14.07.2015

Ovarian cancer treatment guidelines australia

Ovarian cancer remains the leading cause of gynecologic malignancy mortality in the United States and is fourth overall in women behind lung, breast and colorectal cancer. The 1994 National Institutes of Health (NIH) Consensus Conference on ovarian cancer concluded that there is no effective method for screening and detecting early ovarian cancer. The usual symptomatology associated with ovarian malignancies is that of advanced disease: abdominal pain, bloating, increasing abdominal girth, general digestive disturbances, abdominal and pelvic discomfort, and, at times, uterine bleeding. It has been estimated that routine pelvic examination will detect only 1 case of ovarian carcinoma in 10,000 asymptomatic women examined.
The evaluation of presenting symptoms of the pelvic mass would include other gynecologic disorders, such as leiomyomata, tubo-ovarian abscesses, endometriomas, gastrointestinal disorders, such as diverticular disease and neoplasia, and, rarely, urologic disorders, such as a pelvic kidney. Alpha-fetoprotein (AFP) is elevated in most endodermal sinus tumors, embryonal cell carcinomas, or mixed germ cell tumors containing these elements and is useful not only in their diagnosis but in evaluating therapeutic response.Human chorionic gonadotropin (hCG) is elevated in patients with nongestational ovarian choriocarcinoma and may also be elevated in patients with dysgerminoma and embryonal cell carcinoma. Lactate dehydrogenase (LDH) may be of potential value in patients with ovarian dysgerminoma.
Carcinoembryonic antigen (CEA) levels, although not specific for ovarian tumors, are sometimes found to be elevated in patients with mucinous ovarian tumors, and, hence, serial levels may prognosticate the clinical course, with rising values preceding clinical disease. CA-125 is known to be elevated in more than 80% of patients with epithelial ovarian malignancies, especially serous. Radionuclide imaging utilizes radioisotopes chelated to antibodies directed against tumor-specific antigens. Diagnostic paracentesis is generally not considered of definitive value since patients with ovarian malignant ascites will not always demonstrate malignant cells in diagnostic specimens. Laparoscopy is helpful in evaluating patients with ovarian enlargement that is not well defined on pelvic examination and ill defined radiographically.
Appropriate determination of stage, or the extent of disease at the time of diagnosis, is of critical importance in the management of epithelial ovarian cancer, since both treatment and prognosis are strongly dependent on stage. Unlike many other human malignancies, the staging system for ovarian cancer is based on the results of a properly performed surgical procedure, together with the results of clinical and histopathologic evaluations.
Appropriate determination of the stage of disease in patients with ovarian cancer requires a properly performed surgical procedure. A complete and systematic exploration of the abdominal cavity from the diaphragms to the pelvic floor must be performed, and any suspicious areas biopsied. Surgery should include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, except in selected patients with a well-differentiated tumor limited to one ovary, in whom it may be possible to preserve reproductive potential. A thorough preoperative discussion with the patient about the risks of staging laparotomy and her wishes regarding future childbearing are critical in surgical planning for ovarian cancer.
A gynecologic oncologist, if available, should be consulted regarding the appropriate procedures and participate in the surgical staging. The DOXIL® dose may be reduced or delayed to help manage adverse reactions such as hematologic toxicities, hand-foot syndrome, and stomatitis. DOXIL® is contraindicated in patients who have a history of severe hypersensitivity reactions, including anaphylaxis, to doxorubicin HCl.
Cardiomyopathy: Doxorubicin HCl can result in myocardial damage, including acute left ventricular failure. Most common adverse reactions observed with DOXIL® (>20%) are asthenia, fatigue, fever, anorexia, nausea, vomiting, stomatitis, diarrhea, constipation, hand-foot syndrome, rash, neutropenia, thrombocytopenia, and anemia. DOXIL®(doxorubicin HCl liposome injection) is indicated for the treatment of patients with ovarian cancer whose disease has progressed or recurred after platinum-based chemotherapy. DOXIL® is indicated for the treatment of AIDS-related Kaposi's sarcoma in patients after failure of prior systemic chemotherapy or intolerance to such therapy. This site is published by Janssen Products, LP which is solely responsible for its contents. Hormones called insulin and glucagon, which help your body control blood sugar levels, are made in special cells in the pancreas called islet cells.
