Endometrial cancer may spread as follows: From the surface of the uterine cavity to the cervical canal Through the myometrium to the serosa and into the peritoneal cavity Via the lumen of the fallopian tube to the ovary, broad ligament, and peritoneal surfaces Via the bloodstream, leading to distant metastases Via the lymphatics The higher (more undifferentiated) the grade of the tumor, the greater the likelihood of deep myometrial invasion, pelvic or para-aortic lymph node metastases, or extrauterine spread.