Cardiac tumors natural history: Difference between revisions

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{{Primary tumors of the heart}}
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{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}
{{Cardiac tumors}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}} {{DMakkar}}
 
==Overview==
Patients with heart tumors may develop systemic constitutional symptoms like fever, fatigue, and joint problems. Depending on the location of tumors, specific symptoms may manifest. The prognosis for benign cardiac tumors is favorable, but there is a potential of recurrence, but the prognosis for malignant tumors is poor.
 
==Natural History==
Cardiac tumors can arise in a multitude of ways, resulting in diverse clinical presentations. Irrespective of cardiac tumor type, cardiac symptoms primarily depend on tumor position and extent.<ref name="pmid22091416">{{cite journal| author=Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, Anastasiou-Nana M| title=Cardiac tumors. | journal=ISRN Oncol | year= 2011 | volume= 2011 | issue=  | pages= 208929 | pmid=22091416 | doi=10.5402/2011/208929 | pmc=3195386 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22091416  }} </ref>
*Patients may develop systemic symptoms including fever, fatigue, and joint pains but can be asymptomatic as well. Myxomas were asymptomatic in 72% cases in a study by Dias et al.<ref name="pmid25029470">{{cite journal| author=Dias RR, Fernandes F, Ramires FJ, Mady C, Albuquerque CP, Jatene FB| title=Mortality and embolic potential of cardiac tumors. | journal=Arq Bras Cardiol | year= 2014 | volume= 103 | issue= 1 | pages= 13-8 | pmid=25029470 | doi=10.5935/abc.20140096 | pmc=4126756 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25029470  }} </ref>
*Tumors can impede blood flow, causing hemodynamic abnormalities, poor cardiac output, or heart failure.
*Malignant tumors may especially cause weight loss, anorexia, and exhaustion.
*In addition, valvular disease can lead to stenosis or regurgitation.<ref name="pmid22892935">{{cite journal| author=Avakian SD, Takada JY, Mansur Ade P| title=Giant obstructive left atrial myxoma resembling mitral valve stenosis. | journal=Clinics (Sao Paulo) | year= 2012 | volume= 67 | issue= 7 | pages= 853-4 | pmid=22892935 | doi=10.6061/clinics/2012(07)25 | pmc=3400890 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22892935  }} </ref>
*Local infiltration of the cardiac conduction system could result in arrhythmias.
*Non-specific features like pericardial effusion and compression of nearby structures, such as the coronary arteries, might develop.
*Clinically, the tumor type (benign or malignant), anatomical location, time duration of receiving treatment and available treatment options are the most critical clinical criteria in determining a cardiac tumor patient's natural history of disease.
*The relapse rate of benign cardiac tumors is minimal. In some familial types of benign tumors, such as familial myxomas, however, incidence rates of tumor recurrence can reach as high as 22%.<ref name="pmid29556752">{{cite journal| author=Palaskas N, Thompson K, Gladish G, Agha AM, Hassan S, Iliescu C | display-authors=etal| title=Evaluation and Management of Cardiac Tumors. | journal=Curr Treat Options Cardiovasc Med | year= 2018 | volume= 20 | issue= 4 | pages= 29 | pmid=29556752 | doi=10.1007/s11936-018-0625-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29556752  }} </ref> In certain syndromes like Tuberous Sclerosis the rhabdomyomas disappear and have  a good prognosis.
*In contrast, malignant tumors often have a poorer prognosis and are difficult to treat due to their more invasive behavior, metastatic origin, and high recurrence rate. Malignant tumors have a much greater mortality rate. Most of the patients succumb to the tumor within an year even with treatment<ref name="pmid29556752">{{cite journal| author=Palaskas N, Thompson K, Gladish G, Agha AM, Hassan S, Iliescu C | display-authors=etal| title=Evaluation and Management of Cardiac Tumors. | journal=Curr Treat Options Cardiovasc Med | year= 2018 | volume= 20 | issue= 4 | pages= 29 | pmid=29556752 | doi=10.1007/s11936-018-0625-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29556752  }} </ref>
 
==Complications==
:*Emboli into coronary arteries
:*Retrograde flow through cardiac lymphatics
:*Direct extension from [[mediastinum]]
:*Emboli or spread via great veins => endocardial metastases
::*[[Hypernephroma]]
::*Testicular sarcoma
::*IVC [[leiomyosarcoma]]
::*[[Ovarian cancer]]
::*[[Colon cancer]]


== Prognosis ==
== Prognosis ==
The vast majority of the tumors of the heart have a benign course and are not directly fatal.  However, even the benign tumors of the heart can be lethal due to either direct extension into the electrical conduction system of the heart (causing [[third degree AV block|complete heart block]] or a fatal dysrhythmia), or due to [[embolism|emboli]] from the tumor mass that may have lethal sequelae.
The vast majority of the tumors of the heart have a benign course and are not directly fatal.  However, even the benign tumors of the heart can be lethal due to either direct extension into the electrical conduction system of the heart (causing [[third degree AV block|complete heart block]] or a fatal dysrhythmia), or due to [[embolism|emboli]] from the tumor mass that may have lethal sequelae.


