Tumors of the heart (cancer, myxoma, sarcoma): types, treatment
Tumors of the heart are rare, and if found malignant the tumor, the layman will call it «cancer of the heart», although this terminology is not quite right. Primary malignant tumors of the heart are sarcomas, and cancer actually grows there from a neighboring body or is metastatic in nature.
Tumors of the heart are quite heterogeneous in nature formations. The source may be the myocardium, pericardium or the inside layer of the body, the valves, the septum between the Atria or ventricles and vascular system. No age limits, when there is a tumor, they can be detected in a fetus diagnosed in children, adults, young, Mature or senile. They are equally affected both women and men.
If neoplasia originate from the tissues of the heart, then they will be called primary. Such tumors account for less than 0.2% of all neoplasms of the organ. Much more often doctors are faced with a situation when the disease is secondary – metastasis of cancer to other organs, germination of carcinoma of the lung, stomach, esophagus, etc. Secondary tumors are 30 times more often than the primary.
Regardless of the histological features and the location of the tumor, they all have heart failure, tamponade of an organ, embolism, life-threatening arrhythmias, so even in the case of a completely benign tumors only method of treatment is surgical operation, the delay which is a serious mistake.
Types of cardiac tumors
Primary tumors of the heart growing out of its structures are:
Benign tumors make up three quarters of all cardiac tumors, and a leader among them, a myxoma, which is found in 80% of cases. The remaining 20% is represented by teratomas and formations of connective-tissue origin lipoma, rhabdomyoma, vascular tumors, fibroids, cysts of the pericardium.
Malignant neoplasms represented by sarcomas of the muscle, adipose tissue, walls of blood vessels, mesothelium covering the heart is on the outside, there are neoplasm of hematopoietic tissue – lymphoma. Secondary malignant neoplasm «come» to the heart from adjacent organs – lungs, esophagus, trachea, pleura, stomach, mammary gland. In this case, detect the complexes of cancer, according to the structure of the corresponding carcinomas of the organs where they originated.
It is worth saying a few words on terminology, to let the reader know why heart cancer is not growing. From the point of view of science, cancer is formed from epithelial and connective tissue tumors are called sarcomas. Malignant tumor of the heart is formed of muscle, fat and other varieties of connective tissue, and therefore the term «cancer» for her does not apply, and it is better to define it as «sarcoma». In the case that the body discovered carcinoma, sprouted from other bodies or appeared there as a result of metastasis, it will not be called cancer of the heart, but instead will point to the secondary nature of the lesion, necessarily naming the source of the cancer.
Benign tumors of the heart
Myxoma is the most common type of cardiac tumors, representing about half of all cases. Among the patients are several times more women, the average age of 30-50 years. Atrial myxoma (most commonly the left) starts its growth in the interatrial septum, fixing the likeness to her feet and gradually filling the cavity of the heart. Less frequently detected ventricular myxoma.
Myxoma looks like a globular node soft or dense (less) consistency, filling the lumen of the atrium or ventricle. The average diameter is 3-4 cm, but some myxoma may reach 8 cm, preventing the flow of blood and emptying of the heart chambers. Loose, lobed myxoma is a very dangerous separation of fragments of the tumor, which were covered in the blood system and can cause embolism.
Until, as a myxoma reaches the valve hole or fill a chamber of the heart, the manifestations of it may not be. In case of violation of blood flow, the overlap of the atrioventricular valves hanging myxomas, symptoms are similar to those for heart disease. Increases circulatory disorders with manifestations in both blood circuits.
The second place on prevalence after the mix is papillary fibroelastoma, a favorite localization which are the valves – the mitral on the left and tricuspid on the right half of the heart. Externally they resemble papillomas form papillary growths on the valve leaves, but buds are deprived of the vessel, unlike true papillomas. At work fibroelastoma the valve leaflets is not affected, but they create a great risk of tumor embolism in the separation of the papillae.
