spread
Last reviewed 01/2018
The spread of colonic cancer is variably:
- lymphatic:
- most common
- through mesenteric and para-aortic nodes, and eventually, the thoracic duct
- may involve supraclavicular nodes in late stages
- direct extension:
- through the bowel wall into adjacent structures, e.g. small intestine, stomach, duodenum, ureter, bladder, uterus, abdominal wall
- haematogenous spread:
- 10-15% of cases
- to liver in 75%, lung, or bone
- transcoelomic spread:
- through the serosa and tumour cells into the peritoneal cavity forming local deposits of malignant nodules
- the recto-vesical or recto-uterine pouches are often involved and on digital rectal examination can be felt as a hard shelf - Plummer's shelf
- other common sites include omentum, and ovaries - Krukenberg tumour
- intraluminal metastasis:
- exfoliated cells may become trapped in an anastomotic suture or staple line during operation "anastomotic recurrence".