Do the lymph nodes have to be affected in order for a metastis to occur or can you have mets without node involvement?

There are different kinds of mets. Some are local, into surrounding tissues, some are regional, such as to the cervical nodes, and others are distant. Depending on the location of the primary, and the earliness of discovery, this can change radically. Primary lesions located in the posterior of the mouth tend to move more quickly into the cervical nodes, but anterior lesions can also do so just not as quickly. While cervical mets are the most common pathway of spread, invasive cancers can move deeply into surrounding tissues and involve the circulatory system, which can also allow for distant spread of the disease. Cervical node involvement is the predominant pathway of spread, but with caner, there are few absolutes.