Cardiac tumors

What are cardiac tumors?

Cardiac tumors are abnormal growths in the heart or heart valves. There are many types of cardiac tumors. But, cardiac tumors, in general, are rare. The tumors can be cancerous (malignant) or noncancerous (benign). Tumors that begin growing in the heart and stay there are called primary tumors. Tumors that start in another part of the body and move to the heart (metastasize) are called secondary tumors. Most cardiac tumors are benign. But, even benign tumors can cause problems because of their size and location. Sometimes, small pieces of tumor fall into the bloodstream and are carried to distant blood vessels and get in the way of blood flow to vital organs (embolism).

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What causes cardiac tumors?

A small percentage of patients with cardiac tumors have a family history of the condition. Sometimes, the tumors can be part of another health condition, such as NAME Syndrome, LAMB Syndrome or Carney Syndrome. Most often, the tumor develops without any of those conditions or family history. They are the result of cell overgrowth that either starts in the heart or moves to the heart.

 

What are the types of cardiac tumors?

Primary Tumors

Primary tumors affect only 1 in 1,000 to 100,000 people. The most common type of primary cardiac tumor is myxoma. Most of these are benign. Patients of any age can develop a myxoma. They are more common in women than men. Most times, the tumor grows in the left upper chamber of the heart (left atrium) at the atrial septum, which divides the two upper chambers of the heart. Myxomas can grow in other areas of the heart or in the heart valves, but such growth is rare. About 10 percent of myxomas are hereditary or develop as a result of other diseases.

 

Other types of benign primary tumors are papillary fibroelastomas, fibromas, rhabdomyomas, hemangiomas, teratomas, lipomas, paragangliomas and pericardial cysts. Malignant primary tumors include pericardial mesothelioma, primary lymphoma and sarcoma.

 

Secondary Tumors

Secondary cardiac tumors are much more common than primary tumors. They do not start in the heart. Instead, they move to the heart after developing in another area of the body. Most often, these tumors start in the lungs, breasts, stomach, kidneys, liver or colon. They can also be tumors related to lymphoma, leukemia or melanoma.

 

What are the symptoms of cardiac tumors?

Many times, patients do not know they have a cardiac tumor. They are often found when the patient has an echocardiogram for another reason. If the tumor becomes hardened by calcium deposits (calcified), it may be seen on a chest X-ray. Most primary cardiac tumors are discovered when patients are in their 50s and 60s. However, they can be found in younger patients, too.

Patients with cardiac myxoma in the left atrium may develop symptoms. This is due to blocked blood flow through the mitral valve. The blood flow may be blocked all the time, or just when the patient is in a certain physical position (i.e., lying down). While many patients have no symptoms, if blood flow is blocked and there is increased pressure in the left atrium, it can cause shortness of breath, lightheadedness or a cough. The inflammation may cause a fever, and the patient may have joint pain or not feel well.

 

What are the risks of cardiac tumors?

Tumors that block blood flow can cause heart failure, stroke, atrial fibrillation and blood clots. Another risk is embolism. This means that part of the tumor or a blood clot can travel to other parts of the circulatory system.

 

How are cardiac tumors diagnosed?

If your doctor thinks you may have a cardiac tumor, the diagnosis can be confirmed using an echocardiogram, Computed Tomography (CT) scan, magnetic resonance imaging (MRI), or radionuclide imaging.

 

How are cardiac tumors treated?

Because cardiac tumors can lead to problems with blood flow, surgery to remove the tumor is usually the treatment of choice. But, whether surgery is needed depends on the tumor size, whether it causes symptoms, and the patient’s overall health.

Removal requires open heart surgery. But, in many cases, the surgery can be done robotically or using a minimally invasive technique. During the surgery, the surgeon removes the tumor and the tissue around it to reduce the risk of the tumor returning. Because the surgery is complicated and requires a still heart, a heart-lung machine will be used to take over the work of your heart and lungs during surgery.

Recovery after traditional surgery is usually 4 to 5 days in the hospital, and 6 weeks total recovery time. If the tumor is removed using a robotic or minimally invasive approach, your hospital stay will likely be shorter, and you should make a full recovery in about 2 to 3 weeks. After surgery, you will need to have an echocardiogram every year to make sure that the tumor has not returned and that there are no new growths.

 

Mediastinal tumors

What are mediastinal tumors?

Mediastinal tumors are benign or cancerous growths that form in the area of the chest that separates the lungs. This area, called the mediastinum, is surrounded by the breastbone in front, the spine in back, and the lungs on each side. The mediastinum contains the heart, aorta, esophagus, thymus and trachea.

The mediastinum is divided into three sections:

1.The anterior (front)

2.The middle

3.The posterior (back)

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Mediastinum tumors are mostly made of reproductive (germ) cells or develop in thymic, neurogenic (nerve), lymphatic or mesenchymal (soft) tissue.

 

Who is affected by mediastinal tumors?

In general, mediastinal tumors are rare. Mediastinal tumors are usually diagnosed in patients aged 30 to 50 years, but they can develop at any age and form from any tissue that exists in or passes through the chest cavity. The location of tumors within the mediastinum varies according to the age of the patient. In children, tumors are commonly found in the posterior (back) mediastinum. These mediastinal tumors often begin in the nerves and are typically benign (noncancerous). In adults, most mediastinal tumors occur in the anterior (front) mediastinum and are generally malignant (cancerous) lymphomas or thymomas.

 

Is a mediastinal tumor serious?