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Latest revision as of 04:29, 7 July 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Dheeraj Makkar, M.D.[3]

Overview

Patients with heart tumors may develop systemic constitutional symptoms like fever, fatigue, and joint problems. Depending on the location of tumors, specific symptoms may manifest. The prognosis for benign cardiac tumors is favorable, but there is a potential of recurrence, but the prognosis for malignant tumors is poor.

Natural History

Cardiac tumors can arise in a multitude of ways, resulting in diverse clinical presentations. Irrespective of cardiac tumor type, cardiac symptoms primarily depend on tumor position and extent.[1]

  • Patients may develop systemic symptoms including fever, fatigue, and joint pains but can be asymptomatic as well. Myxomas were asymptomatic in 72% cases in a study by Dias et al.[2]
  • Tumors can impede blood flow, causing hemodynamic abnormalities, poor cardiac output, or heart failure.
  • Malignant tumors may especially cause weight loss, anorexia, and exhaustion.
  • In addition, valvular disease can lead to stenosis or regurgitation.[3]
  • Local infiltration of the cardiac conduction system could result in arrhythmias.
  • Non-specific features like pericardial effusion and compression of nearby structures, such as the coronary arteries, might develop.
  • Clinically, the tumor type (benign or malignant), anatomical location, time duration of receiving treatment and available treatment options are the most critical clinical criteria in determining a cardiac tumor patient's natural history of disease.
  • The relapse rate of benign cardiac tumors is minimal. In some familial types of benign tumors, such as familial myxomas, however, incidence rates of tumor recurrence can reach as high as 22%.[4] In certain syndromes like Tuberous Sclerosis the rhabdomyomas disappear and have a good prognosis.
  • In contrast, malignant tumors often have a poorer prognosis and are difficult to treat due to their more invasive behavior, metastatic origin, and high recurrence rate. Malignant tumors have a much greater mortality rate. Most of the patients succumb to the tumor within an year even with treatment[4]

Complications

  • Emboli into coronary arteries
  • Retrograde flow through cardiac lymphatics
  • Direct extension from mediastinum
  • Emboli or spread via great veins => endocardial metastases

Prognosis

The vast majority of the tumors of the heart have a benign course and are not directly fatal. However, even the benign tumors of the heart can be lethal due to either direct extension into the electrical conduction system of the heart (causing complete heart block or a fatal dysrhythmia), or due to emboli from the tumor mass that may have lethal sequelae.

The malignant tumors of the heart have a worse prognosis. Cardiac sarcomas generally lead to death within 2 years of diagnosis, due to rapid infiltration of the myocardium of the heart and obstruction of the normal flow of blood within the heart.[5][6]

References

  1. ↑ Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, Anastasiou-Nana M (2011). "Cardiac tumors". ISRN Oncol. 2011: 208929. doi:10.5402/2011/208929. PMC 3195386. PMID 22091416.
  2. ↑ Dias RR, Fernandes F, Ramires FJ, Mady C, Albuquerque CP, Jatene FB (2014). "Mortality and embolic potential of cardiac tumors". Arq Bras Cardiol. 103 (1): 13–8. doi:10.5935/abc.20140096. PMC 4126756. PMID 25029470.
  3. ↑ Avakian SD, Takada JY, Mansur Ade P (2012). "Giant obstructive left atrial myxoma resembling mitral valve stenosis". Clinics (Sao Paulo). 67 (7): 853–4. doi:10.6061/clinics/2012(07)25. PMC 3400890. PMID 22892935.
  4. ↑ 4.0 4.1 Palaskas N, Thompson K, Gladish G, Agha AM, Hassan S, Iliescu C; et al. (2018). "Evaluation and Management of Cardiac Tumors". Curr Treat Options Cardiovasc Med. 20 (4): 29. doi:10.1007/s11936-018-0625-z. PMID 29556752.
  5. ↑ Burke AP, Cowan D, Virmani R (1992). "Primary sarcomas of the heart". Cancer. 69 (2): 387–95. PMID 1728367.
  6. ↑ Burke AP, Virmani R (1991). "Osteosarcomas of the heart". Am J Surg Pathol. 15 (3): 289–95. PMID 1705103.

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