12th May 2024

A 57-year-old woman presents with abdominal distension, bloating, and early satiety over the last four months.

A 57-year-old woman presents with abdominal distension, bloating, and early satiety over the last four months. Her medical history is notable for a BRCA1 gene mutation. Abdominal examination reveals ascites, and a pelvic ultrasound shows a complex mass in the right ovary. CA-125 levels are elevated, and a biopsy during laparotomy confirms high-grade serous carcinoma. CT imaging indicates peritoneal implants throughout the abdomen.

Which is the most likely route by which this tumour spread throughout the peritoneal cavity?