0:04

Neck cancer as well, comes with big neck mass.

0:08

Right. Biopsy come back. Squamous cell carcinoma.

0:14

Right. They're sending for staging

0:15

and also hoping that we can identify the primary site.

0:20

We know a lot of time these patients are, um, based

0:24

with the tongue primary or consular primary.

0:27

We know that, but sometimes, like this case,

0:31

we couldn't identify the primary site.

0:33

Right. Did we? I don't think we did.

0:40

So these are, um, patients.

0:43

It's, we, we know that some patients will come.

0:46

We have unknown primary sites.

0:51

It's usually a lot of them are head, neck cancer.

0:53

The other entity that we have unknown, uh,

0:56

primary is the melanoma sometimes comes, um,

1:00

the static disease with unknown primary

1:03

and um, with, uh, patient comes.

1:06

Um, and um,

1:11

we still do not know where is the primary site

1:13

ambitions are treated.

1:15

Um, for um, all the like for

1:21

extended extended time.

1:23

And we never really, we, we really never

1:26

identified the primary site.

1:32

Yeah, I was just confirming that.

1:34

I I as a, as far, okay,

1:36

other thing I wanna show you here is this.

1:38

You see this here for collectivity here

1:40

and it's in the, it's a, it's a, um, oops, sorry.

1:50

It isogenic disease. This here, which is here. Yeah.

1:56

What I, I on this see

2:02

and sometimes you see this

2:03

and there's a small lymph node that is hypermetabolic

2:05

and you know this is reactive inflammatory just

2:07

because there's vision has a autogenic disease,

2:09

a root canal or something.

2:11

So just don't over pull it. Right.

2:14

So this is a, they come for two reasons.

2:18

One for, um, hoping that we can identify the primary 'cause.

2:21

FDG is very good in that a lot

2:22

of time we do identify the primary,

2:24

but I, they wanted a case of unknown primary where we,

2:28

we can't because sometimes we cannot identify the primary.

2:31

Sometimes we can identify a primary that nothing,

2:34

nobody else can, but sometimes we cannot.

2:37

Um, and also it's good for staging.

2:39

So the staging is that we have this big lymph node,

2:42

few other smaller lymph nodes like this one here

2:48

and um, two B lymph node.

2:50

Uh, right. And then what is the more important?

2:54

The more important is that nothing else, right?

2:58

Noticed distant disease. I tried to pick

3:02

for you guys cases that are simple, not complicated.

3:07

When you start working in, um, pet reading,

3:11

more pet depends also on

3:14

where are you reading really In private centers usually get

3:18

the simple cases you work.

3:21

If you're working on a university,

3:23

usually we get more complicated cases here, see the torso

3:28

simply nice and nothing, no evidence of disease.

3:32

So it just, uh, know the disease in the neck and that's it.

3:35

Know the standards. Okay.

3:37

So we stage the case for them as well.

3:41

So know that a lot of time we can help

3:44

finding the primary side,

3:46

but sometimes you cannot find the primary side.

3:48

There are theories about that.

3:49

There are theories about the immune system

3:52

that the primary side is small, the static to a lymph node,

3:54

then the immune system takes care of the primary side,

3:58

but the lymph nodes start growing there.

4:01

There there's a, a theory about that.

4:03

Um, why some cancers, we find the static disease,

4:07

but we never really find the primary side, stuff like that.

4:10

There are some theories about this because it's a dilemma.

4:13

Dilemma. Oncology word.