Ana, to address you question, I don't have specifics to point at other than to say these distant mets do occur. The real question in my mind is the terminology. Are these really metastasis of the original disease, which would mean essentially incomplete primary treatment because they were too small to be found at the time the patient was declared NED, or are the secondary primaries. I've had a secondary primary early on, and it was a brand new disease not a continuation of my old one. Given these data are drawn from hospitals with widely varying protocols for treatment, there is bias in much of this. It could be that some protocols are just not as effective as others, and really do not get everything (that is an over simplification but the idea is correct), But all cancers have the potential to metastasis and oral cancers actually for the most part must do so to kill. They involve finally going to a vital organ most often the lungs and there is where they bring people to the end of their journey. So while kidney is not seen as often as the lungs, it can happen anywhere. Also remember that besides primary treatment there is so much that can be involved in whether or not a patient will develop a DM, not the least of which is that their genetic make up and body's immune ability is not uniform among all people.