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In a series of 76 patients with carcinoma of the tongue the occurrence of metastasis was related to the size and histological features of the primary tumour. 64% of patients with metastasis and 10% of patients with clinically negative neck showed spread beyond the node capsule. Fast tracks (long lymphatic pathways uninterrupted by nodes) seemed to be involved in the spread of metastatic cancer in at least 20% of patients with metastasis. With surgery and adjuvant radiotherapy based on the pathological stage, metastases confined to lymph nodes did not appear to affect short-term outcome.