Pathways of spread and the usual metastatic sites !
- Topic
Cancers spread through three routes: across body cavities, through lymphatics and through blood. Each cancer has favourite destinations.
Updated 2026-11-01
What it is
Malignant tumours spread by seeding of body cavities, by lymphatic spread and by haematogenous spread. As a rule carcinomas favour lymphatics and sarcomas favour blood, but there are important exceptions. Knowing the usual sites explains many presentations: bone pain in prostate cancer, ascites in ovarian cancer, a Virchow node in gastric cancer.
Key facts
- Portal blood carries gastrointestinal tumour cells first to the liver; caval blood carries cells to the lungs first.
- The brain receives metastases mostly from lung, breast, melanoma, kidney and colon.
- Bone metastases are mostly lytic (kidney, lung, thyroid); prostate gives blastic lesions and breast often mixed ones.
- Lymph node enlargement near a cancer may be reactive hyperplasia, not metastasis: only histology decides.
- Seeding can also happen along a needle tract or a surgical wound, which is why some biopsies are planned carefully.
Where common cancers go
| Primary | Main route | Usual sites |
|---|---|---|
| Ovarian carcinoma | Peritoneal seeding | Peritoneum, omentum (ascites) |
| Prostate cancer | Venous plexus, blood, lymph | Spine and pelvis (osteoblastic), nodes |
| Osteosarcoma | Blood | Lungs |
| Renal cell carcinoma | Renal vein, blood | Lung, bone (lytic), brain |
| Gastric adenocarcinoma | Lymph, peritoneum, portal blood | Nodes (Virchow), liver, ovaries (Krukenberg) |
| Breast cancer | Lymph, blood | Axillary nodes, bone, lung, liver, brain |
| Lung cancer | Lymph, blood | Brain, bone, adrenals, liver |
| Colorectal cancer | Lymph, portal blood | Nodes, liver, then lungs |
| Melanoma | Lymph, blood | Nodes, skin, lung, liver, brain |
Clinical notes
- Sentinel node biopsy stages the axilla in breast cancer and the regional basin in melanoma with less morbidity than full dissection.
- Lytic bone metastases can cause hypercalcaemia and pathological fractures.
- In Colombia, gastric cancer is common and often diagnosed late, when nodal and peritoneal spread are already present.
Test yourself
Think of the answer, then tap the question to see it.
Which carcinomas characteristically spread through veins?
Renal cell carcinoma (renal vein), hepatocellular carcinoma (portal and hepatic veins), follicular thyroid carcinoma and choriocarcinoma.
What is a Krukenberg tumour?
Bilateral ovarian metastases of signet-ring adenocarcinoma, most often from the stomach.
Why does prostate cancer reach the vertebrae so often?
Through the valveless vertebral venous plexus (Batson plexus) and the bone environment that favours its growth; the lesions are usually osteoblastic.
Where does osteosarcoma metastasise first?
To the lungs, through the bloodstream, like most sarcomas.
Related
- Invasion and metastasis: the metastatic cascade, step by step
- Grading and staging: what TNM means
- Benign vs malignant tumours: the comparison table
- Local effects of tumours and cancer cachexia
Related conditions
- Ovarian cancer
- Prostate cancer
- Osteosarcoma
- Renal cell carcinoma
- Gastric cancer
- Breast cancer
- Lung cancer
- Melanoma
- Hepatocellular carcinoma
- Colorectal cancer
- Follicular, oncocytic (Hürthle cell) and anaplastic thyroid carcinoma
- Gestational trophoblastic neoplasia (choriocarcinoma)
- Carcinoma of unknown primary
- Hypercalcaemia of malignancy
Elsewhere in DurgiPedia
- How the lymphatic system works
- Lymph node and spleen under the microscope
- Serous membranes: pleura and peritoneum
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Metastatic Cancer: When Cancer Spreads (National Cancer Institute (NCI), 2026); Gastric Cancer (StatPearls (NCBI Bookshelf), 2026); What Is Cancer? (National Cancer Institute (NCI), 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.