Because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery.
When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used.
Patients whose tumor cannot be totally removed, but who have a blockage of the tubes that transport bile (biliary obstruction) must have that blockage relieved. Managing pain and other symptoms is an important part of treating advanced pancreatic cancer. Chemotherapy and radiation are often given after surgery to increase the cure rate (this is called adjuvant therapy). Testicular cancer is cancer that starts in the testicles, the male reproductive glands located in the scrotum. White men are more likely than African-American and Asian-American men to develop this type of cancer. Seminoma: This is a slow-growing form of testicular cancer usually found in men in their 30s and 40s. Nonseminoma: This more common type of testicular cancer tends to grow more quickly than seminomas.
Symptoms in other parts of the body, such as the lungs, abdomen, pelvis, back, or brain, may also occur if the cancer has spread. An examination of the tissue is usually done after the entire testicle is surgically removed. Once cancer is found, the first step is to determine the type of cancer cell by examining it under a microscope. Surgical treatment removes the testicle (orchiectomy) and may also remove nearby lymph nodes (lymphadenectomy).
Radiation therapy using high-dose x-rays or other high-energy rays may be used after surgery to prevent the tumor from returning.
Joining a support group where members share common experiences and problems can often help the stress of illness. The survival rate for men with early-stage seminoma the least aggressive type of testicular cancer  is greater than 95%.
If you are of childbearing age, ask your doctor about methods to save your sperm for use at a later date.
The United States Preventive Services Task Force recommends against routine screening for testicular cancer because there is no known effective screening technique. In a little over half of the cases, this mutation develops in a child whose family has never had eye cancer.
The eye may need to be removed (a procedure called enucleation) if the tumor does not respond to other treatments. If the cancer has spread beyond the eye, the likelihood of a cure is lower and depends on how the tumor has spread. Call your health care provider if signs or symptoms of retinoblastoma are present, especially if your child's eyes look abnormal or appear abnormal in photographs.
A vaginal tumor is an abnormal growth of tissue in the vagina, a female reproductive organ. Most cancerous vaginal tumors occur when another cancer, such as cervical or endometrial cancer, spreads. Women whose mothers took diethylstilbestrol DES, which was prescribed to prevent miscarriages during the first 3 months of pregnancy are at increased risk for developing adenocarcinoma. Sarcoma botryoides of the vagina is a rare type of cancer that mainly occurs in infancy and early childhood. Anaplastic carcinoma (also called giant and spindle cell cancer) is the most dangerous form of thyroid cancer. Medullary carcinoma is a cancer of non-thyroid cells that are normally present in the thyroid gland.
Papillary carcinoma is the most common type, and it usually affects women of childbearing age. Patients who are treated for thyroid cancer must take thyroid hormone pills for the rest of their lives.
If the cancer does not respond to surgery or radiation and has spread to other parts of the body, chemotherapy may be used. Sometimes, people with strong family histories and genetic mutations related to thyroid cancer will have their thyroid gland removed for preventive purposes.
Radiotherapy, also known as radiation treatment, is the controlled use of high energy X-rays to treat many different types of cancer.
The length of each course of radiotherapy will depend on the size and type of cancer and where it is in the body.
Radiotherapy is sometimes used to treat thyroid disease, as well as some blood disorders and other benign conditions. Radiotherapy is usually given as a course of treatment that lasts for a number of days or weeks. Most people who have radiotherapy to treat a serious condition, such as cancer, have five treatments a week (one treatment a day, Monday to Friday) with a break at the weekend. Radiation treatment is divided into a number of small doses called fractions, which are usually given over a number of weeks.