Due to their location in the mediastinum, mediastinal tumors (both benign and malignant) that are left untreated can cause serious complications including invading the heart, pericardium (the lining around the heart), and great vessels (the aorta and vena cava). Tumors located in the posterior (back) mediastinum can cause compression of the spinal cord.

 

What causes mediastinal tumors?

There are several types of mediastinal tumors, with their causes linked to where they form in the mediastinum.

Anterior (front) mediastinum

Germ cell – The majority of germ cell neoplasms (60 to 70%) are benign and are found in both males and females.

Lymphoma – Malignant tumors that include both Hodgkin’s disease and non Hodgkin’s lymphoma.

Thymoma and thymic cyst – The most common cause of a thymic mass, the majority of thymomas are benign lesions that are contained within a fibrous capsule. However, about 30% of these may be more aggressive and become invasive through the fibrous capsule.

Thyroid mass mediastinal – Usually a benign growth, such as a goiter, these can occasionally be cancerous.

Middle mediastinum

Bronchogenic cyst – A benign growth with respiratory origins.

Lymphadenopathy mediastinal – An enlargement of the lymph nodes.

Pericardial cyst – A benign growth that results from an “out-pouching” of the pericardium (the heart’s lining).

Thyroid mass mediastinal – Usually a benign growth, such as a goiter. These types of tumors can occasionally be cancerous.

Tracheal tumors – These include tracheal neoplasms and non-euplastic masses, such as tracheobronchopathia osteochondroplastica (benign tumors).

Vascular abnormalities including aortic aneurysm and aortic dissection.

Posterior (back) mediastinum

Extramedullary haematopoiesis – A rare cause of masses that form from bone marrow expansion and are associated with severe anemia.

Lymphadenopathy mediastinal – An enlargement of the lymph nodes.

Neuroenteric cyst mediastinal – A rare growth, which involves both neural and gastrointestinal elements.

Neurogenic neoplasm mediastinal – The most common cause of posterior mediastinal tumors, these are classified as nerve sheath neoplasms, ganglion cell neoplasms, and paraganglionic cell neoplasms. Approximately 70% of neurogenic neoplasms are benign. Oesophageal abnormalities including achalasia oesophageal, oesophageal neoplasm and hiatal hernia. Paravertebral abnormalities including infectious, malignant and traumatic abnormalities of the thoracic spine. Thyroid mass mediastinal – Usually a benign growth, such as a goiter, which can occasionally be cancerous. Vascular abnormalities – Includes aortic aneurysms.

What are the symptoms of a mediastinal tumor?

Almost 40% of people who have mediastinal tumors experience no symptoms. Most of the growths are often discovered on a chest x-ray that is performed for another reason. When symptoms are present they are often a result of the compression of surrounding structures, such as the spinal cord, heart or the pericardium (the heart’s lining), and may include:

  • Cough
  • Shortness of breath
  • Chest pain
  • Fever
  • Chills
  • Night sweats
  • Coughing up blood
  • Hoarseness
  • Unexplained weight loss
  • Lymphadenopathy (swollen or tender lymph nodes)
  • Wheezing
  • Stridor (a high-pitched, noisy respiration, which can be a sign of respiratory obstruction, especially in the trachea or larynx)

 

How is a mediastinal tumor diagnosed?

The tests most commonly used to diagnose and evaluate a mediastinal tumor include:

  • Chest x-ray
  • Computed tomography (CT) scan of the chest or CT-guided needle biopsy
  • Magnetic resonance imaging (MRI) of the chest
  • Mediastinoscopy with biopsy (Performed under general anesthesia, this examination of the chest cavity uses a lighted tube inserted through a small incision under the chest bone; a sample of tissue is taken to determine if cancer is present. Mediastinoscopy with biopsy allows doctors to accurately diagnose 80 to 90% of mediastinal tumors, and 95 to 100% of anterior mediastinal tumors.)

 

How are mediastinal tumors treated?

The treatment used for mediastinal tumors depends on the type of tumor and its location:

  • Thymic cancers require surgery, followed by radiation or chemotherapy. Types of surgery include thoracoscopy (a minimally invasive approach), mediastinoscopy (minimally invasive) and thoracotomy (a procedure performed through an incision in the chest).
  • Lymphomas are recommended to be treated with chemotherapy followed by radiation.
  • Neurogenic tumors found in the posterior (back) mediastinum are treated surgically.

 

What are the benefits of minimally invasive surgery to treat mediastinal tumors?

As compared with traditional surgery, patients who undergo minimally invasive surgery, such as video-assisted thoracoscopy (VATS) mediastinoscopy, experience:

  • Decreased postoperative pain
  • Shorter hospital stay
  • More rapid recovery and return to work
  • Other possible benefits include reduced risk of infection and less bleeding.

 

What are the risks of minimally invasive surgery to treat mediastinal tumors?

There are complications of radiation, chemotherapy and surgical treatment of mediastinal tumors. Your health care team will discuss the possible risks and potential benefits of each treatment option with you. The possible complications of minimally invasive surgical treatment include:

  • Damage to the surrounding area, which may include the heart, pericardium (the heart’s lining) or spinal cord. Pleural effusion (a collection of fluid between the thin layers of tissue lining the lung and the wall of the chest cavity, or pleura)
  • Postoperative drainage
  • Postoperative infection or bleeding

Your health care team will provide specific instructions to prepare you for each treatment or procedure. They will also provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

 

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