Gastric carcinoma may advance by one of five routes:
direct spread, e.g. to surrounding structures such as the oesophagus and pancreas
lymphatic spread
haematogenous dissemination
transperitoneal implantation: under the influence of gravity, tumour cells pass into the peritoneum and thence to the pelvic floor. Seedlings may occur at any point, but classically, secondary tumours of the ovaries may arise in females - Krukenberg's tumour.
iatrogenic seeding, e.g. due to the displacement of tumour cells at endoscopic biopsy or laparotomy
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