Radiotherapy is often used in combination with other treatments, such as chemotherapy (powerful medication that is used to treat cancer). Chemoradiotherapy can be used to try to cure a cancerous tumour, to shrink a tumour before it is removed using surgery, or after surgery to reduce the risk of relapse. Some skin conditions that affect the penis can go on to develop into cancer if they are left untreated. The first signs of penile cancer are often a change in colour of the skin and skin thickening.
Sometimes the cancers appear as flat growths, which are bluish-brown in colour, or as a red rash, or small crusty bumps. Your GP will examine you and refer you to a hospital specialist for expert advice and treatment.
The specialist will examine the whole of the penis and your groin to feel for any swellings. If the biopsy shows that you have cancer, your doctor will refer you to a specialist centre, which may be some distance from your home.
The doctors at the centre will usually do some further tests to check whether or not the cancer has spread.
The results of these tests will help the specialist to decide on the best type of treatment for you.
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. If you have any enlarged lymph nodes in the groin, your doctor may put a needle into the node to get a sample of cells (biopsy).


The stage of a cancer is a term used to describe its size and whether or not it has spread beyond its original site in the body. Stage 1 describes a cancer at an early stage when it's usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Number stages may also be further subdivided to give more detailed information about tumour size and spread.
In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. Your treatment will be carried out in the specialist centre that you have been referred to. The type of treatment you are given will depend on a number of things, including the position and size of the cancer, its grade, whether or not it has spread and your general health. Before you agree to any treatment, your specialist will talk to you about the possible side effects and how to deal with them. Small, surface cancers that have not spread are treated by removing only the affected area and a small area around it. If the cancer is affecting only the foreskin, it may be possible to treat it with circumcision alone.
If the cancer has spread over a wider area, you will need to have an operation known as a wide local excision. The surgeon may also remove a small number of lymph nodes from your groin to find out if the cancer has spread.
You will need to stay in hospital for about five days and have the wound dressed regularly for up to a fortnight. It may be possible to have a penis reconstructed after amputation (if there are no signs that the cancer has spread anywhere else in the body). Sometimes it is also possible for surgeons to reconnect some of the nerves in order to provide sensation and the necessary blood flow to allow the reconstructed penis to become erect. It used to be a common treatment for small cancers of the head of the penis glans, but nowadays it is used less often today because of improvements in surgery.
However, radiotherapy may be used to treat affected lymph nodes in the groin to help reduce the risk of the cancer spreading. It may also be given to treat symptoms such as pain, if the cancer has spread to other parts of the body like the bones. Radiotherapy is normally given as a series of short daily treatments in the hospital's radiotherapy department.
Before each session of radiotherapy, the radiographer will position you carefully on the couch and make sure that you are comfortable. Radiotherapy is not painful, but you do have to lie still for a few minutes while your treatment is being given.
Long-term, the side effects of radiotherapy can cause thickening and stiffening of healthy tissues (fibrosis). Chemotherapy may also be given as tablets, or by injection into a vein for more advanced cancer.
After your treatment is completed, you will have regular check-ups and possibly scans or x-rays.
Everyone has their own way of coping with difficult situations; some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. It can help to talk to your partner about how you are feeling, and about the changes in your relationship. Ovarian cancer is the fifth most common cancer among women, and it causes more deaths than any other type of female reproductive cancer.
Women who take estrogen replacement only (not with progesterone) for 5 years or more seem to have a higher risk of ovarian cancer. Surgery such as a pelvic laparoscopy or exploratory laparotomy may be done to evaluate symptoms and perform a biopsy to help make the diagnosis.
No lab or imaging test has ever been shown to be able to screen for or diagnose ovarian cancer in its early stages.
Surgery performed by a specialist in female reproductive cancer has been shown to result in a higher success rate. Your doctor may also order a computed tomography (CT) scan of your chest, abdomen, and pelvic area and a chest x-ray. Call for an appointment with your health care provider if you are a woman over 40 years old who has not recently had a pelvic examination.
