Cancer in Heart Disease Patients
Cancer in Heart Disease Patients
Cardiovascular disease and cancer are the leading causes of mortality in many parts of the world. There are several reasons for both diseases occurring in the same patient (Box 1). Coronary artery disease (CAD) and cancer share risk factors such as age, use of tobacco and obesity. Other reasons may be the consequences of radio- and chemo-therapy in long-term survivors of malignancy. These treatments have a direct impact on the heart, which require, in some cases, surgical correction. Malignancy can also occur during long-term follow-up after coronary artery bypass graft (CABG). The increase in diagnostic facilities makes the detection of heart disease and treatable cancer also more likely. For these reasons, the simultaneous or consecutive presence of both diseases is not so rare: in several larger cardiovascular series, the presence of malignancy ranged between 1.9 and 4.2%. In one oncologic series, cardiovascular disease was present in 25.3% of patients. Referral of patients with both conditions occurred once or twice a month to cardiovascular surgical departments.
Early reports concerning the treatment of both diseases were limited to cases and small series with a relatively short follow-up. These reports started to appear around the year 2000, indicating that this problem received attention only very recently. The results of these series indicated that a combined cardiac and pulmonary procedure is feasible. Some case reports also focused on digestive tract tumors, with digestive bleeding and antithrombotic treatment after any cardiac procedure. The attention was mainly directed at the cardiac procedure, the type of incision and the need for an extracorporeal circulation (ECC) device with its assumed risk for tumor dissemination. Two types of reports should be distinguished (Box 2):
In the latter type of report, the tumor can be detected during the cardiologic examination. Asymptomatic heart disease can be discovered during staging of the tumor, which can become symptomatic as a consequence of tumor-induced anemia. Ideally, both types of report should contain overall and cancer-free survival as the outcome after any treatment option.
The number of patients presenting with both diseases is likely to increase. Most of the published reports are limited to one type of malignancy. Therefore, this article aims to offer an overview of cardiovascular treatment strategies for cardiac patients who have simultaneous or prior malignancy of any type. The focus for patients with simultaneous disease is on risk assessment, percutaneous coronary intervention (PCI) and CABG. The focus for cardiac patients with prior cancer is mainly directed at the cardiac effects of cancer treatment and, to a lesser degree, to the results after heart surgery in these patients. Some attention is also given to the effects of the use of an ECC device. This is followed by a summary of clinical results.
The Frequency of Cardiac Disease & Cancer in the Same Patient
Cardiovascular disease and cancer are the leading causes of mortality in many parts of the world. There are several reasons for both diseases occurring in the same patient (Box 1). Coronary artery disease (CAD) and cancer share risk factors such as age, use of tobacco and obesity. Other reasons may be the consequences of radio- and chemo-therapy in long-term survivors of malignancy. These treatments have a direct impact on the heart, which require, in some cases, surgical correction. Malignancy can also occur during long-term follow-up after coronary artery bypass graft (CABG). The increase in diagnostic facilities makes the detection of heart disease and treatable cancer also more likely. For these reasons, the simultaneous or consecutive presence of both diseases is not so rare: in several larger cardiovascular series, the presence of malignancy ranged between 1.9 and 4.2%. In one oncologic series, cardiovascular disease was present in 25.3% of patients. Referral of patients with both conditions occurred once or twice a month to cardiovascular surgical departments.
Early reports concerning the treatment of both diseases were limited to cases and small series with a relatively short follow-up. These reports started to appear around the year 2000, indicating that this problem received attention only very recently. The results of these series indicated that a combined cardiac and pulmonary procedure is feasible. Some case reports also focused on digestive tract tumors, with digestive bleeding and antithrombotic treatment after any cardiac procedure. The attention was mainly directed at the cardiac procedure, the type of incision and the need for an extracorporeal circulation (ECC) device with its assumed risk for tumor dissemination. Two types of reports should be distinguished (Box 2):
Those concerning a prior tumor in patients with heart disease, treated with curative intent;
Those with a focus on simultaneous presence of malignancy and heart disease.
In the latter type of report, the tumor can be detected during the cardiologic examination. Asymptomatic heart disease can be discovered during staging of the tumor, which can become symptomatic as a consequence of tumor-induced anemia. Ideally, both types of report should contain overall and cancer-free survival as the outcome after any treatment option.
The number of patients presenting with both diseases is likely to increase. Most of the published reports are limited to one type of malignancy. Therefore, this article aims to offer an overview of cardiovascular treatment strategies for cardiac patients who have simultaneous or prior malignancy of any type. The focus for patients with simultaneous disease is on risk assessment, percutaneous coronary intervention (PCI) and CABG. The focus for cardiac patients with prior cancer is mainly directed at the cardiac effects of cancer treatment and, to a lesser degree, to the results after heart surgery in these patients. Some attention is also given to the effects of the use of an ECC device. This is followed by a summary of clinical results.
