The records of 256 patients with nasopharyngeal carcinoma have been reviewed to determine the incidence and location of distant metastases. Sixty-three patients underwent autopsy. The incidence of distant metastases was 36% overall, and 51% in the autopsy patients. Bones, distant lymphnodes, liver, and lungs were the most common sites of distant metastases. Liver was the most common site in the autopsy patients. Compared to other major histological subtypes, undifferentiated carcinoma had the highest incidence of bone but lowest incidence of lung metastases. There was a strong correlation between advanced locoregional disease and distant metastases. Of those patients who developed distant metastases, 98% were discovered within 3 years or earlier. Thorough evaluation of the above organs/systems is indicated at the time of initial staging work-up and at follow-up, specifically for patients with advanced locoregional disease. A literature review of distant metastases in nasopharyngeal carcinoma is presented.