Removal of the ovaries and tubes in women who have a mutation in the BRCA1 and BRCA2 genes may reduce the risk of developing ovarian cancer, although ovarian cancer may still develop in other areas of the pelvis.
Medulloblastomas are tumors located in the cerebellum, the part of the brain that controls balance and other complex motor functions.
They grow most often in the central part of the cerebellum, and less frequently in the outer parts of the cerebellum.
Medulloblastoma is the most common malignant (cancerous) central nervous system tumor in children. Medulloblastomas occur most commonly in children between ages of 3 and 8 but can be seen in children and adults of any age. The outcome for children with medulloblastoma has improved dramatically over the past several decades. Our team provides a unique degree of specialization across many disciplines, which translates into advanced treatment options for patients with medulloblastoma and other brain tumors. Learn more about our Pediatric Brain Tumors Program, where we care for children with benign and malignant brain and spinal tumors.
As shown on the figure, the regions of high incidence (dark red) are Eastern and South-Eastern Asia, and Middle and Western Africa. A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group.
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Although significant advances have been made in the evaluation and treatment of ovarian cancer, the overall long-term survival has not changed significantly during the past 20 years. It is noted that all are essentially nonspecific and, once present, are most often associated with spread of malignancy throughout the abdominal cavity with involvement of the visceral and parietal peritoneal surfaces. Although the character of a mass found at the time of examination is not diagnostic, a unilateral, cystic mass that is mobile and less than 10 cm in diameter is more consistent with a benign process when compared to the solid, bilateral, fixed and larger lesion with cul-de-sac nodularity. CA-125 measurements may be useful in following the response to therapy and the presence of persistent or recurrent disease in women who had an elevation at the time of known disease.
Although a promising research technique, its role in the diagnosis of preclinical disease and its usefulness in the follow-up of patients with disease is still under evaluation.
Paracentesis can, however, be performed in the selected patient to evaluate cirrhosis as an etiology for ascites or to relieve symptoms.
Its role in the evaluation of patients with persistent symptomatology and negative diagnostic evaluation has been shown as well. Historically, inadequate assessment of stage has been a major problem in the management of patients with ovarian cancer.
The current staging system of the International Federation of Gynecology and Obstetrics (FIGO) is shown in Table 1. Surgery generally involves exploratory laparotomy through a vertical abdominal incision to allow access to the upper abdomen.
In patients who appear grossly to have stage I or stage II disease, an infracolic omentectomy and sampling of aortic and pelvic lymph nodes are mandatory for complete staging. A supracervical hysterectomy may be indicated in the presence of extensive carcinomatosis in the cul-de-sac. The surgical goal should be optimal cytoreduction to less than 1 to 2 cm to optimize response to chemotherapy. Studies in the United States and abroad have shown that ovarian cancer patients staged by a gynecologic oncologist have significantly smaller residual disease and improved survival compared to those operated on by nongynecologic oncologists.
See additional information on Infusion-Related Reactions in Warnings and Precautions below. The risk of cardiomyopathy with doxorubicin HCl is generally proportional to the cumulative exposure. Based on HFS toxicity grade, dose reduction, delay in administration, or discontinuation of DOXIL® may be required. This site is intended for use by healthcare professionals of the United States and Puerto Rico. Palliative care tams and hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.
However, in more than 80% of patients the tumor has already spread and cannot be completely removed at the time of diagnosis. For pancreatic cancer that cannot be removed completely with surgery, or cancer that has spread beyond the pancreas, a cure is not possible and the average survival is usually less than 1 year.
When the health care provider holds a flashlight up to the scrotum, the light does not pass through the lump. This treatment has greatly improved survival for patients with both seminomas and nonseminomas.
