Alrehaili Mohammad, Tashkandi Emad
Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah, Saudi Arabia.
College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Case Rep Oncol. 2020 Dec 7;13(3):1441-1445. doi: 10.1159/000511600. eCollection 2020 Sep-Dec.
Colorectal cancer (CRC) is one of the most common malignancies in the world. It typically metastasizes to the lymph nodes, liver or lungs. Cardiac involvement is considered the least likely metastatic complication of malignant tumors including CRC. We report a rare case of metastatic rectal cancer to the liver, ovaries, lungs and peritoneum that presented initially with a 1-week history of rectal bleeding. Her hospital course was complicated by progressive dyspnea and palpitations secondary to right atrial metastasis based on imaging studies including cardiac MRI with contrast. The patient was not fit for chemotherapy or any surgical intervention given her poor prognosis and functional status in the setting of advanced stage of her disease. After discussion with the patient and her family, a decision was made to change her code status to DNR (do not resuscitate) and focus on palliative treatment of her disease. She expired about 2 weeks following her discharge date. Based on this case report, we recommend a high index of suspicion for cardiac metastasis when dealing with cardiac or respiratory complaints in cases of CRC that need careful evaluation with echocardiography and MRI.
结直肠癌（CRC）是世界上最常见的恶性肿瘤之一。它通常会转移至淋巴结、肝脏或肺部。心脏受累被认为是包括CRC在内的恶性肿瘤最不可能出现的转移并发症。我们报告了一例罕见的转移性直肠癌病例，其转移至肝脏、卵巢、肺部和腹膜，最初表现为1周的直肠出血病史。根据包括心脏磁共振成像（MRI）增强扫描在内的影像学检查，其住院过程因右心房转移继发进行性呼吸困难和心悸而变得复杂。鉴于患者在疾病晚期预后较差且功能状态不佳，不适合进行化疗或任何手术干预。在与患者及其家属讨论后，决定将其急救状态改为“不要复苏”（DNR），并专注于对其疾病的姑息治疗。她在出院日期约2周后去世。基于本病例报告，我们建议在处理CRC患者出现心脏或呼吸相关症状时，高度怀疑心脏转移，此时需要通过超声心动图和MRI进行仔细评估。
