The first is through the peritoneum; the second is through the axillary, inguinal and paraaortic lymph nodes; the third is venous, spread through the anastomoses between the umbilical veins and the epigastric, lateral thoracic or internal mammary veins. Additionally, a venous spread can be through the anastomoses between the umbilical veins and the portal vein, if there is hepatopathy.