spread of cervical carcinoma
1-The main pathways for the spread of invasive cervical cancer consist of the following: (1) microscopic spread into the vaginal mucosa beyond a visible or palpable tumor; (2) extension into the endometrium or myometrium of the corpus; (3) direct extension into the parametrium and, in advanced stages, into the adjacent structures; and (4) spread into the regional pelvic lymph nodes and, potentially, into the retroperitoneal, inguinal, or thoracic lymph nodes.
2-The extrauterine spread of cervical cancer occurs primarily by means of direct extension and lymphatic invasion that initially affects the contiguous tissues in the region of the laterally positioned cardinal ligament. Later, the tumor may involve the anterior or posterior parametrium, which are separated from the cervix by the pubovesicocervical fascia. The lateral paracervical and parametrial regions are more vulnerable to tumor invasion than the anterior and posterior parametrium because of the lack of a protective fascial covering at the lateral regions and because of the natural lymphatic drainage through the lateral paracervical tissues into the cardinal ligaments.
3-The local spread of cervical cancer may progress through the parametrium to involve the ureters and, eventually, the pelvic sidewalls. In some patients, the sciatic plexus is involved. Hydronephrosis, pyelonephritis, and renal failure are common complications of progressive disease. Involvement of the urinary bladder and rectum can occur in advanced cases because of direct tumor extension or subsequent to invasion of the vesicouterine or uterosacral ligaments, respectively. A vesicovaginal fistula or rectovaginal fistula may or may not develop. A tumor that extends through the posterior aspect of the cervix or corpus infrequently leads to intraperitoneal spread. Adnexal metastases are uncommon intheearlystages of the disease.
4-Lymphatic tumor spread usually occurs in a fairly orderly pattern or sequence that first involves the regional paracervical and parametrial lymph nodes and then the internal and external iliac lymph nodes. This may then be followed by spread to the common iliac nodes, the para-aortic nodes, and eventually the supraclavicular nodes via the thoracic duct. Metastasis to the para-aortic lymph nodes without involvement of pelvic lymph nodes is unusual.
5-Hematogenous tumor spread may be a result of a lymphatic venous anastomosis or direct venous invasion. The most common sites of hematogenous metastases are the lungs, bones, and liver.

http://emedicine.medscape.com/article/402329-media