Cardiac Sarcoma
What is cardiac sarcoma?
Cancer is made of abnormal cells that grow out of control. The abnormal cells often
grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade)
nearby areas. And they can spread to other parts of the body. This is called metastasis.
Cardiac sarcoma is a type of cancer that starts in the muscle or blood vessels of
the heart. The cancer can be either primary or secondary. A primary cardiac tumor
is one that starts in the heart. It is very rare. A secondary cardiac tumor is from
cancer that starts somewhere else in the body and then spreads to the heart. Secondary
cardiac tumors are more common than primary tumors.
What are the symptoms of cardiac sarcoma?
The symptoms of heart tumors vary, depending on where the tumor is. Tumors of the
heart may be on the outside surface of the heart. They may be inside one or more chambers
of the heart (intracavitary). Or they may be within the heart muscle tissue.
Cardiac sarcomas are most often a type of sarcoma called angiosarcoma. Most angiosarcomas
occur in the right upper chamber (atrium) of the heart, but they can also be found
in the left atrium. The tumor blocks blood flow in and out of the chamber. This blockage
may cause symptoms like chest pain and swelling of the feet, legs, ankles, or belly
(abdomen). It may cause the veins in your neck to stand out (distend). This is because
the blood coming back to the heart after traveling through the body can’t easily go
into or be pumped out of the right atrium.
Cardiac angiosarcomas that occur on the thin sac that surrounds the heart (pericardium)
can cause fluid to collect in the sac. If enough fluid builds up, it affects how well
the heart can pump blood. Some signs of this buildup may include chest pain, shortness
of breath, fatigue, and fluttering heartbeat (palpitations).
Tiny pieces (emboli) of cardiac sarcomas may break off and travel through the blood
to other parts of the body. The tiny pieces may block blood flow to an organ or body
part. This can cause pain and damage to that organ or body part. The tiny pieces can
affect the brain by causing a stroke. Or they can affect the lungs by causing shortness
of breath.
Other symptoms can include coughing up blood (hemoptysis), heart rhythm problems,
hoarse voice, and swelling in the face. Signs of cardiac sarcoma not related to where
the tumor is in the heart may include fever, weight loss, night sweats, fatigue, and
a general feeling of not being well.
The symptoms of cardiac sarcoma often seem like other health conditions. It's important
to see a healthcare provider if you have symptoms. Only a healthcare provider can
tell if you have cancer or some other problem that needs to be treated.
How is cardiac sarcoma diagnosed?
Your healthcare provider will ask about your symptoms and medical history. They will
give you a physical exam. You will need tests to look at your heart and see how well
it's working. These may include:
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Echocardiogram (echo). This test uses sound waves (like an ultrasound) to look at how well your heart’s
chambers and valves are working. This test has become the most useful tool in diagnosing
cardiac sarcoma. It lets the healthcare provider see the exact size of the tumor and
where it is. Transesophageal echo is a type of echo that uses a thin, flexible tube
with a transducer at its tip. The provider guides the tube down your throat and into
your esophagus. This gives more detailed pictures of the heart because the esophagus
is right behind the heart.
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Electrocardiogram (ECG). This test records the electrical activity of your heart. It can show rhythm problems.
These are also known as arrhythmias or dysrhythmias. Cardiac sarcoma may cause changes
in the heart's rhythm. The test can also show signs of heart muscle damage.
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CT scan. This imaging test uses X-rays and a computer to make detailed images of the inside
of your body from different angles. These include bones, muscles, fat, and organs.
CT scans can help your provider better see how big the tumor is, exactly where it
is, and other features.
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MRI. This imaging test uses large magnets, radio waves, and a computer to make detailed
images of organs and tissues inside your body. This test also helps your provider
better see the tumor's size, location, and other features.
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PET (positron emission tomography) scan. This imaging test may be done to find where the tumor is. For a PET scan, a safe,
radioactive liquid (tracer) is injected into the bloodstream. It takes about 45 minutes
for the tracer to be in your system. Once the tracer is there, the healthcare provider
takes a scan of your body.
