Mechanisms of Metastasis in Colorectal Cancer and Metastatic Organotropism: Hematogenous versus Peritoneal Spread

Figure 3

Development of peritoneal carcinomatosis: (1) detachment of colorectal cancer cells from their primary tumor and gain of motility, (2) anoikis evasion, (3) adherence to peritoneal surface, (4) invasion into peritoneum, and (5) proliferation and formation of peritoneal metastasis. Several adhesion molecules have been identified to be crucial in the adhesion process to the peritoneal surface, including integrins, proteoglycans, mucins, and members of the immunoglobulin superfamily. A multitude of cells and factors are involved in the process of invasion including peritoneal macrophages (PMs), peritoneal mesothelial cells (PMCs), peritoneal fibroblasts (PFBs), and subperitoneal fibroblasts (SPFs). Factors that have been identified to play a role in peritoneal carcinomatosis in CRC are highlighted red.