The disease-free survival rate for Stage II and III cancers is slightly lower, depending on the size of the tumor and when treatment is begun. This recommendation does not apply if there is a personal history of an undescended testicle. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology:Testicular cancer. If the mutation runs in the family, there is a 50% chance that an affected person's children will also have the mutation. A cure, however, may require aggressive treatment and even removal of the eye in order to be successful.
It is especially important when more than one family member has had the disease, or if the retinoblastoma occurs in both eyes. It is much less common in men who have had all or part of their foreskin removed (been circumcised) soon after birth. If you notice white patches, red scaly patches, or red moist patches of skin on your penis, it's important to see your doctor so that you can get any treatment that you need. Later symptoms include a growth or sore on the penis, especially on the glans (head of the penis) or foreskin, but also sometimes on the shaft of the penis. Like most cancers, penile cancer is easiest to treat if it is diagnosed early, so if you have any worries it is best to go to your doctor straight away.


To make a firm diagnosis, the doctor will take a sample of tissue (a biopsy) from any sore or abnormal areas on the penis. Knowing the particular type and stage of the cancer helps the doctors decide on the most appropriate treatment for you. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.
They might use words like ‘early’ or ‘local’ if the cancer hasn't spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. In high-grade tumours, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
This will either be a hospital with a surgeon who specialises in treating penile cancer or a cancer treatment centre.
With advances in surgical techniques, it's usually possible to preserve the penis or to reconstruct it surgically.
They may be done under local or general anaesthetic, depending on individual circumstances. If the nodes in your groin are obviously enlarged you will usually have all the nodes in your groin removed (radical groin dissection).
In this situation it is possible to give back a normal appearance by using skin from somewhere else in the body (skin graft). Amputation may be partial (where part of the penis is removed) or total (removal of the whole penis).
This may be when someone is not well enough to have an operation or doesn't want to have surgery. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully from the next room. The treatment won't make you radioactive and it is perfectly safe for you to be around other people, including children, after your treatment.
The skin on your penis may become sore during your treatment and for a period of time afterwards. In some men, this can result in a narrowing of the tube that carries urine through the penis (the urethra) and so can cause difficulty in passing urine. Your doctor must discuss the treatment with you so that you have full understanding of the trial and what it involves.
These are all normal reactions, and are part of the process many people go through in trying to come to terms with their illness. This can be very difficult and you may need to get help from a specialist nurse or counsellor. The more children a woman has and the earlier in life she gives birth, the lower her risk for ovarian cancer. Women with a personal history of breast cancer or a family history of breast or ovarian cancer have an increased risk for ovarian cancer. Screening women with pelvic ultrasound or blood tests, such as the Ca-125 has not been found to be effective and is not recommended. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Ovarian Cancer. Prophylactic and risk-reducing bilateral salpingo-oophorectomy: recommendations based on risk of ovarian cancer.
If you would like to view summary information about brain tumors first, see the overview on brain tumors. Therefore, we are happy to announce that there is a new Guide for Patients available on our website: A Guide for Patients with Liver Cancer. Lower rates (light pink) are observed in developed regions, with the exception of Southern Europe where the incidence in men is significantly higher than in other developed regions.
Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. In this guide, you can find, amongst other information, the diagnosis procedure, an enumeration of possible causes of the disease and treatment options, as well as some valuable advice to help patients and relatives cope with the diagnosis and treatment.
You can find an overview of publications in which are the Anticancer Fund or the the website are mentioned here. More than 70% of women have their disease diagnosed in advanced stages (III or IV) and have a 5-year survival less than 30%. When ascites or upper abdominal metastatic disease is present, bloating, heartburn, diminished appetite, nausea, and generalized discomfort are often the case. Other physical findings are those that would be expected with the presence of abdominal disease, chiefly, ascites or a ballottable omental mass. While CT may not detect the presence of a gastrointestinal tract primary as well as barium enema or colonoscopy, the preoperative identification of parenchymal liver metastases, suprarenal lymphadenopathy, or extensive mesenteric disease by CT may influence the degree of intraoperative cytoreductive efforts. Uncomplicated ovarian cysts satisfying benign criteria may be managed laparoscopically in selected cases.
