What is the pathophysiology of treatment-related cardiotoxicity in cancer?

• A. Heart function improves with treatment.
• B. Cardiac function is unaffected.
• C. Only surgical procedures affect the heart.
• D. Chemotherapy or radiotherapy can reduce cardiac function.

Answer: (D)

Treatment-related cardiotoxicity happens when cancer therapies directly injure the heart, leading to a decline in how well it can pump. Chemotherapy, especially anthracyclines, generates reactive oxygen species that damage heart cell mitochondria and other cellular structures, and can interfere with DNA repair in cardiomyocytes, promoting cell death and weakening contraction. This can cause a dose-dependent, sometimes progressive cardiomyopathy. Radiotherapy to the chest can inflame and scar the heart tissue, damage the coronary arteries, and affect valves or the pericardium, all of which compromise cardiac function. Together, these effects reduce the heart’s ability to pump effectively, potentially leading to heart failure. That’s why chemotherapy or radiotherapy can reduce cardiac function. The other statements don’t fit because they imply no effect or that only surgery affects the heart, which isn’t accurate given these systemic treatment risks.