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

From: Common primary tumours of the abdomen and pelvis and their patterns of tumour spread as seen on multi-detector computed tomography

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