Cardiac Sarcoma
What is cardiac sarcoma?
Cardiac sarcoma is a type of tumor that occurs in the heart.
Cardiac sarcomas are malignant, or cancerous.
Tumors are considered to be either primary tumors or secondary
tumors. A primary tumor is the original site of tumor growth.
A secondary tumor originates from another tumor elsewhere in the
body. Primary tumors of the heart are present in 0.001 to 0.28
percent of autopsies in the general population.
Cardiac sarcoma is a primary malignant tumor. Primary tumors
of the heart occur rarely, and over 75 percent of primary cardiac
tumors are benign, or non-cancerous. Thus, cardiac sarcoma is
very rarely seen.
What are the symptoms of cardiac sarcoma?
The symptoms of heart tumors will vary, depending on the location
of the tumor. Tumors of the heart may occur on the outside surface
of the heart, within one or more chambers of the heart (intracavitary),
or within the muscle tissue of the heart.
Cardiac sarcomas, most frequently, are a type of sarcoma called
angiosarcoma. Angiosarcomas usually begin in the right atrium
(right upper chamber) of the heart, or on the pericardium (outer
surface) of the heart. Approximately 25 percent of angiosarcomas
occur inside the heart chamber, resulting in 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.
Cardiac angiosarcomas that occur on the pericardium can cause
increased fluid in the pericardial sac, the thin covering that
surrounds the heart. If enough fluid accumulates within the pericardial
sac, the heart's ability to pump blood is affected. Some signs
of this occurrence may include chest pain, shortness of breath,
fatigue, and palpitations.
Tiny pieces (emboli) of cardiac sarcomas may break off and travel
through the bloodstream to other parts of the body. An embolus
may block blood flow to an organ or body part, causing pain and
damage to the organ or body part that lies beyond the point at
which the blood flow is obstructed. Emboli can affect the brain
(causing a stroke), the lungs (causing respiratory distress),
and/or other organs and body parts.
Other signs of cardiac sarcoma not related to the location of
the tumor in the heart may include fever, weight loss, night sweats,
and malaise (fatigue, tiredness, or "not feeling well").
The symptoms of cardiac sarcoma may resemble other cardiac or
medical conditions. Always consult your physician for a diagnosis.
How is cardiac sarcoma diagnosed?
The methods for diagnosing cardiac sarcoma 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 (also known as echo) - 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 sarcoma, allowing the physician
to see the exact size and location of the tumor.
- electrocardiogram (ECG or EKG) - a test that records
the electrical activity of the heart, shows abnormal rhythms
(arrhythmias or dysrhythmias), and detects heart muscle damage;
cardiac sarcoma may cause changes in the heart's rhythm, however,
these EKG changes may indicate other heart problems, so other
diagnostic tools are needed to make a definitive diagnosis of
cardiac sarcoma or any other type of heart tumor.
- 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), both horizontally and vertically, 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.
Treatment for cardiac sarcoma:
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
Once a cardiac sarcoma has progressed to the point that symptoms
begin to occur, it has often spread to other parts of the body
(in 80 percent of cases), making treatment difficult and challenging.
This spread to other parts of the body is called metastasis. The
type of treatment for cardiac sarcoma depends largely upon the
location and size of the tumor, as well as the extent of metastasis.
The physician may determine that the tumor can be removed, which
is done with an open-heart surgical procedure. This is often difficult,
however, because of the location of the tumor.
In some cases, the sarcoma has invaded the heart to such an extent
that it is impossible to remove it completely. In this situation,
heart transplantation has been attempted. However, a patient must
receive immunosuppressive medication (medications which help to
prevent the body from rejecting foreign tissue) after transplant,
and this medication may stimulate new growth of sarcoma.
An exciting new prospect for treatment of cardiac sarcoma is
autotransplantation. Autotransplantation is a surgical procedure
in which the patient's own heart is removed so that the tumor
can be more completely and easily removed from the heart tissue.
After the tumor is removed, the heart is replaced into the patient.
Because the patient has not received a heart from another person,
there is no need for immunosuppressive medications.
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