12th May 2024

A 63-year-old woman presents with abnormal uterine bleeding, pelvic pressure, and a history of unexplained weight loss.

A 63-year-old woman presents with abnormal uterine bleeding, pelvic pressure, and a history of unexplained weight loss. She has a personal history of unopposed oestrogen therapy and a family history suggestive of hereditary nonpolyposis colorectal cancer (HNPCC). An MRI of the pelvis reveals a mass confined to the uterus with suspected invasion into the cervical stroma. A biopsy of the lesion confirms high-grade endometrial carcinoma.

Which is the most likely route by which this tumour spread to the cervical stroma?