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Chest X-ray. This test makes images of internal tissues, bones, and organs. It may show an enlarged
heart. Or it may show fluid in your lungs (pulmonary congestion).
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Cardiac catheterization (angiogram). With this test, the provider threads a long flexible tube (catheter) through your
blood vessels into your heart. Then they take X-rays after injecting a contrast dye
into 1 of your arteries. This test can show narrowing, blockages, and other problems
of certain arteries.
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Biopsy. This is done by taking out a small sample of the tumor for testing. Other tests can
suggest that the tumor is cancer, but a biopsy is the only way to know for sure.
How is cardiac sarcoma treated?
Finding the best treatment for cardiac sarcoma can be difficult. This is because these
cancers are so rare. The treatment plan for cardiac sarcoma is based on:
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Your age
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Your overall health and past health
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How sick you are
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How well you can handle certain medicines, procedures, or therapies
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How fast the cancer cells are growing
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If the tumor can be removed or the cancer has spread
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Your opinion and preferences
By the time a cardiac sarcoma starts to cause symptoms, it has often spread to other
parts of the body (metastasized). This makes treatment difficult. The type of treatment
for cardiac sarcoma depends mainly on where the tumor is and how big it is. It also
depends on how far it has spread.
The provider may see that the tumor can be removed. This is done with open-heart surgery.
You may need chemotherapy (chemo) after surgery to try to lower the risk of the cancer
coming back. It’s not yet known how well chemo works for this cancer.
In some cases, it may not be possible to remove all of the tumor. In this case, your
provider may advise a heart transplant. You'll need to take medicine for the rest
of your life. This is to keep your body from rejecting the transplant. But this medicine
may increase the risk that the sarcoma will come back (recur).
Another treatment option is autotransplantation. For this, the surgeon takes your
heart so the tumor can be more easily removed. You'll be on a heart-lung bypass machine
during the surgery. When the tumor has been removed, the surgeon puts your heart back.
Because you don’t have a donor heart, you won't need to take medicines to prevent
rejection.
If the cancer has spread to other parts of your body, you may get radiation therapy
or chemo. This is done to help relieve symptoms, help you live longer, or improve
your quality of life.
Talk with your healthcare providers about the risks, benefits, and possible side effects
of all treatments.
What are possible complications of cardiac sarcoma?
Cancer treatment such as chemo and radiation can damage normal cells. This causes
side effects. Talk with your healthcare provider about ways to manage your side effects.
There may be things you can do and medicines you can take to help prevent or control
side effects.
Can cardiac sarcoma be prevented?
Researchers don’t yet know how to prevent this type of cancer.
When should I call my healthcare provider?
Call your healthcare provider if you have:
Key points about cardiac sarcoma
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Cardiac sarcoma is a type of cancer that starts in the muscle or blood vessels of
the heart.
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The symptoms of heart tumors vary, depending on where the tumor is. They can include
swelling of legs or belly, fatigue, chest pain, and other symptoms.
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You will need tests to look at your heart and see how well it's working. These may
include an echocardiogram, ECG, imaging scans, or other tests.
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Finding the best treatment for cardiac sarcoma can be difficult. Treatment may include
surgery, radiation therapy, or chemotherapy.
Next steps
Tips to help you get the most from a visit to your healthcare provider:
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Know the reason for your visit and what you want to happen.
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Before your visit, write down questions you want answered.
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Bring someone with you to help you ask questions and remember what your provider tells
you.
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At the visit, write down the name of a new diagnosis and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
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Know why a new medicine or treatment is prescribed and how it will help you. Also
know what the side effects are and when they should be reported.
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Ask if your condition can be treated in other ways.
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Know why a test or procedure is recommended and what the results could mean.
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Know what to expect if you do not take the medicine or have the test or procedure.
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If you have a follow-up appointment, write down the date, time, and purpose for that
visit.
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Know how you can contact your provider if you have questions, especially after office
hours and on weekends and holidays.