Myxoma and cancer: which tumors are more common

How common are heart tumors?

Heart tumors are rare (approximately 0.05% of all cancers). The most common (75%) of the primary ones are benign lesions. Malignant more rare - about 25%. In adults, myxoma is most often diagnosed, in children - rhabdomyoma, fibroma. Malignant formations in the heart are almost always observed only in men. The most common heart tumors are metastases from cancer of other organs.

Most likely causes

Unfortunately, despite numerous scientific studies, in the course of which various genetic mutations and antigens of viral particles were discovered, the cause of cardiac tumors is still unknown. However, it is well established that many of them have a hereditary etiology.

What types are found

So, all cardiac tumors can be divided into 3 types:

1. Primary benign - these include myxomas, rhabdomyomas, lipomas, teratomas, angiomas, papillary fibroelastomas.
2. Primary malignant - represented mainly by sarcomas (angiosarcomas, fibrosarcomas), endothelioma and mesothelioma are also found.
3. Secondary malignant are metastases of cancer of other organs (breast, lung, stomach). Their appearance in the heart indicates a deeply neglected oncological process.

Let's take a closer look at the most common types - myxoma, rhabdomyoma, angiosarcoma.

Mixoma

Myxoma is the most common primary heart tumor (about 50%). Despite the similar names, myxoma of the heart and myxomatosis of the mitral valve are completely different diseases.

Myxoma is more common in women between 30 and 50 years of age. It can be located in any cavity, but is more common in the left atrium. In about 3% of cases, pathology develops within the framework of a hereditary syndrome called the Carney complex. In such patients, there is a large number of age spots on the skin, fibroadenomatosis of the mammary glands and Itsenko-Cushing's syndrome caused by abnormal hyperproduction of adrenal cortex hormones (obesity, purple stretch marks on the skin of the abdomen and thighs, high blood glucose levels).

Usually myxoma is large enough - from 2 to 15 cm, which is why it can almost completely block the heart chamber.

Approximately 20% of patients with a small tumor have an asymptomatic course. One of the main symptoms of the disease is “myxomal intoxication”. A person's body temperature rises, joints begin to ache, he loses weight, the level of hemoglobin in the blood decreases, and “inflammatory markers” appear - leukocytosis, high ESR and C-reactive protein. At first glance, it may appear that the patient has a chronic infection (eg tuberculosis) or an autoimmune disease from the field of rheumatology.

The development of such symptoms is explained by the body's immune response to proteins produced by the tumor. After removal of myxoma, these signs quickly disappear.

The two main problems that myxoma brings are obstruction of blood flow inside the heart and thrombotic complications.

Due to the fact that less blood enters the left ventricle, people with myxoma often experience dizziness and lose consciousness. Rapid tumor growth leads to the rapid development of symptoms of chronic heart failure (CHF) - shortness of breath, constant fatigue, leg edema, heaviness in the right side, etc. Characteristic features of CHF with myxoma are the rapidity of onset (from 3 to 6 months) and resistance to drug therapy.

A common complication is cardioembolism. Blood clots form on the surface of the tumor, which clog the arteries, stopping blood flow in different parts of the body. Due to the loose structure of the neoplasm, its fragments can separate and go into "free swimming".

If I suspect myxoma, the first thing I do is auscultate the heart. I can almost always hear pathological a diastolic murmur that becomes more intense when standing.

To exclude the Carney complex, I prescribe tests to determine the level of hormones of the adrenal cortex - small and large dexamethasone tests, cortisol of saliva, daily urine, etc.

Routine diagnostic methods (ECG and X-ray) are useless to detect not only myxoma, but all other cardiac tumors. Visualizing research methods are recognized as more informative in this regard, i.e., during which we can see both the organ itself and its cavities. Such diagnostic methods include:

• Echocardiography (Ultrasound of the heart, Echo-KG) - the main diagnostic method is a mix. On the monitor, a tumor is defined as a round-shaped formation with clear edges, usually located in the atrial or interventricular septum in the vicinity of the valve cusps. Myxoma is located on a pedicle, so that it can move from the atrium to the ventricle and back. Sometimes it is required to conduct transesophageal echocardiography.
• Computer or magnetic resonance imaging (CT, MRI) - this is additional research. I prescribe them in case of an unclear ultrasound picture, or in order to better assess the volume of tumor growth.

The only way to treat myxoma is to remove it surgically. An abdominal operation is performed under general anesthesia - the chest is opened, the patient is connected to a heart-lung machine.

