When the heart and cancer converge

Jennifer Picado was just a few months away from finishing medical school when she got devastating news from her doctor.

The heart palpitations and breathing difficulties that she was struggling with for the past three years were not, as had been suspected initially, symptoms of anxiety. They were caused by a tumour that had grown right on her heart.

“The first surgeon I saw told me it was inoperable,” recalls Jennifer, a 27-year-old resident of Montreal. “So I spoke to other surgeons who said the tumour needed to be removed right away, but the problem was that none of them had any experience removing cardiac tumours.”

A referral from a cardiologist at McGill University Health Centre changed everything for Jennifer. She was directed to Dr. Robert James Cusimano, a cardiac surgeon at the Peter Munk Cardiac Centre and one of only two doctors in North America with the expertise to treat such cardiac tumours. The second is Dr. Michael J. Reardon, a cardiac surgeon at Houston Methodist Hospital in Houston.

Cardiac tumours, which are relatively rare, can originate in the heart or spread to the heart from other parts of the body. Whether they are malignant or benign, these growths are considered a serious health threat and can kill if left untreated.

“Eventually, a cardiac tumour could block blood flow through the heart,” says Dr. Cusimano, whose specialized training and experience include heart transplants. “Even if your tumour is not malignant, you can still die from it.”

On May 12, 2016, Dr. Cusimano performed surgery on Jennifer to remove the cardiac tumour – a procedure that Dr. Reardon attended as an adviser and observer. About two-and-a-half weeks later, she walked across an auditorium stage at McGill University to accept her medical school diploma.

“My goal was to get out of hospital and graduate,” she recalls. “Thanks to Dr. Cusimano, I made it to the ceremony.”

Dr. Robert James Cusimano, left, and University of Toronto med student David Scholl examine patient images.

Dr. Cusimano’s expertise in cardiac tumours was developed not in medical school, but over 24 years on the job at the Peter Munk Cardiac Centre. Because of the centre’s reputation for innovation and excellence in cardiovascular care, it gets hundreds of referrals each year from around the world for heart surgeries, including those that call for the removal of abnormal growths. Dr. Cusimano says this has given him more opportunities than usual to work on heart tumours and to learn to respond to each unique case.

“Where and how a tumour has grown determines what we do when a patient comes to us,” he explains. “For example, if it’s across a blood vessel, [then] we do a bypass. If it has invaded a valve, then we need to do a valve replacement.”

Dr. Cusimano is now working on spreading awareness about heart tumours, educating other physicians and healthcare professionals on treatment options to develop more widespread expertise.

“My goal is to create a cardiac tumour centre of excellence in Canada, which can help people not only in this country, but also around the world,” says Dr. Cusimano.