Why don’t we ever hear about heart cancer?

Robert Dunton, MD

“It’s not something we see very often,” said Robert Dunton, MD, chief of cardiothoracic surgery at Upstate University Hospital. He went on to provide this answer:

Benign tumors of the heart are probably more common than malignant (cancerous), but both are pretty rare. The most common of the benign tumors is known as a myxoma, but there is a whole host of other benign tumors. When you consider malignant tumors, they are either a primary heart tumor, or metastatic, meaning it spread to the heart from somewhere else. Usually it’s from somewhere else. It’s very unusual for the heart to have its own malignant tumor.

That’s probably because the heart is made up of specialized muscle cells. Although the heart is composed of other types of connective tissue, most of it is a very specialized muscle, and muscle, as a rule, is a rare place to have malignant tumors.

The predominant symptom is often one of breathing difficulties. Folks may feel short of breath, have what we all dyspnea. That’s because these tumors, when they’re inside the heart, can kind of roll around and get in the way and block blood flow for short periods of time, and the patient will feel those symptoms. Less commonly, folks will have either chest pains or palpitations, feel their heart skip a beat. Sometimes with myxomas, patients can have almost like a flu-like illness,  with fevers, muscle aches and pains.

These are diagnosed with cardiac echocardiogram, which can be done from the outside as well as the inside. If we do an echo of the heart from the outside, we’re limited because we have to look between the ribs. So there’s a probe that can go down the patient’s esophagus, and from the inside, there’s nothing in the way, so we get much better pictures. It’s called a trans-esophageal echo. Another test that’s really quite elegant is called cardiac magnetic resonance imaging, using the MRI machine. Sometimes we’ll use an MRI picture of the heart to further diagnose or plan what type of operation the patient may require.

Generally, most tumors in the heart have to be removed. The benign tumors, we remove because they can certainly, even though they’re benign, cause some significant problems. They can create blockage in terms of blood flow. In other words, they get in the way. They can create arrhythmias or heart irregularities, palpitations or other heart rhythm disturbances. One of the concerns we have about tumors inside the heart is that pieces of them can break off. They can go through the circulation and create injury. If a particle comes off of a tumor, it can go to the brain and cause a stroke or go to the kidney and cause kidney damage.

We remove malignant tumors to prevent those same problems, but also because malignant tumors can grow and get much worse and can also spread. Like any cancer, we would consider trying to remove it all. The problem is, in the heart we are limited as to how much tissue we can remove.

There are surgeons who have reported operating on a patient for a malignant tumor by actually removing the heart, like you would if your patient was going to have a transplant. They remove the heart, and on the table in the operating room, work on it to remove the malignant tumor, reconstruct things and then put it back in. That is called auto-transplantation. Some patients have even been treated with a transplant.

These are definitely unusual, but here at Upstate, we’ve seen four in the last 18 months. Three  had myxomas. The fourth had a primary tumor, meaning it developed in the heart, that turned out to be cancerous. So it’s not so uncommon that we don’t ever see it, and it has to be part of a physician’s diagnostic thinking.

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