DISTANT visceral metastasis occurs relatively infrequently in squamous cell carcinoma of the head and neck. Local involvement rather than spread below the clavicles is in part explained by the role of cervical lymphatics as temporary barriers between the primary tumor and the rest of the body. Distant spread therefore has in the past been viewed as blood-borne metastasis. However, search of the available literature yields several articles dealing with the problems of cervicomediastinal tumor extension, the suggested rationale for which lies in the anatomic communications between the cervical and mediastinal lymphatics at the base of the neck. The possibility of a purely lymphatic route is anatomically reasonable and finds additional support by recent in vivo dye-injection studies of cervical lymphatics following subclavian vein ligation in rabbits and cats.1 A case of far-advanced nasopharyngeal carcinoma is reported which demonstrates cervicomediastinal extension of tumor with invasion of the pulmonary hilar parenchyma.