Cardiovascular

Cardiac metastases from colorectal cancer: a comprehensive systematic review of clinical presentation, cardiac involvement, and outcomes.

TL;DR

CRC cardiac metastasis typically manifests as a solitary right-sided intracavitary lesion in the context of systemic disease and carries a poor prognosis, with overall mortality of 64.2%.

Key Findings

Cardiac metastases from colorectal cancer most commonly presented as solitary intracardiac lesions with a marked predilection for right-sided cardiac chambers.

  • 53 cases met inclusion criteria from a systematic search of PubMed, Scopus, and Web of Science from inception to October 2025
  • Most cardiac lesions were intracardiac (78%) and solitary (92.2%)
  • The right ventricle was the most commonly affected chamber (45.8%), followed by the right atrium (35.4%)
  • PRISMA 2020 guidelines were followed; data extracted using a standardized template with descriptive statistics performed using Jamovi v2.7

The patient population with CRC cardiac metastases had a mean age of 62.7 years with a slight male predominance.

  • Mean age was 62.7 ± 11.75 years (median 66; IQR 55.5–71)
  • Male predominance was noted at 53.8%
  • Left-sided primaries were most common (50.9%), followed by rectal (26.4%) and right-sided tumors (15.1%)

Dyspnea was the leading symptom of CRC cardiac metastasis, though a notable proportion of patients were asymptomatic.

  • Dyspnea was the leading symptom, occurring in 65.4% of cases
  • 19.2% of patients were asymptomatic at the time of cardiac metastasis diagnosis
  • The high rate of asymptomatic cases underscores the importance of multimodality imaging for early detection

Extra-cardiac metastases preceded cardiac involvement in the majority of cases, most frequently to the liver and lungs.

  • Extra-cardiac metastases preceded cardiac involvement in 60.8% of cases
  • Liver metastases were most common (46%), followed by lung metastases (32%)
  • This pattern suggests cardiac metastasis typically occurs in the context of advanced systemic disease

Overall mortality among patients with CRC cardiac metastases was high at 64.2%, despite curative-intent treatment being attempted in more than half of cases.

  • Overall mortality was 64.2%
  • Curative-intent treatment was attempted in 52.8% of cases
  • Palliative care was provided in 28.3% of cases
  • The authors concluded that the condition 'carries a poor prognosis' and that 'individualized multidisciplinary management are essential'

What This Means

This research synthesized all published case reports of colorectal cancer (CRC) spreading to the heart, a very rare event. Analyzing 53 documented cases, the researchers found that when colorectal cancer does spread to the heart, it almost always forms a single tumor (in over 92% of cases) and tends to appear on the right side of the heart — most often in the right ventricle or right atrium. The majority of patients already had cancer spread to other organs, particularly the liver and lungs, before their cardiac involvement was discovered. The most common symptom was shortness of breath, but nearly 1 in 5 patients had no symptoms at all, meaning the cardiac tumor was found incidentally. This research suggests that the outlook for patients with this condition is very poor, with nearly two-thirds of reported patients dying from their disease. While over half of patients received treatment aimed at cure, the overall mortality rate of 64.2% highlights the severity of this complication. The authors note that because some patients are asymptomatic, early and thorough imaging using multiple techniques is important for detecting cardiac involvement in CRC patients, especially those with existing metastases. Because this condition is so rare, the entire body of published evidence amounts to only 53 cases, all from individual case reports rather than large clinical trials. This research suggests that establishing collaborative registries to pool data from multiple institutions would be critical for developing better evidence-based treatment guidelines. Clinicians managing advanced colorectal cancer should maintain awareness of the possibility of cardiac metastasis, particularly when patients develop new cardiopulmonary symptoms.

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Citation

Abdul-Hafez H, Awashra A, Elgendy M, Rakab M, Ali A, Mahafdah B, et al.. (2026). Cardiac metastases from colorectal cancer: a comprehensive systematic review of clinical presentation, cardiac involvement, and outcomes.. Clinical & experimental metastasis. https://doi.org/10.1007/s10585-026-10428-8