Human heart is surrounded by a sac made up of fibrous tissue called pericardium. Its main function is to protect the heart. Pericardium has two layers the outer parietal and inner visceral. Normally in between the two layers there is small amount of fluid; usually less than 50 ml. Pericardial effusion is a condition in which there is excess buildup of fluid in the pericardium. Pericardial effusion can develop slowly or rapidly leading to various symptoms such as chest pain, shortness of breath, palpitation etc. If the fluid accumulation is in large amount, it can cause life threatening cardiac tamponade in which the heart is compressed and its pumping mechanism is compromised.Pericardial effusion is caused by vide variety of reasons. One of them is due to cancer. It can be primary cancer of the heart, which is rare. In majority of cases the effusion is due metastasis from lung cancer or breast cancer. Treatment of pericardial effusion due to cancer is two-fold. This consists of treatment of cancer and treatment of effusion.
Causes of Fluid Around The Heart In Cancer Patients:
- Pericardial effusion is caused due to many reasons. Mild pericardial effusion usually develops in many patients suffering from cancer. It can be due to infection or may be because of cancer itself. Infection with bacteria or viruses can produce pericardial effusion. A cancer patient is more susceptible to contract bacterial and viral infection because of low immunity. Radiation and chemotherapy treatment in cancer can weaken the immune system. Besides cancer itself, can lower the immunity in an individual. Both these factors increase risk of bacterial and viral infection in the patient. These microorganisms can overpower the weak immunity and attack various organs and system of the body. This also includes the pericardium or the lining surrounding the heart.
- Primary cancer of heart and its lining is very rare. But if present it can produce pericardial effusion. Cancer that originates in heart is mainly sarcomas. Most of the tumors are benign.
- Majority of malignant heart tumors are metastases from the primary cancer somewhere else in the body. Cancer that originates near the heart such as lung cancer, breast cancer, Hodgkin’s lymphoma and kidney cancer can cause metastatic cancer of heart and pericardium. The cancer cells from primary cancer site can spread to heart and pericardium through blood or lymph fluid.
- Cancer treatment can also damage heart and pericardium. Radiation in the region of chest can damage the tissues in chest. Radiation is often used to shrink malignant inoperable malignant tumor. Sometimes it is used prior to surgery so that the shrunk tumor becomes easy to remove surgically. Radiation around the chest can produce irritation and inflammation of the tissue in the chest silhouette, which also includes the pericardium. Chemotherapy is used to treat primary and secondary cancer in the body. Certain medications used in chemotherapy can produce irritation and inflammation in the pericardium resulting in excessive accumulation of fluid between the layers of pericardium.
Possible Treatment Option:
Treatment of pericardial effusion in people suffering from cancer is twofold. Treatment is aimed to ease the symptoms of pericardial effusion such as breathing distress, chest pain, palpitation etc. Secondly the underlying cause which in this case is cancer needs to be addressed. Once fluid around the heart is confirmed, it has to be treated. If the effusion is in small amount, it can be treated with medicines that include antibiotics and anti inflammatory steroids. Large effusion needs to be treated urgently and methods include pericardiocentesis. In this procedure the pericardial fluid is aspirated and cytotoxic drugs are introduced in the pericardial cavity. Other method is using pericardial shunt and balloon pericardiotomy. The underlying cancer is treated with chemotherapy and radiation or surgery depending on the extent of spread and severity of cancer.