Topic Resources
A tumor is any type of abnormal growth, whether cancerous (malignant) or noncancerous (benign). Tumors in the heart may be
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Primary (noncancerous or cancerous)
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Metastatic (always cancerous)
Primary heart tumors are tumors that originate in the heart. Primary heart tumors are rare, occurring in fewer than 1 of 2,000 people. Most primary heart tumors are noncancerous.
Metastatic heart tumors are cancers that developed in another organ and then spread to the heart. Most heart tumors are metastatic cancer, and most are cancers that spread from the lungs.
Both primary and metastatic tumors may develop in the sac that surrounds the heart (pericardium). Tumors in the pericardium may squeeze (constrict) the heart, preventing it from filling properly. Chest pain and heart failure may develop.
Noncancerous primary heart tumors
In adults, about half of noncancerous primary heart tumors are myxomas.
Myxomas usually develop in the heart's left upper chamber (atrium).
They may develop from embryonic cells located in the inner layer
(lining) of the heart's wall.
In infants and children, the most common type of noncancerous
primary heart tumor is a rhabdomyoma. Rhabdomyomas, which typically
occur in groups, usually grow within the heart wall and develop directly
from the heart's muscle cells. Rhabdomyomas commonly develop during
infancy or childhood, often as part of a rare disease called tuberous sclerosis.
Another common noncancerous primary tumors in infants and
children are fibromas. Fibromas, which typically occur as a single
tumor, usually grow within the heart muscle and develop from the heart's
fibrous tissue cells.
Several other types of primary heart tumors can develop, but all are rare. Some are cancerous and some benign.
Cancerous primary heart tumors
Cancerous primary heart tumors include
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Sarcoma
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Mesothelioma
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Lymphoma
Sarcomas are cancers that develop from connective tissues (blood vessels, nerves, bones, fat, muscles, and cartilage). Sarcomas develop in the right or left atrium and can block blood flow through the heart. Tumors in the right atrium can spread to the lungs.
Mesothelioma
is a rare cancer that can develop in the membrane that covers the heart
(pericardium), although it most often develops in the membrane that
covers the lungs (pleura). Pericardial mesothelioma can spread to the
spine and brain.
Lymphoma
is a cancer of white blood cells known as lymphocytes. Lymphoma usually
develops in the lymph nodes, spleen, and/or bone marrow. Lymphoma that
develops in the heart is extremely rare. It usually occurs in people who
have AIDS and grows rapidly.
Metastatic heart tumors
Metastatic heart tumors originate in some other part of the
body—usually the lungs, breasts, kidneys, blood, or skin—and then spread
(metastasize) to the heart. They are always cancerous. Metastatic heart
tumors are 30 to 40 times more common than primary heart tumors. About
10% of people who have lung cancer or breast cancer—two of the most common cancers—and an even larger proportion of people with melanoma have metastases to the heart.
Symptoms
Heart tumors may cause no symptoms, minor symptoms, or symptoms of life-threatening heart malfunction.
Noncancerous tumors can be as deadly as cancerous ones if they interfere with the function of the heart.
Major symptoms of heart tumors include
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Heart failure (causing swelling of the legs, shortness of breath, and fatigue)
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Abnormal heart rhythms (causing palpitations, weakness, or fainting)
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Hypotension, also called low blood pressure (leading to dizziness and fainting)
Minor symptoms may include
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Fever
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Fatigue (lethargy)
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Joint pain
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Small red spots on the skin (petechiae)
Heart murmurs (sounds caused by turbulent blood flow through the heart) develop in about half of the people who have tumors that develop near or on a heart valve (such as myxomas and fibromas) because blood does not flow through the valve normally.
Heart tumors, especially myxomas
and sometimes fibroelastomas, may degenerate so that pieces of them
break off and travel through the bloodstream (becoming emboli). Emboli
may lodge in small arteries and block blood flow. Also, blood clots that
form on the surface of tumors, such as myxomas, may break off as emboli
and block arteries. Symptoms due to emboli depend on where the material
goes and therefore which tissues or organs are affected by the blocked
artery. For example, emboli that block an artery in the brain can cause a
stroke.
Diagnosis
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Imaging with echocardiography, computed tomography (CT), and/or magnetic resonance imaging (MRI)
Primary heart tumors are difficult to diagnose because they are
relatively uncommon and because their symptoms resemble those of many
other disorders. Doctors may suspect a primary heart tumor in people who
have heart murmurs, abnormal heart rhythms (causing palpitations, weakness, or fainting), unexplained symptoms of heart failure
(causing shortness of breath, swelling of the legs, and fatigue), or
unexplained fever (which may be due to a myxoma). Metastatic heart
tumors are suspected when people who have cancer elsewhere in the body
come to a doctor with symptoms of heart malfunction. More often, heart
tumors are diagnosed when a person is undergoing testing for another
medical condition, such as for difficulty breathing.
If a tumor is suspected, echocardiography
is usually done to confirm the diagnosis. For this procedure, a probe
that emits ultrasound waves is passed over the chest, producing an image
of heart structures. If another view of the heart is needed, the probe
can be passed down the throat into the esophagus to record signals from
just behind the heart. This procedure is called transesophageal echocardiography.
Computed tomography (CT) or magnetic resonance imaging (MRI) can provide additional information and can often distinguish noncancerous from cancerous tumors.
Unlike with tumors in most other parts of the body, doctors
rarely do a heart biopsy (taking a tissue sample to look at it under a
microscope). Heart biopsy may be dangerous depending upon the location
of the tumor, and doctors can usually tell the difference between benign
and cancerous heart tumors from the results of imaging tests.
Treatment
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Surgical removal of noncancerous (benign) heart tumors
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Sometimes chemotherapy or radiation for people with cancerous heart tumors
Noncancerous (benign) heart tumors
A single small noncancerous primary heart tumor can be surgically removed, usually resulting in a cure. If a large noncancerous primary tumor is significantly reducing blood flow through the heart, removal of the part of the tumor that does not grow into the heart wall may improve heart function. However, if a large part of the heart wall is involved, surgery may be impossible.
Rhabdomyomas regress without treatment in most affected newborns and usually do not require treatment.
In infants and children, a fibroma that does not affect
the wall between the ventricles (septum) may be successfully removed.
Tumors that affect this wall usually also affect the electrical conduction system of the heart
and cannot be surgically removed. Children with this type of tumor
usually die of an abnormal heart rhythm at an early age. If a fibroma is
large, blocks blood flow, and has grown into the surrounding tissue, heart transplantation may be required.
Transplantation is very rarely done in either children or adults,
and only noncancerous tumors are typically considered for heart
transplantation.
Cancerous heart tumors
Primary cancerous tumors cannot be surgically removed and are
usually fatal. Chemotherapy or radiation therapy is sometimes used to
slow progression of disease. Treatment of metastatic cancer depends on
what organ the cancer came from and may include chemotherapy.
Pericardial tumors
Noncancerous tumors in the pericardium can be removed surgically,
but cancerous tumors are not removed because they have usually already
spread elsewhere in the body. If the tumor secretes fluid that
interferes with heart motion, this fluid can be drained with a small
plastic tube inserted by needle into the space between the pericardium
and the heart (the pericardial space). Sometimes drugs are injected into
the pericardial space to slow the tumor's growth.
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