Background: Cancer of the oral tongue is the second most common cancer among males in various parts of India. Despite advances in diagnosis and treatment the failure rates in cancer of the oral tongue are high and survival poor. Majority of these failures occur in untreated neck. Method: A retrospective review of the records of 75 patients undergoing surgery for the treatment of squamous cell carcinoma of the oral tongue was carried out to ascertain the pattern of metastasis in the neck and to evaluate the sensitivity of clinical examination in predicting nodal spread. Results: All the patients underwent primary surgery. Cervical lymph node metastasis was found in 35.6% of T1 and T2 tumours and 62.35% of T3 and T4 tumours. Sensitivity of clinical examination was found to be 54.5% and specificity of 61.9%. Level II was the most commonly involved (63.6%). Isolated level IV involvement was never found in clinically negative neck. Tumour stage and node status were found to have a significant impact on disease free survival in both univariate and multivariate analysis. Conclusions: As the sensitivity and specificity of the clinical examination is low we suggest that methods like ultrasound or CT Scan of the neck should be regularly employed to improve the sensitivity and specificity of the examination. Furthermore as isolated level IV involvement is never found in our series, we suggest that a prophylactic supraomohyoid neck dissection should be carried out in all patients with a clinically node negative neck with cancer of oral tongue, to achieve a better disease free survival. Introduction Squamous cell carcinoma of the tongue is a common malignancy treated by surgeons. Incidence of tongue cancer in India is second highest in the world. Among males the age adjusted incidence rate is as high as 14/100,000 per/year in Ahmedabad while among females it is 7.4/ 100,000 in Mumbai . In Trivandrum the incidence of tongue cancer is 5.2/ 100,000 among males and 2.4/ 100,000 among females . Published: 03 July 2003 World Journal of Surgical Oncology 2003, 1:10 Received: 16 January 2003 Accepted: 03 July 2003 This article is available from: http://www.wjso.com/content/1/1/10 © 2003 Nithya et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.