Sarcoma - Metastases to the Heart

Although heart metastases are identified in 25% of people who die of cancer, detection and diagnoses of heart metastases in living patients are surprisingly low (1% of pediatric sarcoma patients). We wanted to share this information because although most cancer patients feel as if they are having frequent tests and imaging to look for new signs of cancer, cardiac metastases are commonly missed when standard studies only include conventional CT, MRI, and PET scans.

Tumors in the heart can come from neighboring lung metastases that travel up through the lung vessels in to the heart, direct extension from metastases in the lung, or from mets that arrive from the bloodstream.

If you have a met to the heart, you want to have it surgically removed as soon as safely possible because it can become deadly whether your cancer responds well to treatment or not. If the tumor invades the heart, then it can cause the heart to stop pumping well; but other causes of mischief include obstructing blood flow into or out of the heart, or breaking off and forming metastases to other parts of the body like the brain.

We wanted to post about heart metastases because we found out about them only because our dd was on a Phase I / II trial that required an ECHO.  The mass was seen on ECHO - and although it was about the size of a golf ball, it didn't block any of the valves - and there were no changes in EKG or abnormal sounds that the cardiologist could hear. The important point is your doctor should have a high index of suspicion to find these - and the screening study is likely to be an ECHO. We had been watching our dd's lung mets - and thought these were still fairly far (1-2 cm) from the main pulmonary vessels by chest CT - but when we didn't know is that they can sneak into small pulmonary veins that aren't well seen on chest CTs (the resolution is too small) and travel into the heart. On Chest CT the heart is bright white - so intracardiac tumors can't be seen.

Recently we heard that young woman with cardiac tumors seemed to be responding to a promising clinical trials medication, but she unexpectedly died. The problem with medical treatments and cardiac tumors is that even when a cancer responds to treatment, a tumor in the heart can be just as deadly.

Our dd had open heart surgery a few weeks ago and the tumor was removed. The surgery was surprisingly quick (13 minutes on cardiac bypass) and her recovery was quick too (discharged on the 3rd day of after the operation). She was able to be back at school in less than 2 weeks and required no pain medication by then. Her recovery was much quicker than when she had a thoracotomy. As tough as it is to face difficult news such as a heart metastasis, the earlier diagnosis the better - and surgery can be effective.

Metastases to the heart
Management of intraatrial lung tumors
Cardiac metastases in soft tissue sarcomas