OnCo
Cancers & treatments· Atlas

Where cancers spread

Metastatic patterns for 26 cancers. Where a cancer goes decides which scans are done at staging and follow-up, and which symptoms to take seriously. Arrow weight follows how often a site is involved across autopsy and registry series; the sources are listed under each map.

Cervical cancer5 sites
  1. Pelvic and para-aortic lymph nodesmost common
  2. Lungscommon
  3. Bonecommon
  4. Liverless common
  5. Peritoneumless common
Sources: 12
Colorectal cancer6 sites
  1. Livermost common
  2. Lungscommon
  3. Peritoneumcommon
  4. Distant lymph nodescommon
  5. Boneless common
  6. Brainrare
  • Liver: Portal venous drainage sends colon cancer to the liver first; resectable liver metastases can be cured
  • Lungs: Rectal cancers reach the lung more often than colon cancers (systemic venous drainage)
  • Peritoneum: Commoner in right-sided and mucinous tumours
Sources: 123
Endometrial cancer6 sites
  1. Pelvic and para-aortic lymph nodesmost common
  2. Vagina (local recurrence)common
  3. Peritoneumcommon
  4. Lungscommon
  5. Liverless common
  6. Boneless common
  • Peritoneum: Serous and carcinosarcoma histologies behave like ovarian cancer
Sources: 12
Gastric & gastro-oesophageal junction cancer6 sites
  1. Peritoneummost common
  2. Livermost common
  3. Distant lymph nodescommon
  4. Lungsless common
  5. Ovaries (Krukenberg tumour)less common
  6. Boneless common
  • Peritoneum: Diffuse-type tumours seed the peritoneum; staging laparoscopy looks for it
  • Liver: Intestinal-type tumours favour the liver
Sources: 12
Glioma & glioblastoma3 sites
  1. Elsewhere in the brain (white matter tracts, corpus callosum)most common
  2. Spinal cord and leptomeningesless common
  3. Outside the nervous systemrare
  • Elsewhere in the brain (white matter tracts, corpus callosum): Infiltrates along white matter; recurrence is usually within 2 cm of the original site
  • Outside the nervous system: Extracranial metastasis is exceptional; lymph node spread does not occur because the brain has no conventional lymphatics
Sources: 1
Head and neck squamous cell carcinoma5 sites
  1. Cervical lymph nodes (levels I-V)most common
  2. Lungscommon
  3. Boneless common
  4. Liverless common
  5. Distant lymph nodesless common
  • Cervical lymph nodes (levels I-V): Neck node status is the main prognostic factor and decides neck dissection or radiotherapy
  • Lungs: The commonest distant site; also where second primary cancers from smoking appear
Sources: 12
Hepatocellular carcinoma6 sites
  1. Elsewhere in the liver and portal veinmost common
  2. Lungscommon
  3. Regional lymph nodescommon
  4. Bonecommon
  5. Adrenal glandsless common
  6. Peritoneumless common
  • Elsewhere in the liver and portal vein: Intrahepatic spread and portal vein invasion dominate and drive staging
Sources: 12
HER2-positive breast cancer5 sites
  1. Bonemost common
  2. Livercommon
  3. Lungscommon
  4. Braincommon
  5. Distant lymph nodescommon
  • Brain: Brain metastases occur in a large share of patients over the disease course; CNS activity of newer anti-HER2 drugs matters
Sources: 12
HR-positive / HER2-negative breast cancer6 sites
  1. Bonemost common
  2. Livercommon
  3. Lungs and pleuracommon
  4. Distant lymph nodescommon
  5. Brainless common
  6. Ovaries and peritoneum (lobular)rare
  • Bone: 65-75% of patients with advanced disease develop bone metastases. Often the first and only site for years
  • Ovaries and peritoneum (lobular): Invasive lobular carcinoma favours serosal and gynaecological sites
Sources: 123
Melanoma7 sites
  1. Skin and soft tissue (in-transit, satellite)most common
  2. Regional then distant lymph nodesmost common
  3. Lungscommon
  4. Livercommon
  5. Braincommon
  6. Boneless common
  7. Small bowelless common
  • Liver: Uveal melanoma spreads almost exclusively to the liver
  • Brain: One of the cancers most likely to reach the brain; brain MRI is part of stage IV staging
Sources: 12
Mesothelioma5 sites
  1. Pleura and chest wall (local spread)most common
  2. Other lungcommon
  3. Peritoneumcommon
  4. Liverless common
  5. Bonerare
  • Pleura and chest wall (local spread): Grows along the pleura and into the chest wall and diaphragm; distant spread is late
Sources: 1
Multiple myeloma3 sites
  1. Bone (lytic lesions: spine, skull, ribs, pelvis)most common
  2. Soft tissue plasmacytomasless common
  3. Blood (plasma cell leukaemia)rare
