A11. The routes of spread of malignant tumors

Last updated on September 10, 2021 at 17:55

Transcoelomic spread

Transcoelomic metastasis refers to the dissemination of malignant tumours into body cavities by penetrating the surface of the peritoneal, pleural, pericardial, or subarachnoid spaces. Of these, transperitoneal metastasis is the most common.

Ovarian tumours spread transperitonally most of the time, although they can also spready through the lymphatics or blood vessels. Ovarian metastasis to the liver is typical.

Lymphatic spread

Lymphatic spread is most typical for carcinomas and is evidenced by spread to the sentinel lymph node.

Haematogenous spread

Haematogenous spread most commonly follows veins rather than arteries, due to their thinner, easier-to-invade walls.

Colorectal spread to the liver through the portal vein is typical.

Spread by iatrogenic implantation

Malignant tumours may spread during medical procedures used to diagnose or treat a malignancy; a process also called seeding. Preventing this is an important principle in the diagnosis and treatment of cancer. Here are some examples used to prevent this:

  • During a laparoscopic tumour removal, the tumour is first put into a sample bag and then removed from the abdominal cavity
  • After tumour removal, the abdominal cavity is often washed with distilled water, which causes lysis of any exfoliated tumour cells
  • Needle biopsy and incisional biopsy are not performed for certain tumours, like HCC, breast cancer

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