Cancer-Related Heart Disease

Primary heart tumors, which are very rare, are tumors that originate in the heart, and may develop in any of the heart tissues.

• The most common primary heart tumors are sarcomas — cancers that develop from blood vessel tissue.
• Half of all primary heart tumors are noncancerous tumors called myxomas. Three-quarters of myxomas occur in the left atrium.
• Sometimes, myxomas run in families.
• Myxomas typically develop in young men in their mid-20s. Myxomas that are not hereditary usually develop in women ages 40 to 60.

Secondary heart tumors, which are always cancerous, originate in other parts of the body — most often the lungs, breasts, blood or skin — and spread (metastasize) to the heart.

• Secondary heart tumors are 30 to 40 times more common than primary heart tumors, but are still rare.
• Cancer metastasizes to the heart in about 10 percent of lung or breast cancer cases, and about 75 percent of malignant melanoma (a type of skin cancer) cases.
• Secondary cancers spread by direct invasion of the pericardium — the sac that surrounds the heart — or through the bloodstream or lymph system.

The symptoms of cancerous and noncancerous heart tumors are the same, but vary depending on the location of the tumor. Symptoms of cancerous heart tumors can worsen more quickly, as these tumors grow faster. Symptoms may include:

• Heart failure
• Arrhythmia
• Coughing up blood
• Heart murmur
• Weight loss
• Fever

Other Signs of Heart Tumors

• Primary tumors may spread to the spine, nearby tissues or organs such as the lungs or brain.
• Myxomas grow from a stalk and may swing back and forth with the flow of blood, blocking the mitral valve, causing blood flow to stop and start intermittently. This may cause fainting, shortness of breath or fever.
• Myxomas may degenerate so that pieces of them break off and travel through the bloodstream, turning into blood clots that block blood flow.

Heart tumors can be detected by:

• CT scan
• Cardiac MRI
• Echocardiogram
• Angiogram

Primary heart tumors are difficult to diagnose because they are so rare. They may be suspected in those who have a heart murmur, arrhythmia, unexplained fever or unexplained symptoms of heart failure.

Secondary heart tumors are suspected when people who have cancer in other places in the body exhibit symptoms of heart disorders.

• Surgery: A single, small noncancerous primary heart tumor, including a myxoma, can be surgically removed, usually resulting in a cure.
• Chemotherapy or radiation: may be used to reduce symptoms of cancerous tumors.
• Fluid drainage: for tumors in the pericardium that cause fluid to accumulate around the heart.

Heart Disease Secondary to Cancer Treatments

Some cancer treatments may cause damage to the heart, or can cause a heart attack from spasm or narrowing of the arteries that deliver blood to the heart. Some experts recommend that cancer patients, particularly breast cancer patients, get a formal heart risk assessment before their cancer treatment regimen is decided.

• Certain chemotherapy regimens may increase the risk of cardiomyopathy or heart attack. Some commonly used breast cancer drugs can sometimes cause weakening of the heart muscle.
• Radiation, particularly to an area of the body that includes the heart, can also increase the risk of cardiomyopathy and heart attack.

Cardiac Amyloidosis

Cardiac amyloidosis is a disorder often seen in patients with multiple myeloma.

• Caused by deposits of an abnormal protein (amyloid) in the heart tissue, which can make it hard for the heart to work properly, cardiac amyloidosis occurs when these deposits take the place of the normal heart muscle.
• Treatment options include chemotherapy or anti-inflammatory medication.
• The way electrical signals move through the heart can also be affected by cardiac amyloidosis, leading to arrhythmias, which may be treated with medication and a pacemaker.
• Eventually, the heart muscle fails as a result of cardiac amyloidosis. Patients with this condition rarely live longer than one to two years.