Non-bacterial thrombotic endocarditis (NBTE) presented a diagnostic dilemma in a 54-year-old woman with metastatic colon cancer. A large mass on the tricuspid valve initially suggested tumoral invasion. However, prompt anticoagulation led to complete resolution, indicating NBTE. This case highlights the challenges of differentiating NBTE from metastatic disease in high-risk patients. While transthoracic and transesophageal echocardiography (TTE and TEE) raised suspicion of tumor spread, anticoagulant therapy achieved successful resolution, potentially offering an alternative management approach. The case report proposes considering novel oral anticoagulants (NOACs) like apixaban for such scenarios.