The effect of rare-earth Ce on the evolution behaviour of inclusions in heavy rail steel was studied. The addition of Ce can significantly reduce the number and size of class A, B, D, and Ds inclusions in the heavy rail steel smelting process. According to the statistical analysis of the size of inclusions in steel, the number and size of A and B inclusions in steel tend to decrease significantly, while D and Ds inclusions disappear. Ce splits the aluminium inclusion into several small-sized inclusions and improves the morphology of the large-size aluminium inclusion, thereby making aggregation and growth difficult while facilitating easy floating and removal. Because the addition of Ce reduces the concentration of S element in steel, MnS inclusions are difficult to grow. The decrease in the number and size of core inclusions required for MnS growth leads to a corresponding decrease in the number and size of MnS inclusions. Meanwhile, the S element also easily gathers on the surface of CaO–MgO–Al2O3–SiO2–CeO inclusions, forming composite inclusions that are more easily removed, thus reducing the quantity and size of MnS inclusions.