TGF-alpha has been previously suggested as a marker of poor outcome at follow-up and specifically for lymph node metastasis [21], whether this is linked to hypoxia is yet to be seen but this kind of change in the bulk of the tumour may explain how HIF1-alpha induction by hypoxia in the primary tumour can increase metastasis even though this recurrence often happens many years after removal of the primary tumour. The gene discussed is TGFA; the disease is neoplasm.