Cardiac tumor

Disease Description (Causes and Symptoms)

• Definition summary: Benign or malignant tumors that develop in the heart (both primary and metastatic tumors are possible). Primary tumors are rare, and most are metastatic. Approximately 75% of adults have benign tumors, with cardiac myxoma accounting for about half of benign tumors. Myxomas mainly occur in the left atrium and are relatively common in women and people in their 30s–60s.
• Causes and pathophysiology:
  • Primary: Histologically benign (e.g., myxoma, fibroma) or malignant (e.g., cardiac sarcoma).
  • Metastatic: Cardiac invasion or metastasis from cancers of other organs, such as lung cancer, breast cancer, or melanoma.
  • Pathophysiology: When a tumor is located in the cardiac chamber (inflow/outflow tract) or myocardium, it can cause obstruction of blood flow, valvular dysfunction, reduced ventricular contractile function, or abnormalities of electrical conduction. Embolism caused by tumor fragments is possible.
• Main symptoms:
  • Often discovered incidentally without symptoms
  • Shortness of breath, fatigue on exertion, and symptoms of congestive heart failure (features of left- or right-sided heart failure)
  • Irregular pulse, syncope, or sudden death (due to cardiac conduction disorders, ventricular tachycardia, etc.)
  • Symptoms of systemic embolism (in the brain, kidneys, peripheral blood vessels, etc.)
  • Worsening due to mechanical obstruction (e.g., severe symptoms when the left ventricular outflow tract is obstructed)

Treatment Methods

• Diagnostic approach: Transthoracic or transesophageal echocardiography is performed first; cardiac MRI or chest CT is used when necessary to assess the location, size, and involvement of surrounding structures. Tissue confirmation is established by pathology during or after surgery.
• Surgical treatment:
  • Most benign tumors, including mobile myxomas, are treated with complete resection (an endoscopic cardiac approach or open-heart surgery with cardiopulmonary bypass).
  • Emergency or early surgery is recommended when the tumor obstructs blood flow or carries a high risk of embolism.
  • Because complete resection is difficult for extensively invasive malignant tumors, adjuvant chemotherapy or radiation therapy may be considered.
  • Heart transplantation may be considered in some cases of irreversible myocardial involvement and heart failure (with strict indications).
• Medication and nonsurgical treatment:
  • Medication treatment of the tumor itself is limited (applied in some cases, such as chemotherapy for malignant cardiac sarcoma).
  • Anticoagulants may be considered when there is a risk of embolism or suspected thrombus associated with the tumor (individual assessment is required).
  • Arrhythmia management is determined based on the symptoms and mechanism, using antiarrhythmic drugs, pacemaker/defibrillator implantation, or catheter ablation. If the tumor is the cause of the arrhythmia, removal of the tumor may improve it.
• Lifestyle management and precautions:
  • Manage the risks of bleeding and infection before and after surgery, and discuss whether anticoagulants are being taken
  • If obstructive symptoms are present, restrict activity (maintain rest) and establish an emergency treatment plan
  • Long-term follow-up (including regular echocardiography)
• Prognosis:
  • Benign tumors have a good prognosis when completely resected. Recurrence is rare, but recurrence within several years has been reported (mostly within 4 years after surgery, with late recurrence rarely occurring).
  • Malignant or metastatic tumors have a poor prognosis and require adjuvant treatment to relieve symptoms and prolong survival.

Checklist Before an Outpatient Visit (Including Sample Questions)

• What to bring
  • A list of current medications, including thrombolytics, anticoagulants, and antiplatelet agents
  • Medical history and surgical records (including heart surgery and cancer history)
  • Recent test results (echocardiography, chest CT/MRI, and blood test results or image files, if available)
  • A record of changes in symptoms (onset, frequency, triggers, and detailed features of syncope, chest pain, or shortness of breath)
  • Allergies and family history (heart disease and hereditary tumors)
• Checks before an outpatient visit
  • Whether there is a fever or any symptoms of infection (surgery may be postponed if an infection is present before surgery)
  • Confirm instructions for taking anticoagulants (whether they need to be stopped before specific tests or procedures)
• Sample questions (including questions patients can actually ask their doctors)
  • What are the side effects of this medication (e.g., an anticoagulant or antiarrhythmic drug)?
  • Is my tumor benign, and how likely is it to be malignant?
  • If surgery is needed, is it urgent? What is the likelihood that surgery will cure it?
  • Is there a risk of recurrence? How often should follow-up tests be performed?

General Sample Questions to Ask the Doctor

• If surgery is needed, what surgical method will be used, and what are the expected complications (bleeding, infection, and the possibility of needing repeat surgery)?
• Does my tumor increase the risk of embolism or sudden death? What immediate measures can be taken to reduce this risk?
• Are there medication treatments that can be used instead of surgery (such as chemotherapy, radiation therapy, or antiarrhythmic treatment)?
• What is the plan for follow-up testing after surgery and over the long term (the frequency of echocardiography and CT/MRI, if needed)?

Disease-Specific Sample Questions

• My tumor appears to be a left atrial (or left ventricular) myxoma. Does it need to be surgically removed immediately? If we wait, what complications could occur?
• An arrhythmia (or WPW syndrome, etc.) is suspected to be associated with the tumor. How likely is the arrhythmia to improve after tumor removal? If the arrhythmia persists, what additional treatment options are available?