Cardio-Oncology: Radiation and Heart Disease

Understand Your Condition

Cancers Linked to Heart Problems


If you have cancer, your physician may recommend a treatment that involves radiation therapy to the chest area. You should be aware of the side effects that radiation therapy may cause to the heart. These potential adverse effects are known as radiation cardiotoxicity.

In this section, you will learn about cancers that have a higher risk of causing radiation injury to the heart.

Hodgkin’s Lymphoma

Overview: Hodgkin’s lymphoma is a cancer of the lymphatic system that arises from a type of white blood cells called lymphocytes. It frequently involves the lymph nodes in the center of the chest. This area, called the mediastinum, is next to the heart. It typically affects young adults (ages 20-35) or older adults (ages 55 and up).

Causes: The exact cause of this cancer is unclear. Some scientists believe that a virus, called the Epstein-Barr virus, causes changes in lymphocytes that lead to Hodgkin’s lymphoma.

Symptoms: Most patients have a painless mass in the neck, underarm, or groin. If the mediastinum is involved, patients may notice shortness of breath or chest pain. Some patients may also have fevers, excessive sweating (especially at night), intense itching, severe fatigue, and weight loss.

Treatment: The most common treatments for Hodgkin’s lymphoma are chemotherapy and radiation therapy.

Risk of Radiation Cardiotoxicity: Radiation therapy for Hodgkin’s lymphoma is often used to treat the mediastinum. This area is very close to the heart, and therefore the heart can receive some radiation during treatment. This risk may be increased by the use of certain chemotherapy drugs, such as anthracyclines (e.g. doxorubicin).

Breast Cancer

Overview: Breast cancer is the most common type of cancer in women. It can sometimes spread to involve the lymph nodes around the breast. These lymph nodes are found in the underarm area and next to the breastbone (sternum).

Causes: Breast cancer most commonly affects older women, although younger women can also develop breast cancer. A woman’s risk for breast cancer may be influenced by hormonal factors such as high estrogen exposure and by reproductive factors including age at first pregnancy and age at menopause. Being overweight also increases the risk of breast cancer in older women. In addition, genetic mutations may be inherited that greatly increase the risk of developing breast cancer in some families, such as mutations in the BRCA1 or BRCA2 genes.

Symptoms: Common symptoms of breast cancer may include a mass in the breast or underarm area. However, with mammograms, many breast cancers are now found before they cause symptoms.

Treatment: Surgery is a  standard part of treatment for most women with breast cancer. Doctors may also treat patients with chemotherapy, radiation therapy, and/or targeted therapies

Risk of Radiation Cardiotoxicity: Women with cancer of the left breast or with cancer in the lymph nodes near the breastbone (sternum) may be at a higher risk for radiation cardiotoxicity. Radiation therapy to these areas can affect the heart. The risk of radiation cardiotoxicity may be increased by the use of certain chemotherapy drugs, such as doxorubicin.

Lung Cancer

Overview: There are many types of lung cancer, but all of them can involve the lymph nodes in the middle of the chest. This disease remains the No. 1 cause of cancer death in the United States and across the world. Lung cancer is a serious disease, but in its early stages some patients can be cured.

Causes: Smoking is the single biggest cause of lung cancer. Less common causes include exposure to radon gas and asbestos.

Symptoms: Cough, chest pain, and shortness of breath are the most common symptoms of lung cancer.

Treatment: Like many cancers, treatment of lung cancer is different depending on which parts of the body are involved. In some cases, doctors perform surgery, which may be followed by chemotherapy or radiation therapy, or both. In other cases, surgery is not performed and doctors recommend radiation therapy, or a combination of radiation therapy and chemotherapy. In many cases, doctors treat with chemotherapy or targeted radiation therapy alone.  

Risk of Radiation Cardiotoxicity: Radiation therapy is frequently used in lung cancer. Lung cancers in the central lungs or in the lymph nodes at the center of the chest are close to the heart. Therefore, radiation therapy to these areas can also affect the heart.

Esophageal Cancer

Overview: The esophagus is a muscular tube that carries food from the back of the mouth, through the middle of the chest, and to the stomach. Two types of cancer can affect the esophagus: squamous cell carcinoma and adenocarcinoma.

Causes: Smoking and alcohol use are the main causes of squamous cell carcinoma of the esophagus. In contrast, adenocarcinoma of the esophagus is caused mainly by stomach acid.
Symptoms: Both types of esophageal cancer cause similar symptoms. Patients find it difficult or painful to swallow, which can lead to weight loss.

Treatment: Most patients undergo combinations of treatments for esophageal cancer. Surgery is considered standard treatment. However, patients with aggressive disease may receive radiation therapy and chemotherapy in addition to surgery. If patients cannot have surgery, they may receive radiation therapy and chemotherapy together.

Risk of Radiation Cardiotoxicity: Because the esophagus passes through the middle of the chest, directly behind the heart, treating this area with radiation therapy can affect the heart.

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Published: November 2017
Authors: William Stokes, MD; Priscilla Stumpf, MD; Lavanya Kondapalli, MD; Arthur Liu, MD, PhD
Medical Reviewers: Bonnie Ky, MD, MSCE; Debra Madden, BA; Charles Porter, MD; Karen Lisa Smith, MD, MPH

These modules were developed in collaboration with the Eastern Cooperative Group—American College of Radiology Imaging Network (ECOG-ACRIN) Cardiotoxicity Working Group and Patient Advocacy Group.

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