cardiac tumors are diagnosed when a person is describing symptoms suggestive of some other, more common cardiac problem, such as heart failure or valvular heart disease. Subsequent testing then reveals the actual diagnosis.

    When a cardiac tumor is diagnosed, it is important for the doctor to do the testing necessary to characterize it as fully as possible. It is vital to identify its size, its location, whether it is benign or malignant, and whether it is amenable to surgical therapy. Several cardiac tests can be helpful in making these determinations.

    Because it is noninvasive, relatively inexpensive, and widely available, echocardiography is usually the test used first in the evaluation of a suspected cardiac tumor. The echocardiogram can help the doctor evaluate all four cardiac chambers and the heart muscle itself. In many cases, this test can identify whether a tumor is present, its relative size, its location, and whether it is producing any obstruction to blood flow within the heart.

    If the echocardiogram indicates that a tumor is present, either a cardiac MRI or cardiac CT scan is usually performed to further characterize the anatomy of the tumor. The MRI is preferred when available because it can sometimes reveal important clues as to the specific type of tumor that is present. Certain types of benign cardiac tumors, for instance, have distinctive characteristics that can be identified with an MRI (or sometimes with a CT) scan.

    cardiac catheterization with coronary angiography can be very helpful in mapping out the blood supply of a cardiac tumor. This information is very important if surgery is being considered to remove the tumor. 

    In addition, a biopsy of the tumor can be performed during a cardiac catheterization procedure. However, a biopsy may cause some kinds of cardiac tumors (in particular, myxomas) to embolize. So, biopsies are performed only when it is deemed very important to know the precise cell-type of a tumor before deciding on treatment. 

    To summarize, in the majority of cases, the presence and the location of a cardiac tumor can be adequately characterized with an echocardiogram and either an MRI or CT scan. If surgery is being strongly considered, coronary angiography will also be required. 

    Types and Treatment

    The various types of cardiac tumors can be categorized as benign tumors, malignant tumors, tumors that are sometimes malignant, and metastatic tumors. The treatment of a cardiac tumor depends on the specific type of tumor that is present, whether it is benign or malignant, its location, and the symptoms it is causing.

    It is important to recognize that even benign cardiac tumors can pose a significant problem since they can cause cardiac obstruction and embolization, and that treatment and prognosis vary for each case. No two cases are the same.

    Benign Tumors

    Most cardiac tumors—roughly three out of four—are in the “benign” category. They do not metastasize to other parts of the body, and the harm they produce is due to their local effects within the heart and to any blood clotting they may cause.

    Myxomas

    The most common benign cardiac tumors are the myxomas. Myxomas are roundish, gelatinous tumors that typically are attached to the wall of the heart by a stalk. 

    About 80 percent of myxomas arise in the left atrium; the rest are found in the right atrium. Myxomas commonly produce symptoms of mitral or tricuspid valve stenosis or regurgitation. These tumors can flop around on their stalk as the heart fills and contracts, and in this way, they can cause intermittent, instead of constant, symptoms of valvular dysfunction. These intermittent symptoms may be related to a person’s position—for instance, symptoms may be more common when a person is standing up or lying down.

    The main problem with myxomas, however, is that they very often produce blood clots, and embolization is a high risk in people with these tumors. For reasons that are poorly understood, myxomas also tend to cause generalized, constitutional symptoms such as fever, weight loss, and fatigue. 

    The treatment of myxomas is surgical removal. Surgery should be scheduled as soon as possible after a diagnosis is made to reduce the risk of embolic stroke. 

    Papillary Fibroelastomas

    The next most common type of benign cardiac tumors are papillary fibroelastomas. These are growths that usually arise on one of the heart valves (usually the mitral valve or the aortic valve), that tend to have several “arms” protruding from a central core. In fact, their appearance has been compared to a sea anemone.

    The symptoms they cause are usually due to embolization, rather than to valvular dysfunction. Surgical removal is usually necessary, although if the tumor is small and has not produced symptoms, some cardiologists will recommend careful observation instead.