Peritoneal washings or ascites are obtained for cytologic analysis upon entering the abdomen. In these early stages, random peritoneal biopsies should also be performed from multiples areas, including the pelvis, pericolic gutters, and diaphragms. Prior use of other anthracyclines or anthracenediones should be included in calculations of total cumulative dosage. The relationship between cumulative DOXIL® dose and the risk of cardiac toxicity has not been determined.
Ensure that medications to treat infusion-related reactions and cardiopulmonary resuscitative equipment is available for immediate use prior to initiation of DOXIL®. Patients should be examined at regular intervals for the presence of oral ulceration or any oral discomfort that may be indicative of secondary oral cancer.
Advise females and males of reproductive potential to use effective contraception during and for 6 months after treatment with DOXIL®.
Janssen Products, LP recognizes that the Internet is a global communications medium; however, laws, regulatory requirements, and medical practices for pharmaceutical products vary from country to country. If the doctor suspects that the cancer has spread to lymph nodes in the neck, these will also be removed. This is because men who have not been circumcised may find it more difficult to pull back the foreskin enough to clean thoroughly underneath. This will be done under an anaesthetic (local or general) so that the procedure is painless. The system is made up of a network of lymph nodes (also known as lymph glands), which are linked by fine ducts containing lymph fluid. CT scans use a small amount of radiation, which is very unlikely to harm you and won't harm anyone you come into contact with. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
This border of healthy tissue is important as it reduces the risk of the cancer coming back in the future.
The techniques that may be used include taking skin and muscle from your arm and using this to make a new penis. Staff at the radiotherapy department will be able to give advice on how to look after your skin in the area being treated. If narrowing of the urethra does develop, it can usually be helped by an operation to stretch (dilate) the area. Before any trial is allowed to take place, an ethics committee must have approved it and agreed that it is in the interest of the patients. If you have any problems, or notice any new symptoms between these appointments, let your doctor know as soon as possible. Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal).
This Guide has been written by Reliable Cancer Therapies (RCT) and is based on the ESMO guidelines. Because of such grim statistics, effective secondary methods of treatment or preferably preventive approaches must be developed.
Stage I and lower pelvic disease may be detected by palpation of an asymptomatic mass or be associated with pelvic pressure and urinary frequency. Benign conditions, such as uterine fibroids, endometriosis, or inflammatory or infectious processes, produce CA-125 elevations that limit the specificity of this tumor marker.
Its role in the actual management of malignancy without laparotomy, however, remains controversial and under evaluation. The risk of cardiomyopathy may be increased at lower cumulative doses in patients with prior mediastinal irradiation. The Prescribing Information included here may not be appropriate for use outside the United States and Puerto Rico.
The operation is usually carried out under a general anaesthetic and will involve a short stay in hospital. This is done by passing a tube into the urethra and is performed under a general anaesthetic. Chemotherapy cream may sometimes be used to treat very small, early cancers that are confined to the foreskin and end of the penis (glans). Your GP, hospital doctor, or one of our cancer support specialists can usually put you in touch with a counsellor or specialist nurse.
The use of diagnostic laparoscopy in the face of ascites or suspicious disease results in unnecessary anesthesia, morbidity, expense, and delay in initiating definitive therapy. MUGA or echocardiogram) prior to initiation of DOXIL®, during treatment to detect acute changes, and after treatment to detect delayed cardiotoxicity.
In the event of an infusion-related reaction, temporarily stop the drug until resolution then resume at a reduced infusion rate.
The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for early cancer will usually last up to six weeks.
We’ve provided answers to many questions like these in the following pages, and our expert pediatric subspecialists can explain your child’s condition fully when you meet with us. Administer DOXIL® to patients with a history of cardiovascular disease only when the potential benefit of treatment outweighs the risk.
Discontinue DOXIL® infusion for serious or life-threatening infusion-related reactions.



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