Can endometrial cancer metastasize?

1. Most endometrial cancers grow slowly and are confined to the endometrium or in the uterine cavity for a long time. Some special pathological types, such as serous carcinoma, clear cell carcinoma, carcinosarcoma and high-grade endometrioid carcinoma, can develop very quickly and metastasize in a short period of time. The main metastatic pathways are direct spread, lymphatic metastasis and hematogenous metastasis.

2. Direct spread: In the early stage, the cancer spreads along the endometrium, and can spread to the fallopian tubes along the uterine horns, and can affect the cervical canal and vagina. If the cancer infiltrates the muscle wall, it can penetrate the uterine muscle layer, affect the uterine serosa, and implant in the pelvic peritoneum, rectouterine pouch, and greater omentum.

3. Lymphatic metastasis is the main metastatic pathway of endometrial cancer. When the tumor involves the deep myometrium of the uterus, the cervical stroma or is of high grade, lymphatic metastasis is likely to occur. The metastatic pathway is related to the site of tumor growth: cancer lesions at the fundus of the uterus often metastasize to the para-aortic lymph nodes along the upper lymphatic network of the broad ligament through the pelvic infundibulum ligament. Lesions in the uterine horns or upper anterior wall metastasize to the inguinal lymph nodes along the round ligament lymphatic vessels. The lymphatic metastasis pathway of cancer lesions in the lower uterine segment or that have involved the cervical canal is the same as that of cervical cancer, and may involve the paracervical, obturator, internal iliac, extrailiac and common cervical lymph nodes. Cancer lesions on the posterior wall of the uterus can metastasize to the pararectal lymph nodes along the uterosacral ligament. About 10% of endometrial cancers involve the anterior vaginal wall via retrograde drainage of the lymphatic vessels.

4. Hematogenous metastasis: In late stage patients, the disease metastasizes to various organs throughout the body through the blood, with the most common sites being the lungs, liver, bones, etc.