Ovarian cancer most often spreads within the peritoneal cavity first, with dissemination to surfaces and organs in the abdomen and pelvis. Beyond this intra-abdominal spread, cancer can also reach regional lymph nodes and, less commonly, distant sites through hematogenous (blood-borne) or transcoelomic routes. In practice, the typical sequence is pelvic/peritoneal involvement early, followed by disease across the peritoneal surfaces (such as the omentum, peritoneal lining, and abdominal organs), and then potential spread to regional lymph nodes and distant organs like the liver or lungs as the disease advances. Key patterns commonly described
- Intraperitoneal/transcoelomic spread: Cancer cells detach from the ovarian or fallopian-tube origin and seed the peritoneal surfaces, omentum, and diaphragmatic surfaces. This pattern accounts for the frequent observation of peritoneal carcinomatosis and bulky deposits on peritoneal surfaces in advanced cases.
- Local/direct extension: Tumors may extend directly to adjacent structures in the pelvis, including the bladder, colon, or uterus.
- Lymphatic spread: Involvement of pelvic and para-aortic lymph nodes is common, especially as disease progresses.
- Hematogenous spread: Less common but can occur, leading to metastases in distant organs such as the liver or lungs.
Practical implications
- Initial imaging and staging typically focus on peritoneal involvement, omental disease, and ascites, which reflect the predominant pattern of spread.
- Surgical planning often targets visible peritoneal implants and omental disease, given the common intra-abdominal dissemination.
- Prognosis and treatment decisions are heavily influenced by the extent of peritoneal spread and lymph node involvement, as well as any distant metastases.
If you’d like, I can tailor this to a specific context (e.g., early-stage vs advanced-stage, diagrams of spread, or how spread affects treatment options) or provide a concise comparison of regional vs distant spread with brief clinical implications.
