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

Cardiac metastasis from colorectal cancer (CRC) is exceedingly rare and remains poorly defined in the literature. As survival improves and metastatic patterns evolve, recognizing the clinical and anatomical characteristics of cardiac involvement is increasingly important. This systematic review synthesizes published cases of CRC with cardiac metastases identified through a systematic search to clarify presentation, metastatic pathways, management, and outcomes. Following PRISMA 2020 guidelines, we systematically searched PubMed, Scopus, and Web of Science from inception to October 2025 for case reports and case series describing CRC metastasis to the heart. Eligible reports were screened by two independent authors. Detailed clinical, pathological, imaging, management, and outcome data were extracted using a standardized template. Descriptive statistics were performed using Jamovi v2.7 without inferential analyses given the nature of the data. Fifty-three cases met inclusion. The mean age was 62.7 ± 11.75 years (median 66; IQR 55.5-71), with a slight male predominance (53.8%). Left-sided primaries were most common (50.9%), followed by rectal (26.4%) and right-sided tumors (15.1%). Most cardiac lesions were intracardiac (78%) and solitary (92.2%), with a marked predilection for the right ventricle (45.8%) and right atrium (35.4%). Dyspnea was the leading symptom (65.4%), while 19.2% were asymptomatic. Extra-cardiac metastases preceded cardiac involvement in 60.8%, mainly to the liver (46%) and lungs (32%). Curative-intent treatment was attempted in 52.8%; palliative care in 28.3%. Overall mortality was 64.2%. CRC cardiac metastasis typically manifests as a solitary right-sided intracavitary lesion in the context of systemic disease and carries a poor prognosis. Early multimodality imaging and individualized multidisciplinary management are essential. Collaborative registries are needed to establish evidence-based guidance.