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Published on: 6/16/2001
Last Visited: 6/16/2001
It is unusual , agreed Michael Ewer , MD , associate professor of chemistry at MD Anderson Cancer Center , Houston.Ewer is an oncologic cardiologist whose primary focus is the often serious impact cancer in general can have on the heart's ability to function , particularly through the means used to treat cancer.
Mechanical DifficultiesBoth providers agreed that imaging , especially echocardiography , is key to diagnosis before the heart is damaged beyond repair.Determining the presence of a cancerous growth is particularly important because cardiac tumors are frequently asymptomatic until they cause mechanical problems.
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Without an image to reveal its presence , many of the symptoms of a malignant tumor can look more like coronary artery disease , Dr. Ewer said.In fact , cardiac cancer is often discovered only when the patient is undergoing diagnostic imaging for another condition.
Perhaps [ the patient ] was taking phen-fen and got a cardiac ultrasound to test for valve damage , and a totally asymptomatic mass was noted in the heart.This certainly is something that can happen , he offered.
Echocardiography is the primary tool used to image both for cardiac tumors and for possible reduction of heart function due to cancer treatment.
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Dr. Ewer said breast metastases are found more often simply because there are more instances of breast cancer.Moreover , melanoma is by far the more dangerous , added Dr. Taub , because unlike breast and lung metastases , which wrap around the heart , melanoma can infiltrate the heart muscle itself , interfering with physical pumping and with conduction.
Cancer Treatment Can Affect the HeartWhere cardiac tumors , both primary and metastasized , cannot be treated surgically , other modalities must be employed --- with caution.Both radiation therapy and chemotherapy can themselves cause significant damage to the heart.Indeed , radiation therapy of the heart is avoided whenever possible.
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It doesn't attack the heart muscle in the way a tumor would invade it , explained Dr. Ewer.It causes a change on the cellular level that causes destruction of individual myocytes ( heart muscle cells ).As more and more of these heart muscle cells are destroyed , you have varying degrees of heart contractility ( ability to pump ) ..
Cardiac toxicity is cumulative.After a point , he added , the heart can no longer compensate.Nevertheless , many patients do recover , he noted , in that they adjust to a lower cardiac function.
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Dr. Ewer explained that chemotherapy has to be directed at the kind of cancer present.The risks of treatment must also be weighed against the risks of no treatment.
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In addition to the estimated 10 percent of cancer patients who develop cardiac problems , Dr. Ewer pointed out , there is also another group to be considered : those who have underlying heart disease before getting cancer.
For these patients , the cancer may place added stress on their limited cardiac reserves , he noted.Someone with ischemic cardiac disease or a history of myocardial infarctions is likely to suffer less oxygen-carrying capacity if their hemoglobin levels drop because of their cancer or its treatment.
They have problems with their heart that they wouldn't have gotten into if they hadn't also had a malignancy , he said , describing the interaction of the two diseases as conspiring..
Dr. Ewer added that when heart disease and other medical problems combine , the diagnoses of cardiac conditions , such as heart attacks and congestive heart failure , are more difficult to place in perspective , since the various symptoms of the conditions can overlap and reinforce each other.
Image interpretation must become much more detailed and clinically biased because , with multiple conditions affecting the body , he said , sometimes things can fool you..
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