We know how challenging it is to fight cancer. The treatments you receive, such as chemotherapy and radiation, can sometimes cause other health problems. Have you ever thought that cancer treatments can have an effect on your heart? That is what we medically call Cardiotoxicity . Don't be afraid when you hear this name. This is not something that happens to everyone. But it is very important to be aware of this. So today we will talk about this very simply, in a way that you can understand.
Simply put, what is Cardiotoxicity?
Cardiotoxicity is the damage caused to our heart by some cancer treatments or drugs. Think of the medicine that kills cancer cells as a very powerful warrior. When this warrior fights the cancer cells, sometimes the healthy cells in our heart that are nearby may also be slightly damaged. That's what cardiotoxicity is.
The main thing that can happen is that the heart has a harder time pumping blood throughout the body. The heart muscle can become weak. In some severe cases, this can even lead to a condition called Cardiomyopathy . This means that the heart muscle's ability to pump blood is significantly reduced.
One unique thing about this condition is that it can sometimes occur years after cancer treatment has ended. This risk is especially high in adults who have had cancer treatment as children.
Who is most at risk?
Although anyone who has undergone cancer treatment has a chance of developing this condition, not everyone develops it. However, some people are at a slightly higher risk.
- People taking certain medications: Some chemotherapy drugs and other treatments can affect the heart. We'll talk about that in a bit.
- People who have received radiation therapy to the chest area: When radiation therapy is given for a chest cancer, for example, breast cancer, the radiation can also affect the heart to some extent.
- Those who received cancer treatment at a young age: This risk is slightly higher for adults who received treatment at a young age.
Some studies suggest that up to 20% of adults undergoing cancer treatment may experience some form of heart disease, and between 7% and 10% of these may develop cardiomyopathy or heart failure.
What effects can cardiotoxicity have on the heart?
This condition can cause a variety of heart problems. Not all of these things happen to everyone, but it's important to be aware of the possible causes. See the table below.
| Possible heart condition | Simply put... |
|---|---|
| Cardiomyopathy | The heart muscle becomes weak and unable to pump blood properly. |
| Heart Attack / Myocardial Infarction | Blockage of a vein that supplies blood to the heart. |
| Heart Failure | The heart is weak and unable to pump blood to meet the body's needs. |
| Irregular heartbeat (Arrhythmia) | An unusually fast, pounding, or irregular heartbeat. |
| Heart Valve Disease | The valves that act like gates inside the heart do not work properly. |
| High/Low Blood Pressure | Your blood pressure is abnormally high or low. |
| Fluid buildup around the heart | Fluid accumulation in the thin membrane that covers the heart, causing pressure on the heart. |
What symptoms might you experience?
Heart symptoms related to cardiotoxicity can appear suddenly or develop gradually. If you are undergoing or have just finished cancer treatment, it is important to be aware of these symptoms.
Remember, these symptoms can be caused by other things, but if you have one or more of these, definitely talk to your doctor.
| Symptom | You may feel this way. |
|---|---|
| Difficulty breathing (Dyspnea) | I feel short of breath and wheezing when I walk a little, climb a flight of stairs, or even just stand still. |
| Chest pain or discomfort | It feels like your chest is being squeezed, squeezed, or just feels painful. |
| Leg swelling (Edema) | Areas like the legs, ankles, and feet become swollen and throb when pressed with a finger. |
| Palpitations | It feels like your heart is pounding and beating fast, or like it's skipping a beat. |
| Dizziness and fainting | Spinning and spinning . Spinning and spinning . |
| Abdominal Distension | The abdominal area appears swollen and enlarged due to fluid accumulation in the body. |
What are the main causes of cardiotoxicity?
Although there are thousands of types of cancer treatments, a few main types contribute the most to this condition.
1. Some chemotherapy drugs
Anthracyclines are a class of chemotherapy drugs that are particularly well-known for this. An example is Doxorubicin (Adriamycin®) . These are often used to treat cancers such as leukemia, lymphoma, breast cancer, and multiple myeloma.
2. Targeted Therapy Drugs
Trastuzumab (Herceptin®) is an example of such a drug. It is used to treat breast cancer and stomach cancer. There is an increased risk of cardiomyopathy, especially when this drug is given in combination with an anthracycline.
