It is said that liver cancer is a “Chinese specialty cancer”, indeed, as a major hepatitis country, the population of liver cancer is also huge, nearly half of the world’s liver cancer are in China. The liver is a “silent organ” and the nerves around it are not sensitive, so even if problems occur, they are hard to be detected. As a result, liver cancer is often found to be in the middle to late stage and metastasis has occurred. In turn, metastasis is an important factor affecting the prognosis of liver cancer. Let’s take a look at how advanced liver cancer metastasizes to other organs and which organs are the common metastatic sites of liver cancer? Studies have found that more than 85% of liver cancer patients will develop metastasis. There are two ways of cancer metastasis, namely intrahepatic metastasis and extrahepatic metastasis. There are four types of metastasis: direct spread, trans-lymphatic metastasis, trans-bloodstream metastasis and implantation metastasis. The most common way of metastasis for liver cancer is through bloodstream metastasis, followed by lymphatic metastasis. 1. Intrahepatic metastasis: hematogenous metastasis is the earliest and most common metastasis of hepatocellular carcinoma. After cancer cells invade the intrahepatic blood sinusoid, they can invade the portal vein and hepatic vein branches. The invasion of portal vein becomes cancer thrombus, which can cause intrahepatic dissemination. The main trunk of portal vein can lead to deterioration of liver function, portal hypertension and intractable ascites after cancer embolism. (2) Extrahepatic metastasis: (1) Hematogenous metastasis: Hematogenous metastasis is common in hepatocellular liver cancer, which can be seen in lung, bone, adrenal gland, diaphragm, peritoneum, stomach, kidney, brain, spleen and mediastinum. Among them, lung metastasis is the most common, accounting for about 49.2% of the total metastases, and early lung metastases are often asymptomatic. Cough, blood in sputum, chest tightness and shortness of breath are often advanced. Bone metastases are commonly found in the vertebrae, iliac bones, femur and ribs. (2) Lymphatic metastasis: lymphatic metastasis is the most common in cholangiocarcinoma, mainly in hilar, perihepatic, peripancreatic and retroperitoneal lymph nodes. Among them, metastasis from hilar lymph nodes is the most common, accounting for about 12.6% of total metastases. 3) Direct spread: Rarely, hepatocellular carcinoma can spread and infiltrate into adjacent organs and tissues directly, and even penetrate the stomach wall and diaphragm, leading to gastric perforation and pleural effusion. (4) Implantation metastasis: Occasionally, implantation in the abdominal cavity can form abdominal mass, implantation in the peritoneum can form ascites, and in women, implantation in the ovaries is possible. Finally, it should be reminded that liver cancer is prone to metastasis, and the metastasis rate still reaches more than 60% within 5 years after radical treatment. Patients with metastasis and recurrence should not take it lightly, and regular monitoring and review is very necessary.