Table 3 Summary table of local, nodal and haematogenous spread in colorectal cancer

Local spread

•Invasion through the bowel wall into the peri-colonic fat and adjacent structures

Lymph node spread

•Follows the vascular distribution of vessels in mesocolon;

•Ascending mesocolon: nodes along the ileocolic vessels and right colic vessel;

•Transverse mesocolon: nodes along the middle colic vessels;

•Sigmoid and descending mesocolon: nodes along the inferior mesenteric vein;

•Regional lymph nodes for rectal cancers include: mesorectal, sigmoid mesenteric, inferior mesenteric, lateral sacral, presacral, internal iliac, sacral promontory, superior rectal, middle rectal and inferior rectal

Haematogenous spread

•Liver (via the portal vein) > lung, adrenal glands, bones

Notes

•In rectal cancers that have perforated the peritoneum, transcoelomic spread favours the lower right small bowel mesentery and the pouch of Douglas