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".