How does endometrial cancer metastasize?

Endometrial cancer refers to cancer that occurs in the endometrium, most of which are adenocarcinomas. It is one of the three major malignant tumors of the female reproductive system, with a peak age of 58-61 years old. It accounts for about 7% of the total female cancer index and 25% of female reproductive tract malignant tumors. The incidence has been on the rise in recent years, approaching or even exceeding that of cervical cancer.

How does endometrial cancer metastasize?

1. Direct spread

At the beginning, the cancer spreads along the endometrium, upward through the uterine horn to the fallopian tube, downward to the cervical canal, and continues to spread to the vagina. It can also infiltrate through the muscle layer to the uterine serosa and extend to the fallopian tube and ovary. It can also be widely implanted in the pelvic peritoneum, rectouterine pouch and greater omentum.

2. Lymphatic metastasis

It is the main metastatic pathway of endometrial cancer. When the tumor infiltrates into the deep muscle layer, or spreads to the cervical canal, or the cancer tissue is poorly differentiated, lymphatic metastasis is likely to occur. Its metastatic pathway is related to the location of the cancer growth. The cancer lesions at the fundus of the uterus spread along the lymphatic network of the upper part of the broad ligament, through the pelvic infundibulocytic ligament to the ovaries. Upward to the para-aortic lymph nodes. The cancer lesions in the uterine cornu extend along the round ligament to the inguinal lymph nodes. The cancer lesions in the lower uterine segment and cervical canal have the same lymphatic metastasis pathway as cervical cancer, and can spread to the paracervical, internal iliac, external iliac, and common iliac lymph nodes. The cancer lesions on the posterior wall of the uterus can spread along the uterosacral ligament to the rectal lymph nodes. Endometrial cancer can also spread to the front of the uterus to the bladder, and drain to the anterior wall of the vagina through retrograde drainage.

3. Hematogenous metastasis

Less common. In the late stage, it metastasizes to the lungs, liver, bones, etc. through the blood.