1267 A Case of Cardiac Metastasis: Distant Rare Entity of Colorectal Cancer

Background Cardiac metastasis arising from colorectal cancer is extremely rare (1.4-2%) and carries a poor prognosis. The literature review suggests only 31 case reports. Incidence might be underestimated as the majority remain clinically asymptomatic. Symptoms if present are consistent with heart failure. There are no established treatment protocols for managing this aggressive condition, necessitating an individualized treatment approach. Case Report A 66-year-old female with a past medical history of hypercholesterolemia and smoking was diagnosed with a recto-sigmoid tumour during a bowel cancer screening colonoscopy. The radiological staging was T4a N1b M0. MDT recommended neo-adjuvant radiotherapy ( SCRT). After SCRT restaging, the tumour showed regression in size. She underwent a robotic low anterior resection and de-functioning loop ileostomy, followed by adjuvant chemotherapy with a good response. During the pre-anaesthetic review for reversal of de-functioning loop ileostomy, an echocardiogram and CT PET revealed a mass in the right ventricle wall. This was histologically confirmed as adenocarcinoma on endomyocardial biopsy. MDT advised targeted adjuvant chemotherapy as this mass was inoperable. After 14 cycles of FOLFIRI (Irinotecan+Flurouracil+folinic acid)+Panitumumab, her repeat scans showed a reduction in right ventricular mass. She successfully underwent a reversal of her loop ileostomy with an uneventful recovery. Conclusions Colonic carcinoma can spread to the heart, which is aggressively fatal. Standardizing surveillance is crucial to early detection and improved outcomes. Requires further research to better understand this rare disease progression.