[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Neoplasia](https://durgical.com/en/general-pathology/#a-neoplasia) › Pathways of spread and the usual metastatic sites

[General pathology](https://durgical.com/en/general-pathology/) · [Neoplasia](https://durgical.com/en/general-pathology/#a-neoplasia)

# 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

## Key points

- Seeding of cavities: ovarian carcinoma over the peritoneum (ascites, omental cake).
- Lymphatic: typical of carcinomas; the sentinel node is the first node draining the tumour (breast, melanoma).
- Haematogenous: typical of sarcomas; carcinomas that invade veins: renal cell (renal vein), hepatocellular (portal and hepatic veins), follicular thyroid, choriocarcinoma.
- Liver and lungs are the most common sites of blood-borne metastases; metastases outnumber primary tumours in liver, lung, bone and brain.
- Prostate cancer to the spine through the valveless vertebral venous plexus; its bone metastases are typically osteoblastic.
- Left supraclavicular (Virchow) node: abdominal cancer, classically gastric; Krukenberg tumour: gastric signet-ring cells in the ovaries.

## 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](https://durgical.com/en/conditions/ovarian-cancer/) | Peritoneal seeding | Peritoneum, omentum (ascites) |
| [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/) | Venous plexus, blood, lymph | Spine and pelvis (osteoblastic), nodes |
| [Osteosarcoma](https://durgical.com/en/conditions/osteosarcoma/) | Blood | Lungs |
| [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/) | Renal vein, blood | Lung, bone (lytic), brain |
| [Gastric adenocarcinoma](https://durgical.com/en/conditions/gastric-cancer/) | Lymph, peritoneum, portal blood | Nodes (Virchow), liver, ovaries (Krukenberg) |
| [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) | Lymph, blood | Axillary nodes, bone, lung, liver, brain |
| [Lung cancer](https://durgical.com/en/conditions/lung-cancer/) | Lymph, blood | Brain, bone, adrenals, liver |
| [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/) | Lymph, portal blood | Nodes, liver, then lungs |
| [Melanoma](https://durgical.com/en/conditions/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.

## Memory aid

Carcinomas take the lymph bus, sarcomas take the blood taxi, ovarian cancer just walks across the peritoneal floor.

## 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.

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## Related

- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/)
- [Benign vs malignant tumours: the comparison table](https://durgical.com/en/general-pathology/benign-vs-malignant-tumours-the-comparison-table/)
- [Local effects of tumours and cancer cachexia](https://durgical.com/en/general-pathology/local-effects-of-tumours-and-cancer-cachexia/)

## Related conditions

- [Ovarian cancer](https://durgical.com/en/conditions/ovarian-cancer/)
- [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/)
- [Osteosarcoma](https://durgical.com/en/conditions/osteosarcoma/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Gastric cancer](https://durgical.com/en/conditions/gastric-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Follicular, oncocytic (Hürthle cell) and anaplastic thyroid carcinoma](https://durgical.com/en/conditions/follicular-oncocytic-and-anaplastic-thyroid-carcinoma/)
- [Gestational trophoblastic neoplasia (choriocarcinoma)](https://durgical.com/en/conditions/gestational-trophoblastic-neoplasia/)
- [Carcinoma of unknown primary](https://durgical.com/en/conditions/carcinoma-of-unknown-primary/)
- [Hypercalcaemia of malignancy](https://durgical.com/en/conditions/hypercalcaemia-of-malignancy/)

## Elsewhere in DurgiPedia

- [How the lymphatic system works](https://durgical.com/en/physiology/how-the-lymphatic-system-works/)
- [Lymph node and spleen under the microscope](https://durgical.com/en/histology/lymph-node-and-spleen-under-the-microscope/)
- [Serous membranes: pleura and peritoneum](https://durgical.com/en/histology/serous-membranes-pleura-and-peritoneum/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.cancer.gov/types/metastatic-cancer) (National Cancer Institute (NCI), 2026); [Gastric Cancer](https://www.ncbi.nlm.nih.gov/books/NBK459142/) (StatPearls (NCBI Bookshelf), 2026); [What Is Cancer?](https://www.cancer.gov/about-cancer/understanding/what-is-cancer) (National Cancer Institute (NCI), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/