Venous Tumor Thrombus Across Malignancies: Imaging, Management, and Clinical Implications

Venous tumor thrombus (VTT) is a clinically important manifestation of malignancy that creates diagnostic, therapeutic, and prognostic challenges. Evidence is highly uneven across tumor types: renal cell carcinoma and hepatocellular carcinoma account for much of the available clinical experience, whereas data for rarer tumors, including sarcomas, remain limited. This narrative review was based on a structured PubMed search supplemented by relevant publications identified through reference checking and subsequent topic-specific reading. We review the incidence, imaging evaluation, surgical and non-surgical management, and prognosis of VTT across major malignancies. Although several considerations are shared across tumor types, including assessment of thrombus extent, venous wall involvement, venous patency, collateral circulation, resectability, and systemic disease status, their clinical implications differ according to the underlying malignancy. In particular, treatment strategies established in well-studied tumors should not be directly extrapolated to rarer malignancies with different tumor biology, treatment sensitivity, and patterns of disease progression. A cross-tumor approach may therefore be most useful for defining common questions in VTT assessment and multidisciplinary planning, while treatment decisions remain tumor-specific. Future progress will require standardized reporting, multicenter collaboration, and better integration of emerging systemic therapies into multidisciplinary care.