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Heart Tumors: Etiology and Classification

Reporter: Aviva Lev-Ari, PhD, RN

Cancer-Related Heart Disease

• Primary Heart Tumors

Originate in the Heart

Tumors that originate in the heart are called primary heart tumors.  These are very rare.

May Be Cancerous or Noncancerous

They may develop in any of the heart tissues and may be cancerous or noncancerous.

Cancerous: Sarcomas

The most common primary heart tumors are sarcomas — cancers that develop from blood vessel tissue.

Noncancerous: Myxomas

Half of all primary heart tumors are myxomas, noncancerous tumors that usually are irregular in shape and jellylike in consistency. Three-quarters of myxomas occur in the left atrium. Some of these myxomas run in families. These typically develop in young men in their mid 20s. Myxomas that are not hereditary usually develop in women between the ages of 40 and 60.

• Secondary Heart Tumors

Originate in Other Parts of the Body

Secondary heart tumors are those that originate in other parts of the body — most often, the lungs, breasts, blood or skin — and spread (metastasize) to the heart. These are more common.

Always Cancerous

Secondary heart tumors are always cancerous.

• Secondary heart tumors are 30 to 40 times more common than primary heart tumors, but are still rare.
• About 10 percent of those with lung or breast cancer will have it spread to the heart.
• About 75 percent of those with malignant melanoma (a form of cancer that often arises in the skin) will see it spread to the heart.
• Secondary cancers spread by direct invasion of the pericardium — the sac that surrounds the heart — or through the bloodstream or lymph system.

Relationship Between Heart Disease and Cancer

Some cancer treatments, including chemotherapy and radiation, can also cause heart disease or a weakening of the heart muscle called cardiomyopathy (see heart failure section). Another heart condition, cardiac amyloidosis, is sometimes linked to multiple myeloma.

http://www.bidmc.org/CentersandDepartments/Departments/Medicine/Divisions/CardiovascularMedicine/DiseasesandConditions/CancerRelatedHeartDisease.aspx#sthash.azXoEOnK.dpuf

Amongst Hodgkin lymphoma patients who have received radiation, CVD is one of the most common causes of death.

Physicians and ancillary staff frequently have to take care of patients with concomitant cancer and cardiovascular disease. Some cardiac diseases predates the diagnosis of cancer, whereas other conditions like chemotherapy-induced cardiomyopathy and radiation-related heart disease are directly related to the cardiotoxic side effects of cancer therapy. The cardiotoxic side effects of agents like 5-fluouracil, adriamycin, and tyrosine kinase inhibitors are well known. However, the cardiotoxic profiles of newer investigational chemotherapeutic agents are largely unknown.

Chemotherapy frequently induces thrombocytopenia, which in itself poses therapeutic challenge in the management of conditions like acute coronary syndrome, atrial fibrillation, stroke, and prosthetic valves. Evidence-based treatment of cardiovascular disease in cancer patients is lacking largely because all cardiology trials have excluded patients with cancer and similarly cancer trials have excluded patients with significant cardiovascular comorbidity.

While recently some single-center studies have shown the efficacy of medications like ace inhibitors and beta blockers for the treatment of chemotherapy-induced cardiomyopathy, evidence-based treatment of other major cardiovascular diseases in cancer patients is not well established.

In this issue of cancer and cardiovascular disease, we have covered some common conditions like venous thrombosis, cardiovascular effects of radiation therapy, cardiovascular effects of anthracycline in childhood cancer survivors, and management of aortic aneurysm in cancer patients. The use of newer modality, like computed tomographic angiography, may provide a pivotal role in the investigation of cancer patients with concomitant cardiac problem, as outlined in a clinical investigation in this journal. The case reports presented are some conditions that are unique to cancer population. Cardio-oncology is a growing field.

http://www.hindawi.com/journals/crp/2011/943748/