Figure 1.

Peritoneal dissemination is established through a multistep process. There are two different processes for the attachment of peritoneal free cancer cells on the peritoneum. (A) Trans‐mesothelial process (steps 1–6): step 1, detachment from serosa; step 2, adhesion to mesothelial cells; step 3, contraction of mesothelial cells and submesothelial basement membrane; step 4, adhesion to submesothelial basement membrane; step 5, invasion of cancer cells into submesothelial tissue; step 6, vascular neogenesis, lymphangiogenesis and lymphatic dilatation. (B) Trans‐lymphatic metastasis process (steps 1–3′ or 3″): step 3′, exposure of lymphatic stomata or lymphatic orifices; step 3″, invasion through lymphatic stomata.