Cardiac Tumors are very rare and most of these tumors almost 75% are benign , while rest of the 25 % are malignant . These tumors rarely get clinical attention

1. Presented by
Dr Arshad Hussain Shah ( Kashmiri)
Medical Oncologist
National Cancer Institute Sabratha Libya
Cardiac tumors

2.  Cardiac Tumours are rare and challenging and
present a bizzare clinical situation
 Rarely gain clinical attention , signs of cardiac
involvement are overlooked,due to other
symptoms of disseminated disease
 The incidence of Cardiac tumours has increased
over the past two decade due to better diagnostic
tolls & better understanding of tumour Biology
 Also due to Increased life expectancy in ca pts due
to introduction of newer agents and improved
treatment guidelines

3.  Cardiac mets are found in 20 % of autopsies of
Ca pts with advanced disease
 No Clinical trial results or Meta analysis or
treatment guidelines

4.  CLASSIFICATION
 They are differentiated into primary and secondary
 75% of primary cardiac tumours are Benign
 Most of them are myxomas
 Papillary Fibroelastomas
 Fibromas
 Lipomas
 Haemangiomas,calcified amorphous
tumours,teratomas,rhabdomyomas and uniloculalar
developmental cysts

5.  25% Cardiac tumours are malignant
 Primary Vs Secondry
 Metastatic cardiac spread occur in advanced and
disseminated malignancies ,
 14-15% pts with distant mets are found to have
cardiac involvement ,the risk increases constantly
with the increased tumor burden

6.  The most common neoplasms that metastasize to
the heart are malignant melanoma,Bronchogenic ca,
lymphoma, leukemia and Breast Ca
 Other malignancies that can involve heart are
 Anaplastic thyroid Ca
 HCC
 Adeno Ca of Parotid Gland
 Ca Ovary & Stomach Ca

7.  Primary Malignant Cardiac Tumors are usually
Sarcomas
 Cardiac Angiosarcomas is the most common one ,
Rhabdomyosarcomas,undiff erentiated sarcoma,
liposarcoma,fibrosarcoma
 others primary tumors include pericardial
Mesotheliomas , Lymphoma ,Intrapericardial
Pheochromocytomas
 Local cardiac invasion by Bronchogenic,oesophageal
,and mediastinal tumours

8. Presentation
 Clinical manifestations of cardiac tumors are differentiated in to
four categories: systematic manifestations, embolic events,
cardiac manifestations, and finally manifestations due to
metastases.
 The systematic symptoms and laboratory findings may resemble
those of vasculitis and connective tissue eg Fever, fatigue,
arthralgia, rush, and the Raynaud phenomenon. These
manifestations are attributed to secretion of various factors from
the tumor cells (Interleukin 6, Endothelin).
 Cardiac tumors may be the cause of pulmonary embolism or
peripheral embolism due to the embolism of tumor cells or
thrombus
 . Cardiac manifestations may be caused by direct obstruction of
cardiac or valve function, interruption of coronary flow

9. They may cause arrhythmias or disturbance of the
conduction system and Also obstruction of the
right or left outflow tract or compression of the
cardiac chambers
cardiac manifestations due to metastatic
disease from other organs, these usually affect the
pericardium ( pericardial effusion, cardiac
tamponade, or constrictive pericarditis)

10. Diagnosis
 Xray Chest may show calcifications,cardiomegaly ,effusion
 T.E.E transoesophageal echocardiography
 Shape,size,ext,location ,effusion
 Contrast echocardiography helps in the differential diagnosis
between tumor and thrombus by examining tissue perfusion
 Three-dimensional echocardiography (3D or 2 D Echo)
Investigation of choice Echo where metastasis appear as
cauliflower like pattern in fluid filled pericardial space
 C MRI cardiac MRI better assessment
 echocardiographically aided percutaneous or transvenous cardiac
biopsy
 thallium isotope scan may show filling defects

14. Rx The Rx depends on tumour origin ,type , co morbidities ,age ,PS and
patient’s general condition
 The Rx of choice for Benign Tum is early surgical resection on
cardiopulmonary bypass. These tumours are histologically benign but
patients may die from obstruction, distal embolisation or rhythm disorders
 Rx for malignant tum is usually Palliative and prognosis is poor except for
lymphoma and other chemosensitive tumours
 Surgical intervention in malignant tum is indicated if
1.solitary intracavitary lesion
2.Flow obstruction
3.Good expected survival
4. Cardiac Tamponode
Role of R.T is limited due to cardiotoxicity
percutaneous balloon pericardiotomy in cases of cardiac tamponade,
Pace maker-Conduction defects
Chemotherapy in Lymphome and other chemosensitive tum

15.  Metastatic involvement of the heart and pericardium may go unrecognized until
autopsy.
 Options for treatment are limited . Sudden death is not uncommon
 Cardiac tumours are diverse in clinical presentation, Embolisation, obstruction,
and arrhythmogenesis are the chief modes of presentation , which need early
recognition ,evaluation and Rx
 In conclusion, if patients with known metastatic disease or recurrent tumors
who present with cardiac symptoms, whether based on history or objective
findings clinicians should always consider the possibility of cardiac metastasis

16. THANKS 4 UR ATTENSTION