3. Radiation therapy to the chest area
When radiation is given to the chest for a cancer, such as breast cancer or Hodgkin's Lymphoma, the radiation can travel through the heart. Over time, this can damage the blood vessels and muscles of the heart.
How do doctors diagnose this condition?
If you have the symptoms mentioned above, or if you are in a high-risk group, your doctor will likely order a heart function test. The main test is to check the heart's pumping ability. This is done using a measurement called the Left Ventricular Ejection Fraction (LVEF) . Simply put, this is the percentage of blood the heart pumps out into the body each time it beats.
Below are some tests used to measure these things.
| Test | What do you do with this? |
|---|---|
| Echocardiogram (Echo) | This is the most commonly used. Ultrasound waves (like the scans we get to see babies) are used to look at the heart's beating, size, shape, and how it pumps blood. |
| Cardiac MRI | It uses magnets and radio waves to take very clear, detailed pictures of the heart. This is considered the best way to detect cardiotoxicity. |
| Cardiac Stress Test | They measure how your heart responds to exercise by having you walk on a treadmill or ride a bike. |
| Multigated Acquisition (MUGA) Scan | The LVEF value is measured by injecting a small amount of a radioactive substance that is harmless to the body and using a camera to watch it travel through the heart with the blood. |
| Cardiac CT Scan | A 3D image of the heart is created using multiple X-rays. This can be very useful for people who have had radiation therapy. |
How is this condition treated?
The treatment method depends on the extent of damage to your heart and its cause.
- Changing medications: If it is confirmed that the cancer treatment you are currently taking is affecting your heart, your doctor may decide to stop the medication, reduce the dose, or switch you to a different medication.
- Heart medications: Your doctor may prescribe new medications to help improve heart function and control symptoms. For example:
- ACE Inhibitors: These widen blood vessels and improve blood flow.
- Beta-blockers: These control the heart rate and reduce the pressure on the heart.
- Diuretics: They help to eliminate excess fluid from the body through urine, which reduces swelling.
- Digoxin: Regulates the heart rate and makes the heart pump blood more efficiently.
Can this condition be completely cured?
This is a question that many people have. The answer is, "Sometimes you can, sometimes you can't."
- Cardiotoxicity caused by drugs such as Trastuzumab (Herceptin®) is often reversible . This means that heart function can return to normal once treatment is stopped or another medication is started.
- Damage caused by anthracyclines or radiation therapy is often irreversible . In such cases, lifelong heart support medications and lifestyle changes may be required.
What can be done to reduce the risk?
To be honest, there is no way to 100% prevent cardiotoxicity. Because that treatment is essential to curing cancer. But the most important thing you can do is to recognize this condition as soon as possible.
- Talk to your doctor: Before starting cancer treatment, talk openly with your doctor about the benefits of the treatment, as well as the possible side effects, such as effects on the heart.
- Regular check-ups: During and after cancer treatment, have your heart checked regularly (e.g., an echo scan) as directed by your doctor. This will help detect any problems early and start treatment.
When to seek medical advice immediately!
If you are receiving or have received cancer treatment, and you experience any of the following severe symptoms, go to the nearest hospital's Emergency Department (ETU) immediately.
- A persistent or increasing heart rate.
- Dizziness, blurred vision, or fainting.
- Sudden worsening shortness of breath or chest pain.
- Swelling of the lips or throat.
- Unusual swelling of the legs or feet.
- Weight gain of more than 1.5 kg (3 pounds) within a week.
These symptoms could be a sign of a serious heart attack, so don't delay.
Take-Home Message
- Cardiotoxicity is damage to the heart caused by cancer treatments. This doesn't happen to everyone, but there is a risk.
- Always be aware of symptoms such as difficulty breathing, chest pain, and swelling of the legs.
- Before starting cancer treatment, talk to your doctor about the pros and cons and the possible effects on your heart.
- It is very important to have regular heart tests (such as an echo) as recommended by your doctor, both during and after treatment.
- The earlier a problem is identified, the more likely it is to be successfully treated. Don't panic, be informed, and work closely with your doctor.
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