Rhabdomyoma make up about a fifth of all benign cardiac tumors and most often is diagnosed in childhood. These formations grow from the striated muscle of the myocardium, located in the thickness of the heart wall (septum and left ventricle most often) prone to multiple growth simultaneously in multiple foci. They are dangerous because of the defeat of conducting nerve fibers, and thickening and deformation of the walls of the heart with the development of arrhythmias and organ failure.
Among the more rare varieties of benign cardiac tumors – fibromas, lipomas, hemangiomas, which grow inside the myocardium or the valves (hemangioma, fibroma), and cavities (lipomas). These tumors are striking vascular system, disturbed hemodynamics, fraught with embolism.
Video: a myxoma in the program «Live healthy!»
Malignant tumors of the heart
Malignant tumors of the heart are formed of muscular, fibrous, fatty tissue, vascular wall, pericardium, and they are called sarcomas. The left atrium is the most common place of growth. The disease affects people young and middle age.
Among sarcomas of the leading vascular tumor – angiosarcoma (40%). Besides it, within the heart can be formed, randomio and leiomyosarcoma (of muscular tissue), cm and even osteosarcoma, consisting of immature bone tissue. A quarter of all malignant neoplasias represent undifferentiated sarcomas, robust growth and early metastasis and have a very poor prognosis.
From cells of the pericardium can occur mesothelioma is often diagnosed in men. Immunodeficiency, including acquired (HIV) infection creates a favorable background for appearance of lymphoma of the heart, which grows rapidly with the manifestations of insufficiency of body rhythm disorders.
Symptoms of heart tumors
Most cardiac tumors have similar symptoms associated with the presence of additional tissue in the camera body, disturbance of blood flow through the valve orifice, lesions of the conduction system. Features of clinical picture associated with the location of the tumor inside of the heart, the thickness of the myocardium or on the wings of the valves. The most typical signs of disease:
- The pain and feeling of heaviness in the chest;
- Shortness of breath;
- Tachycardia, a sense of interruptions of rhythm;
- Cyanosis of the skin.
Malignant neoplasms tend to lead to General improvements – weight loss, fever, lack of appetite, pain in bones and joints, possible rash on the skin.
Tumors located outside of the heart, may be manifested by shortness of breath and chest pain. The growth they violate the mobility of the body, preventing proper emptying and filling of its chambers. With the possible collapse and bleeding associated with the development of cardiac tamponade – a condition in which the cavity of the heart bag is filled with blood, blocking reduction on the result of the block – asystole (cardiac arrest) and death.
Compression of the large vascular trunks of the tumor manifests itself in the form:
- Swelling of the face and the upper half of the body upon compression of the superior Vena cava;
- Swelling of the legs and venous congestion in the internal organs, when compression of the inferior Vena cava.
A tumor growing within the myocardium, affect the fibers of the conduction system, therefore, among the main symptoms are cardiac arrhythmias. Patients complain of palpitations with tachycardia, in case of blockades appear shortages and a sense of paralysis in the chest. In addition to arrhythmias, increasing symptoms of heart failure, shortness of breath, weakness, swelling, increased liver.
Tumors located inside the heart chambers, causing disruption of circulation of blood through the Atria, the ventricles and major blood vessels, prevents the filling chambers of the heart or its emptying, can close the valve hole, simulating a stenosis. The main manifestation of these tumors are considered rapidly progressive heart failure.
Myxoma of the left atrium when filling out a this camera develops severe shortness of breath, fainting, chest pain. The characteristic feature of it is the growing heart failure not responding to conservative treatment. Possible sudden death if the obstruction (closure) myxomas of the mitral valve. It is important that the symptoms are aggravated by changing body position.
If the tumor affects the valves, there are signs of stenosis or insufficiency, the stasis in the pulmonary circulation with shortness of breath, pulmonary edema, a tendency to inflammation of the respiratory organs; in large – enlargement of the liver, edema, cyanosis.
