What are cardiac tumors?

Cardiac tumors are growths that arise in the heart’s inner lining, its muscle layer, or the surrounding pericardium. Although cardiac tumors can be benign (non-cancerous) or cancerous, the majority of cardiac tumors – approximately 70% – are non-cancerous.

How are cardiac tumors diagnosed?

The methods for diagnosing cardiac tumors vary, to some degree, on the symptoms present. In addition to a complete medical history and physical examination, diagnostic procedures for cardiac sarcoma may include the following:

• Echocardiogram - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart. Echocardiography has become the most useful tool in the diagnosis of cardiac tumors, allowing the physician to see their exact size and location.

• Electrocardiogram (ECG) - a test that records the electrical activity of the heart, shows abnormal rhythms, and detects heart muscle damage. Cardiac tumors may cause changes in the heart's rhythm; however, these ECG changes may indicate other heart problems, so other diagnostic tools are needed to make a definitive diagnosis.

• Computed tomography (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays and are used to further define the tumor's size, location, and other characteristics.

• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; to further define the tumor's size, location, and other characteristics.

• Chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; may detect heart enlargement or pulmonary congestion.

• Coronary arteriogram (or angiogram) - with this procedure, x-rays are taken after a contrast agent is injected into an artery - to locate the narrowing, occlusions, and other abnormalities of specific arteries.

Benign Cardiac Tumors

Myxoma

The most common type of benign cardiac tumor is the myxoma, which extends in to the heart’s chambers and accounts for 50% of primary cardiac tumors.  Left untreated, these tumors can interfere with the function of cardiac valves; they can obstruct blood flow, and small fragments of tumors can break off and travel through the bloodstream to become lodged in the lungs or other parts of the body.

Rhabdomyoma

Accounting for approximately 20% of benign cardiac tumors, rhabdomyomas form in the myocardium—the muscle layer of the heart.  Rhabdomyomas are the most common cardiac tumor of infants and children.  These tumors can cause arrhythmias and heart failure.

Other Types of Benign Cardiac Tumors

These more rare benign cardiac tumors include:

• Fibroma
• Hemangioma
• Lipoma
• Lymphangioma
• Neurofibroma
• Papillary Fibroelastoma

Cancerous Cardiac Tumors

Cancerous cardiac tumors can originate in the heart (primary tumor), or can spread to the heart from another site in the body (secondary tumor), especially the lung and breast.

Cardiac Sarcoma

Cardiac sarcoma is the most common primary malignant cardiac tumor. Because most cardiac tumors are not malignant, cardiac sarcomas are relatively rare. The most common type of cardiac sarcoma is the angiosarcoma, which usually begins in the right atrium (right upper chamber) of the heart, or on the pericardium (outer surface) of the heart.

Angiosarcomas that occur inside the heart chamber can cause obstruction of the inflow or outflow of blood in the right atrium. This obstruction may cause symptoms such as swelling of the feet, legs, ankles, and/or abdomen, and distension of the neck veins, because the blood coming back to the heart after traveling through the body cannot easily enter or be pumped out of the right atrium. Tiny pieces (emboli) of cardiac sarcomas may break off and travel through the bloodstream to other parts of the body. Cardiac angiosarcomas that occur on the pericardium (the thin covering that surrounds the heart) can cause chest pain, shortness of breath, fatigue, and palpitations.

Other Cancerous Tumors of the Heart

These include:

• Fibrosarcoma
• Liposarcoma
• Rhabdomyosarcoma

Treatment for Cardiac Tumors

Specific treatment for cardiac sarcoma will be determined by the physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Benign cardiac tumors that are small and cause no symptoms can be closely monitored, and may require no treatment.  However, surgery is indicated if, for example, the tumor is causing an arrhythmia or is obstructing blood flow through the heart.  Depending on the type of tumor, outcomes can vary. Most myxomas can be cured by surgical removal, however, rhabdomyomas are more difficult to remove; prognosis will vary depending on the size of the rhabdomyoma.

Malignant heart tumors are removed with an open-heart surgical procedure.  Prognosis depends on the type of tumor, its size, and location.  In cases where the tumor cannot be successfully removed, heart transplantation may be considered.