Cardiac metastasis from colorectal cancer (CRC) is an uncommon and undercharacterized clinical entity. As systemic therapies prolong survival and metastatic patterns evolve, recognition of cardiac involvement is increasingly important for diagnosis, risk stratification, and management. This systematic review synthesizes published case reports and case series to clarify clinical presentation, anatomical patterns of cardiac involvement, management strategies, and observed outcomes.
The review adhered to PRISMA 2020 guidance. Authors performed a systematic search of PubMed, Scopus, and Web of Science from database inception through October 2025 for case reports and case series describing CRC metastasis to the heart. Eligible reports were screened independently by two reviewers. Clinical, pathological, imaging, management, and outcome variables were extracted using a standardized template. Descriptive statistics were calculated using Jamovi v2.7; no inferential statistical testing was undertaken because the dataset comprised individual case-based reports.
Fifty-three cases met inclusion criteria. Patients had a mean age of 62.7 ± 11.75 years (median 66; interquartile range 55.5–71). There was a slight male predominance (53.8%). Distribution of the primary colorectal tumors showed left-sided colon primaries were most common (50.9%), followed by rectal primaries (26.4%) and right-sided colon primaries (15.1%). The source report does not provide further breakdown of comorbidities or staging beyond what was abstracted from individual cases.
Most reported cardiac lesions were intracardiac (78%) and solitary (92.2%). There was a marked predilection for the right-sided cardiac chambers: the right ventricle accounted for 45.8% of cardiac lesions and the right atrium for 35.4%. The abstracted data indicate that left-sided intracavitary lesions and pericardial or myocardial involvement were less frequent but are not quantified further in the abstract.
The predominant presenting symptom across cases was dyspnea, reported in 65.4% of patients. A notable proportion—19.2%—were asymptomatic at the time of cardiac lesion detection. The source text does not list additional symptom frequencies in the abstract, but the symptomatic spectrum in case reports commonly includes signs related to intracavitary obstruction, embolic phenomena, arrhythmia, or systemic features of advanced malignancy; specific frequencies beyond dyspnea and asymptomatic presentation were not reported in the abstract.
In the majority of cases (60.8%), extracardiac metastases were documented before cardiac involvement. The most frequent extracardiac metastatic sites preceding cardiac disease were the liver (46%) and the lungs (32%). This pattern supports the interpretation that cardiac metastasis from CRC commonly occurs in the context of disseminated disease rather than as an isolated event.
Management strategies reported in the included cases were heterogeneous. Curative-intent treatment was attempted in 52.8% of patients, whereas a palliative approach was reported in 28.3% of cases. The abstract does not provide granular detail on the specific therapeutic modalities (for example, resection, systemic chemotherapy regimens, targeted therapy, radiotherapy, or cardiac-directed interventions) or selection criteria for curative versus palliative intent; those details are present in individual reports but are not summarized in the abstract.
Overall mortality across the pooled case series and reports was 64.2%, indicating a generally poor prognosis for patients with CRC cardiac metastasis. Given the case-report nature of the dataset, follow-up durations and timing of death relative to cardiac diagnosis vary and are not standardized in the abstract. These mortality data should therefore be interpreted as descriptive rather than definitive population-level estimates.
Based on the assembled case evidence, CRC cardiac metastasis typically presents as a solitary, right-sided intracavitary lesion within the context of systemic disease and carries a poor prognosis. The authors emphasize early use of multimodality imaging for detection and characterization of cardiac lesions and recommend individualized, multidisciplinary management planning. They call for collaborative registries to aggregate cases prospectively and support development of evidence-based guidance for diagnosis and treatment.
The source material is a systematic review of case reports and case series, which limits the ability to perform inferential statistical analyses or to derive high-level causal conclusions. The rarity of CRC cardiac metastasis and heterogeneity of published reports constrain generalizability. The abstract reports descriptive summary statistics but does not provide granular data on treatment modalities, timing, or standardized follow-up across cases; those details are not reported in the abstract and would require review of the full manuscript and underlying reports for further clarification.
Cardiac metastasis from CRC is rare but should be considered in patients with advanced disease who develop cardiac or cardiopulmonary symptoms. In published cases, lesions most commonly appear as solitary right-sided intracavitary masses, frequently in patients with prior hepatic or pulmonary metastases. Prognosis is poor; management decisions require multimodality imaging and multidisciplinary discussion. Building collaborative registries is necessary to inform future diagnostic and therapeutic strategies.