The Prairie Doc Perspective
A Brush with the Occult
• Here rises a tale of mystery dealing with the occult.
• An 80 something year old gentleman, came into my office a few months ago with a new lump on his neck. It didn't hurt; he had no sores in his mouth;

and he noted nothing else unusual, except that he had been recently widowed and he missed his wife terribly.
•  On exam there was a hard lump behind his ear and jaw measuring about the shape and size of an olive. My initial exam of ear canals, hearing, nasal passages, mouth, tongue, and throat found him to be normal. His voice was clear and there were no palpable irregularities of the trachea, which was positioned midline in his neck.
• I sent him to the Ears-Nose-and-Throat (ENT) specialist to take a direct look with a scope at the back of the nose, throat, vocal cords, and to remove or biopsy the lump. The scope exam was clear but after the biopsy of the lump, the microscopic exam brought the diagnosis of metastatic squamous cell carcinoma of the head and neck, with occult primary.
• In other words his cancer started from skin-like thin sheets of cells that commonly line the upper airways, and the term "occult" is medical lingo for a cancer that has spread from another site but the original "primary" site remains a mystery. I re

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