  • Bone (lytic lesions: spine, skull, ribs, pelvis): Myeloma is a marrow cancer; bone lesions are part of the disease definition (CRAB criteria), not metastases in the usual sense
Sources: 1
Neuroblastoma (paediatric)5 sites
  1. Bone marrowmost common
  2. Bone (skull, orbit, long bones)most common
  3. Lymph nodescommon
  4. Livercommon
  5. Orbit and skinless common
  • Bone marrow: Marrow involvement defines stage M; MIBG scans and marrow biopsies are part of staging
  • Liver: Massive liver involvement in infants (stage MS) can regress on its own
  • Orbit and skin: Periorbital bruising (raccoon eyes) and blue skin nodules in infants
Sources: 1
Neuroendocrine tumours5 sites
  1. Livermost common
  2. Mesenteric and distant lymph nodescommon
  3. Bonecommon
  4. Peritoneumless common
  5. Lungsless common
  • Liver: Liver metastases drive carcinoid syndrome; SSTR PET maps them and Lu-177 dotatate treats them
Sources: 1
Non-small-cell lung cancer6 sites
  1. Other lung and pleuramost common
  2. Bonemost common
  3. Braincommon
  4. Livercommon
  5. Adrenal glandscommon
  6. Distant lymph nodescommon
  • Brain: Adenocarcinoma and EGFR- or ALK-driven tumours spread to the brain often; brain MRI is part of staging
Sources: 123
Oesophageal cancer6 sites
  1. Livermost common
  2. Distant lymph nodesmost common
  3. Lungscommon
  4. Bonecommon
  5. Adrenal glandsless common
  6. Brainrare
Sources: 12
Ovarian cancer6 sites
  1. Peritoneum and omentummost common
  2. Pleura (malignant effusion)common
  3. Liver surface, then parenchymacommon
  4. Retroperitoneal lymph nodescommon
  5. Lungsless common
  6. Brainrare
  • Peritoneum and omentum: Spreads by shedding cells into the abdominal cavity rather than through the blood; ascites is common
Sources: 1
Pancreatic ductal adenocarcinoma5 sites
  1. Livermost common
  2. Peritoneumcommon
  3. Lungscommon
  4. Distant lymph nodescommon
  5. Boneless common
  • Liver: Most patients with metastatic disease have liver involvement
  • Lungs: Lung-only spread carries a better prognosis
Sources: 123
Prostate cancer5 sites
  1. Bone (spine, pelvis, ribs)most common
  2. Distant lymph nodescommon
  3. Liverless common
  4. Lungsless common
  5. Brainrare
  • Bone (spine, pelvis, ribs): 65-75% of patients with advanced disease develop bone metastases. Typically bone-forming (sclerotic) lesions; PSMA PET finds them early
  • Liver: Liver spread marks aggressive, often neuroendocrine-like disease
Sources: 123
Renal cell carcinoma7 sites
  1. Lungsmost common
  2. Bonecommon
  3. Distant lymph nodescommon
  4. Livercommon
  5. Adrenal glandsless common
  6. Brainless common
  7. Pancreas and thyroid (late, unusual sites)rare
  • Bone: Bone-destroying (lytic) lesions
  • Pancreas and thyroid (late, unusual sites): Renal cell carcinoma is known for late spread to odd sites years after nephrectomy
Sources: 12
Sarcomas (soft tissue, bone, GIST)4 sites
  1. Lungsmost common
  2. Boneless common
  3. Liver (GIST, leiomyosarcoma of the gut)less common
  4. Lymph nodesrare
  • Lungs: Sarcomas spread through the blood almost exclusively to the lungs; lung metastasectomy is standard
  • Lymph nodes: Except epithelioid, synovial, rhabdomyosarcoma and clear cell subtypes
Sources: 1
Small-cell lung cancer5 sites
  1. Brainmost common
  2. Livermost common
  3. Bone and marrowcommon
  4. Adrenal glandscommon
  5. Distant lymph nodescommon
  • Brain: About half of patients without prophylactic cranial irradiation develop brain metastases within 3 years. The reason cranial irradiation or MRI surveillance follows a response
Sources: 123
Thyroid cancer5 sites
  1. Cervical lymph nodesmost common
  2. Lungscommon
  3. Bonecommon
  4. Brainrare
  5. Liverrare
  • Cervical lymph nodes: Papillary cancer spreads to neck nodes early and often, with little effect on survival
  • Lungs: Follicular cancer favours blood-borne spread to lung and bone
Sources: 1
Triple-negative breast cancer (TNBC)5 sites
  1. Lungsmost common
  2. Braincommon
  3. Livercommon
  4. Bonecommon
  5. Distant lymph nodescommon
  • Lungs: Visceral spread earlier and more often than in HR-positive disease
  • Brain: Higher brain-metastasis rate than other breast subtypes
Sources: 123

Tiers summarise several series (Disibio and French 2008 autopsy study; Budczies et al. 2015; Riihimäki et al. 2014-2018 Swedish registry studies; Coleman 2006 for bone). Frequencies differ between series taken at diagnosis and at autopsy, so only figures stated in a source are quoted as numbers.