Very characteristic and particularly dangerous when the valve localization of neoplasia embolism by tumor cells. With the defeat of the mitral or aortic valve cellular conglomerates find themselves in a big circle with arterial blood clog the blood vessels of the heart, brain, kidneys, legs, etc. it is Clinically manifest like stroke, myocardial infarction, ischemia of the limbs.
If the tumor emboli to enter the bloodstream from the right heart, then corked a pulmonary artery, its branches, which is manifested by shortness of breath, increase in pressure in the small circle, the extension of the right half of the heart. In case of violation of the blood flow through main artery most often death occurs from acute pulmonary-cardiac insufficiency.
Given the non-specificity of symptoms, which can be in a number of other heart disease, diagnosis of tumors of this organ is no easy task. The probable growth of tumors is most appropriate to send the patient for an ultrasound, if necessary, is CT and MSCT sensing, radio-opaque or radioisotope study of the heart cavities. ECG if the tumor has no characteristic changes, it is recorded arrhythmia, violations conductivity, signs of stress on the heart, etc., which occurs in different cardiac pathology.
Treatment of heart tumors
For the treatment of tumors of the heart are applied surgical intervention, radiation, chemotherapy. The most effective method is recognized as an operation that may involve removal of the tumor, located in the cavity of the organ, area of the myocardium or pericardium with neoplasia.
In case mix and other benign tumors surgery is the only effective method of treatment. Conservative therapy relieves of the symptoms, improves overall health, but the risk of complications and death remains quite high, so ignoring or delaying the timing of the operation is considered to be malpractice.
When you remove a myxoma or other benign tumors growing in the cavity of the atrium or ventricle of the heart, it is imperative to excise not only the part, which creates obstruction of blood flow, but also a platform from which the tumor originates. This is done to reduce the likelihood of recurrence, which is still diagnosed in some patients.
To access the tumorous heart uses the median longitudinal sternotomy when the incision is through the sternum. This access provides a good overview for the physician and sufficient for the manipulation of the heart and large vessels. If necessary, removal of the tumor of the left ventricle, the surgeon penetrates there through the aorta, cutting it transversely.
Any, including benign tumors of the heart, located in the lumen of the body or on the valve can be the cause of embolism, so remove them very carefully, without squeezing, and atomically, at the same aorta should be pinched, and the heart stopped. Digital control cavities is not done, instead they are washed with normal saline to rule out leaving the cells of tumors in the heart. After heart surgery may require additional plastic to restore the valve prosthesis, an annuloplasty..
During manipulation of the heart is stop (cardioplegia) and the establishment of artificial circulation. To maintain the myocardium at this time, there are pharmacological and cold «protection» — treatment of the body with cold saline, the introduction of vessels of pharmacological agents.
In malignant tumors radical attempts of treatment have been undertaken, but experience has shown that soon after surgery have a recurrence, so the main methods of tumors are radiation and chemotherapy. Often malignant tumors are diagnosed at a stage when struck by the significant volume of the heart and surrounding tissues, therefore, to remove the tumor is impossible and the only way to help the patient, irradiate it, or to assign systemic chemotherapy.
For this kind of treatment resorted in secondary, metastatic lesions of the heart. Radiation and chemotherapy do not lead to the cessation of the tumor, but help to reduce its size, facilitating the patient’s condition, so this treatment is considered palliative. In addition to reducing the severity of symptoms, palliative care can prolong a patient’s life for up to five years from the time of detection of the disease.
The prognosis of tumors of the heart serious. Favorable it can be considered in benign tumors which were promptly removed and has not led to complications. Multiple tumors give five-year survival rate of about 15%. Sarcomas and metastatic cancer, the prognosis is not good – patients die within 6-12 months from the onset of the disease, and up to 80% of patients with primary malignant neoplasia at the time of their identification already have metastases.