Liver and kidneys are other places SCC can show up, as far as distant metastesis is concerned. Tumors send out thousands of cancer cells every day into the bloodstream. The bodys immune system typically takes them out (if you are immunocompromised, such as AIDS patients, you are in deep trouble). These cells need a place where they can "stick" and that is typically where transistions in the blood occur, kidneys, liver, lungs, etc. H&N tumors can also pass through the respiratory system so there is also a risk of esophogeal and lung cancer from that aspect as well. The brain is so close that metastesis there is also a possibility. Brain cancer is more problematical because of the "blood/brain barrier" which prevents chemo drugs from entering into the brain. Brain involvement would be classified as either a local or locoregional metastesis. Brain mets from OC are relatively rare.

Some here have refered to a nodal involement as a metastesis but more than likely a positive lymph node is a result of the primary (BOT or tonsil for example) and is actually secondary to it so it's technically not a metastesis. Nodal involvement always bumps the staging up to III or IV, incidentally. Cancer can also be spread through the lymphatic system (which is interconnected throughout the body) so that's why ND's are performed if lymph node involvement is suspected. Cancers can also spread through the spinal cord and that is the most dangerous condition. It's like the cancer is on the freeway and spreads everywhere. If a doctor suspcts that he will order a bone scan performed. Fortunately we do not see that much with H&N cancer

Distant metastesis is what makes me lose sleep at night (well, truth be told, I don't dwell on it that much anymore) - hardly anyone gets screened for that. At least the critical areas of the brain are included in a typical H&N MRI or CT scan. Distant mets may not show up for years after the primary has been treated - or you have have an entirely unrelated cancer so who knows? My mother had breast cancer, melenoma and cervical cancer and none of them were related.

As far as the lungs go, the NCCN guidelines recommend an annual chest x-ray. A spiral CT is the best lung scan but has a LOT more radiation, so I wouldn't recommend an annual one - even if the doctors would order one.

There are many other factors in this very complex topic - tumor type, differenation, time in place, etc.

This is really more of a academic discussion rather than directed to a specific situation. You can literally drive yourself crazy examining all of the technical possibilities (that may well never happen). My advice - take it one day at a time and stay in the "now". The future belongs to God.