It is rare for cancerous tumors, both benign and malignant, to grow in the heart. And if they do, they give very different symptoms that do not always suggest an ongoing neoplastic process. Primary heart tumors are rare and are more common in children than in adults. Fortunately, most of them are benign tumors. In all age groups, the heart can be a site for metastasis from other organs.
Among the primary benign heart tumors, the most common are:
Rhabdomyosarcoma – it rarely occurs in adults, and it usually attacks children before the age of three. These tumors arise from the ventricular septum or the free wall of one of the heart chambers. Sometimes they also develop in the vestibule of the heart. As they expand, they bite into the chamber. They are among the earliest detected neoplastic lesions, which often shrink on their own.
Fibroma – is the second most common in children. Most often it is located in the wall of the left ventricle and in the interventricular septum. But sometimes it also develops in the right ventricle and right atrium. The tumor appears as a single, smooth, white and well-defined tumor. Its internal structure resembles a uterine fibroid.
A snail – it occurs sporadically in children, but in adults it is the most common heart tumor. It usually develops in the left atrium. Sometimes myxoma develops in the right ventricle and right atrium. It is made of gelatinous mass of various colors. It can be colorless, yellow-pink or greenish. It is a benign tumor, but it tends to become malignant.
Lipoma – develops around the atria or ventricles. It is usually composed of mature fat cells and fibrous or muscle tissue. It is a benign tumor.
Hemangioma – it can occur in any of the heart cavities. It can also develop on the surface of the heart, leading to the formation of a bloody exudate in the pericardial sac. Hemangiomas can also attack the heart’s conduction system, causing abnormal rhythms.
Protozoan – only a few cases of this neoplasm have been described in the professional literature. The site of protozoa was mainly the left ventricle or the vicinity of the atrioventricular node. The studies of the removed protozoa show that the tumor may contain nervous tissue, smooth and striated muscles, bone and cartilage tissue, and glandular tissue – thyroid and pancreas.
Fibroelastoma – is a cancer also called papillary neoplasm of the heart valves. Usually it is asymptomatic but may cause narrowing of the heart valves and coronary arteries.
Benign mesenchymal tumor – is recognized extremely rarely.
Primary malignant heart tumors
They most often take the form of sarcomas, and oncologists distinguish many types of this cancer. The primary heart tumor spreads easily through the heart’s ventricles, invading the pericardium and adjacent tissues. This results in a bloody exudate or blood in the pericardial sac, leading to cardiac tamponade. With this type of heart cancer, the prognosis for patients is poor due to the rapid growth of the tumor and destruction of the heart muscle. Besides, this cancer quickly metastasizes.
Metastatic heart tumors are rare in children. In adults, they are 40 times more common than primary heart tumors. The most common sources of cancer metastases to the heart are lung cancer, breast cancer in women and colon cancer, as well as melanomas and lymphomas. Metastases may be tumor-like or diffuse, may infiltrate the pericardial or endocardial surface, or both.
What are the symptoms?
The symptoms that heart tumors can cause depend on their size, number and location. Small bumps, singly in one chamber, may not cause any discomfort. Diffuse neoplastic process of the heart muscle leads to severe organ failure and, consequently, to the death of the patient. Large tumors that push into the heart cavities reduce blood flow. In children, this can be a symptom of cyanosis. A large tumor also reduces the capacity of the left ventricle, thus provoking left ventricular failure.
Rhythm disturbances occur when the tumor locates itself in the conduction of electrical impulses. Complete atrioventricular block, supraventricular or ventricular tachycardia, tachycardia or bradycardia, and sudden death syndrome due to ventricular fibrillation can develop.
People with myxoma most often develop stenosis, i.e. stenosis of the mitral valve or peripheral embolism. Mitral stenosis leads to heart failure. A characteristic symptom is frequent fainting of patients as a result of blockage of the mitral opening. The patient is also at risk of pulmonary embolism. You may experience fever, weight loss, and high ESR. and an increase in the concentration of proteins in the blood serum.
Diagnostics
If a heart cancer is suspected, it is necessary to perform laboratory tests with the determination of tumor markers and cardiological examinations.
A normal electrocardiogram may not show cancer in the heart. The same is true for a chest x-ray. Cancer-related cardiac enlargement is often associated with organ failure. Therefore, for the diagnosis of heart tumors, echocardiography (echo of the heart) is used, which shows not only the size of the tumor, but also its location, mobility, and connection with other structures surrounding the heart. With the help of an echo, it is possible to visualize heart tumors developing in a fetus.
Computed tomography and MRI scans are performed when there is a need to find out how the tumor is infiltrating other parts of the body. Angiography is performed when it is necessary to determine whether the tumor is infiltrating the coronary vessels. It is especially important when the patient is getting ready for surgery. Based on this, the technique by which the operation will be performed is selected.
Treatment of heart tumors
Surgery is the mainstay of treatment for all types of benign heart tumors. If the tumor is impaired organ function, it should be performed as soon as possible. The tumor is removed in extracorporeal circulation. The doctor needs to remove as much tissue as possible so that the tumor does not recover. The patient’s pericardium or a special synthetic material is used to patch cavities. After surgery, the patient must take specialized medications. Benign heart tumors do not require continuation of treatment with chemo- or radiotherapy.
When operating on myxomas, a fragment of the heart muscle is also removed, the septum between the atrium, i.e. the place where the tumor stalk reached. Malignant heart tumors have very poor prognosis. These types of tumors grow rapidly and are often unresponsive to various treatments. So far, no ideal method of operating these tumors has been developed. Most cardiac interventions are undertaken by cardiac surgeons to relieve symptoms and temporarily improve the patient’s quality of life.
So far, no complementary therapy regimens have been developed that could be used in the treatment of malignant heart tumors. If radiotherapy is planned, it is selected individually for each patient, but it is usually used in palliative treatment to irradiate the primary tumor focus and metastases. Chemotherapy, especially for sarcomas, is given because metastases may spread. Most often, however, patients with malignant heart tumors are administered anti-cancer drugs, but their effectiveness is also not impressive.
Text: Anna Jarosz
Watch more in OnetVOD: Can you “like” cancer?