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Second Toronto Cardiac Tumour Conference to tackle neuro-endocrine heart tumours

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Dr. Robert James (R.J.) Cusimano discusses the impact of the Toronto Cardiac Tumour Conference, set to hold its second meeting tomorrow. (Video: PMCC/UHN)

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The impact has been swift, immediate and measureable – from across the street and around the world – all thanks to a small but bold step taken almost one year ago.

"There's been an improved amount of information and knowledge regarding cardiac tumours and the inter-dependency of different specialties in the assessment and treatment of cardiac tumours," says Dr. Robert James (R.J.) Cusimano, cardiac surgeon, Peter Munk Cardiac Centre.

Dr. Cusimano, who is also Associate Professor, Department of Surgery, University of Toronto, is the architect of the Toronto Cardiac Tumour Conference. The second international gathering is set for tomorrow and will delve into the treatment of rare, often-fatal tumours found on or near the heart.

"Since the first tumour conference, there has been more contact with me about cardiac tumours," he says. "I've received emails from individuals from not only other parts of Canada but other parts of the world, who in desperation found out about me through the internet and have asked me to review their cases.

"There have been people from all over Canada calling, even people from Europe calling, asking questions, mostly patients."

One example is Jennifer Picado, who was referred in the spring of last year by a McGill University Health Centre cardiologist. The 27-year-old medical student had a neuro-endocrine tumour in her heart, which was removed in May by a multi-disciplinary medical team led by Dr. Cusimano.

Focus on rare cardiac tumours that impact hormones

"Patients with neuro-endocrine tumours come in two varieties," Dr. Cusimano says. "They all have tumours of the heart which may have detrimental effects on the heart – the physical aspect of having something going into your heart.

"But the neuro-endocrine tumour patients have something in addition. They may have abnormal hormones which may be secreted by the tumour, which may have detrimental effects on their body. That complicates the operation and the lead-up to the operation, so we have to prepare for those abnormal tumours at the time of the operation."

Dr. Cusimano
Dr. Robert James (R.J.) Cusimano, cardiac surgeon, Peter Munk Cardiac Centre and architect of the Toronto Cardiac Tumour Conference, holds a tumour that he and a multi-disciplinary team removed from a 27-year-old Jennifer Picado during a five-hour operation. The second global conference happens tomorrow. (Photo: PMCC/UHN)

Considered even more rare than sarcomas and cancers of the heart, neuro-endocrine tumours will be the area of focus for the second Toronto Cardiac Tumour Conference, which will include speakers from the United States, Europe, and the Middle East.

"The goal for these conferences that I'm going to hopefully have for the next few years is to help people create silos of excellence around the world," Dr. Cusimano says. "Hopefully we in Toronto, at Toronto General Hospital and UHN, will be a silo of treatment for Canadian treatment of cardiac tumours in general, but I also want there to be silos of excellence around the world."

Fundamental shift in medical approach

The other notable area of impact has been in how heart surgeons and medical teams approach treatment of these tumours.

"Sarcomas of the heart are starting to be dealt with more and more with chemotherapy," Dr. Cusimano says. "And, I think the biggest change I've seen even in the last year is a tendency towards more pre-surgical diagnosis more than we were before to try to get some chemotherapy into the people before we actually operated on them.

"There's still an unknown as to whether that is a better treatment option than going in primarily to remove the whole tumour and then starting chemotherapy. But there's a little slant towards that pre-operative chemotherapy this year versus last year, so that's also been a big change."

Jennifer Picado
Jennifer Picado, a 27-year-old medical student, had a neuro-endocrine tumour in her heart removed last May by a multi-disciplinary medical team led by Dr. Cusimano. (Photo: Courtesy The Globe and Mail)

A return guest speaker at this second conference will be Dr. Michael Reardon, considered the world's foremost authority on tumours of the heart.

"Cardiac tumours, particularly malignant cardiac tumours, are most common in the 35 to 50-year age range," says Dr. Reardon, cardiac surgeon, Houston Methodist Hospital.  "These are often people that are young, just starting their families and there's no predisposing factors that we can really figure out.

"It's not like this is somebody that's smoked all their life and got lung cancer. These are people who were living their life and to the best of their knowledge doing everything right, and then one day they get sick.

"And they're often told you don't have long to live. That's why these types of conferences, these types of centres are crucially important. These people do have hope. There are things we can offer. It's just not well known."'

Adds Dr. Cusimano: "We don't know how many people are told that this is a large tumour and there is nothing that can be done for them. I've seen that a few times in the last year, since the first tumour conference and in those individuals, probably three or four of them that I've been able to help get through the process of having something done. So it's hard to say how many are really out there."​

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