    Lipomas

    Lipomas are tumors consisting of fatty cells. In the heart, lipomas tend to grow just below the surface of the heart muscle. While they often cause no symptoms, lipomas may interfere with the heart’s electrical system, producing heart block or atrial or ventricular arrhythmias. If they are large enough or are producing cardiac problems, surgical resection may be required. 

    Benign Cardiac Tumors Seen in Children

    Several benign cardiac tumors are seen mainly in children. These include:

    • Rhabdomyomas: Rhabdomyomas are benign tumors that are located in the wall of the heart muscle or on cardiac valves. They are most often seen in children with tuberous sclerosis. They tend to disappear spontaneously as a child grows older and usually do not require treatment.
    • Fibromas: Cardiac fibromas are tumors consisting of fibrous tissue that usually appear in the ventricular muscle. They do not disappear spontaneously and tend to grow over time. Because of this constant growth, cardiac fibromas usually require surgical resection.
    • Teratomas: Teratomas are benign tumors arising from abnormal embryonic tissue. In the heart, teratomas usually appear in the pericardium. Some of these tumors grow rapidly and need to be resected right away. 
    • Hamartomas: Hamartomas are flat sheets of abnormal tissue that grow on the surface of heart muscle, usually in the left ventricle. They can cause cardiac arrhythmias, most typically incessant ventricular tachycardia. They need to be removed surgically. 

    Malignant Tumors 

    Malignant tumors originating in the heart account for less than 20 percent of all cardiac tumors. 

    Sarcomas

    Sarcomas of the heart are highly malignant cancers that tend to spread rapidly throughout the body. If they are diagnosed early enough, complete resection is necessary. However, most of these tumors will have metastasized before they can be diagnosed. Chemotherapy has not been particularly successful. The average survival of a person with one of these tumors is only 6–12 months.

    Lymphomas

    Lymphomas arising in the heart are very uncommon, but they do occur. They are treated with systemic chemotherapy, similar to lymphomas arising elsewhere in the body, and their prognosis appears to be similar.

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    Possibly Malignant Tumors

    Two types of cardiac tumors occur that can be either benign or malignant: mesotheliomas and paragangliomas.

    Mesotheliomas

    Mesotheliomas are tumors that usually appear in the lining of the lungs. They are usually related to asbestos exposure. Rarely, mesotheliomas can appear in the pericardium. Benign cardiac mesotheliomas can be treated with surgical resection, but when these tumors are malignant resection is not curative and the prognosis is very poor. 

    Paragangliomas

    Paragangliomas can also be either benign or malignant. These tumors arise from neuroendocrine tissue and therefore can produce hormones, usually norepinephrine (very similar to epinephrine).

    For this reason, paragangliomas can cause episodes of tachycardia, headaches, hypertension, and sweating. Surgical resection of both the benign and malignant forms of paragangliomas is required, but surgery can be particularly challenging because these tumors often draw their vascular supply from the heart’s own blood vessels. 

    Metastatic Tumors

    It is not particularly uncommon for malignant tumors arising elsewhere in the body to metastasize to the heart. The cancers most likely to involve the heart include melanoma, breast cancer, lung cancer, liver cancer, esophageal cancer, renal cancer, lymphoma, and thyroid cancer. In people dying of cancer, nearly 10 percent have cardiac involvement on autopsy. 

    The symptoms caused by metastatic cardiac tumors, like those caused by benign tumors, depend on the location of the tumor itself. Because metastatic disease involving the heart usually reflects cancer that is widely spread, only rarely is surgical resection of a metastatic cardiac tumor helpful in relieving symptoms.

    The chief significance of symptoms caused by metastatic cardiac tumors is that they may be confused with symptoms caused by cardiac toxicity from chemotherapy. It may become important to distinguish between the two in order to decide whether to continue with chemotherapy. 

    A Word From Verywell

    The heart can be affected by a wide spectrum of tumors, from primary tumors arising in the heart itself to metastatic tumors from other sites; from benign tumors to malignant tumors; and from tumors that cause no problems and need no treatment to tumors that cause severe or life-threatening problems and that require immediate therapy. Any time a cardiac tumor is discovered, it requires a rapid and full evaluation to characterize its nature so that an optimal management plan can be decided upon as soon as possible.

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