Figure 1.

Main pathways regarding peritoneal metastasis. In ovarian cancer (OC), three steps are described as fundamental to the establishment of peritoneal metastasis. The first is an anatomical feature, the fact that there is an absence of an anatomical barrier protecting the ovary epithelium within the abdominal cavity. The second is that peritoneal fluid serves as a metastatic milieu for cell propagation through immune surveillance, resistance to anoikis, and the formation of spheroids. Finally, the modulation of the immune system in the tumor microenvironment (TME). The TME directly modulates the immune system in its favor through four steps: release of inflammatory cytokines, angiogenesis, the extensive and unregulated proliferation of extracellular matrix (ECM), and finally, angiogenesis to the benefit of neoplastic cells.