To avoid relapses, the tumor is completely removed along with the underlying tissues. If the resulting defect in the heart wall is large, it is closed with a "patch" made of pericardium or synthetic material. Then the cavities are actively washed and the liquid is aspirated. This is done to prevent the remnants of tumor cells from clogging up small vessels. After removing the myxoma, its sample must be sent to the histological laboratory.

It often happens that due to the large size of the formation, the valves are damaged, so the patient may need their prosthetics or plastic, followed by taking anticoagulants (Warfarin). If myxoma has arisen within the framework of the Carney complex, then additionally requires the removal of both adrenal glands and lifelong intake of hormonal drugs (Corteff, Kortineff).

Rhabdomyoma

Rhabdomyoma is the most common benign heart tumor in children under 15 years of age. In about half of the cases, it is combined with such a severe hereditary disease as tuberous sclerosis. The neoplasm is a few dense nodes growing from the muscle wall of the ventricles or the interventricular septum. They can occupy from 25 to 80% of the volume of the chamber.

Due to the fact that the tumor grows from the wall of the myocardium, it compresses the conducting system of the heart, therefore, the symptoms of arrhythmias come to the fore in a person with rhabdomyoma:

• attacks of rapid heartbeat, accompanied by a feeling of fear and lack of air;
• irregularity of the pulse;
• feeling of "fading", interruptions in the work of the heart;
• dizziness, darkening in the eyes;
• loss of consciousness and the subsequent convulsive seizure resembling epilepsy (Morgagni-Adams-Stokes seizure).

With a large formation that creates a circulatory disorder, signs of CHF appear.

To diagnose rhabdomyoma, I prescribe 2 instrumental studies:

• electrocardiography - on an ECG film, I often manage to detect various disturbances of rhythm and conduction (supraventricular and ventricular tachycardias, extrasystoles, atrioventricular and intraventricular blocks);
• echocardiography - ultrasound of the heart shows formations in the thickness of the myocardium of a round shape, which can grow into the lumen of the chambers.

In some cases, due to degeneration, rhabdomyoma tumors shrink in size, and in children under 4 years of age, they can completely disappear altogether. If there are no symptoms, then no treatment is needed.

Heart cancer

Primary malignant neoplasms of the heart are mainly represented by sarcomas. Men are 3 times more susceptible to them than women. In sarcomas, the tumor is more often located in the right parts of the organ.

Due to the rapid growth, heart cancer symptoms appear rather quickly. Signs of chronic heart failure and rhythm disturbances appear rapidly (literally within a few weeks). Often, fluid accumulates in the pericardial sac, which can lead to cardiac tamponade (compression) and very rapid death.

Since this is a malignant tumor, its appearance will be accompanied by general (constitutional) symptoms:

• weakness;
• lack of appetite;
• weight loss;
• prolonged fever.

As in the diagnosis of other cardiac tumors, echocardiography plays a decisive role, but confirmation of a sarcoma requires taking a piece of the mass (biopsy) and conducting a histological examination.

Unfortunately, in 80% of patients at the time of the diagnosis of heart sarcoma, the tumor had already spread outside the organ and metastases. This greatly reduces the success of the treatment.

Sometimes, in the absence of metastases, they resort to such a serious operation as heart and lung transplantation. It allows patients to live longer by 3-4 years.

What is the prognosis for life

With myxomas, the risk of death is approximately 30%. The most common immediate causes are stroke and heart failure. Nevertheless, the prognosis after myxoma of the heart can be considered favorable, since the patient has a chance for a complete recovery thanks to surgical excision of the tumor. With the correct operation, the risk of disease recurrence is minimal (about 4%). Life after removal of myxoma of the heart (I mean its duration) may practically not differ from that of a healthy person.

Most rhabdomyomas regress, that is, they decrease in size, and sometimes disappear completely without any treatment. Still, patients have a risk of death from severe cardiac arrhythmias.

With heart sarcoma, the prognosis is extremely poor. Most patients die within a year after their first symptoms appear.

Rehabilitation after removal of the tumor: how to pass it

After removal of the tumor, especially in the first 6 months, the patient must follow a certain regimen, namely, avoid physical activity (lifting weights, running, etc.). You also need to undergo regular examinations, including examination by a cardiologist, taking an electrocardiogram, and performing an echocardiography. It is advisable to recover in special institutions - in a cardiological sanatorium or a rehabilitation center.