Pericardial Disease in Patients with Cancer

Abstract

Pericardial effusion can develop in patients with acute pericarditis or in association with a wide variety of systemic diseases and is characterized as transudative, exudative, pyopericardium, or hemopericardium. Large effusions are usually related to tuberculous or neoplastic effusions. Primary pericardial tumors are rare, with the vast majority of cases resulting from secondary tumors. Pericardial effusion may be present in 7% to 53% of patients with cancer and is correlated with an advanced stage of the disease. The main types of cancer related to pericardial involvement are lung, breast, blood, and gastrointestinal cancers. The clinical presentation is variable; some patients are asymptomatic, whereas up to one-third may develop cardiac tamponade. In general, the severity of pericardial effusion ranges from moderate to significant, and the diagnostic process should focus mainly on the search for the primary disease and on the hemodynamic condition. The presence of pericardial effusion portends a grave prognosis, and treatment depends on the malignancy. Interventional treatments in patients with cancer include pericardiocentesis, pericardial window, and surgical pericardiectomy.