May 2011 Archives

A new study published May 31 in the Journal of Clinical Oncology reports that beta-blocker use is associated with improved relapse-free survival in all patients with breast cancer, including those with triple-negative breast cancer (TNBC), a particularly aggressive form of the disease.

Previous epidemiological research has shown that breast cancer is potentially more likely to recur in the context of chronic stress and that beta-blockers -- a class of drugs that help in diminishing the effects of the stress pathway by blocking adrenergic stimulation -- may improve breast cancer relapse. These drugs are often used for cardioprotection after heart attacks and to control cardiac arrhythmias and hypertension.

This collaborative study led by Amal Melhem-Bertrandt, M.D., an assistant professor in the Department of Breast Medical Oncology at MD Anderson, found that the use of beta-blockers in patients with breast cancer was associated with an approximately 50% reduction in breast cancer relapse after three years when compared to patients who were not on beta-blockers. The associated improvement in three-year overall survival in the beta-blocker group, although not significant, was approximately 35%..

MD Anderson is partnering with the Von Hippel Lindau (VHL) Family Alliance to host the 2011 VHL national meeting on June 18 at MD Anderson's Dan L. Duncan Building.

The meeting is open to patients, family members and health care providers involved in the treatment of Von Hippel Lindau disease. Experts from the National Institutes of Health, MD Anderson and around the country will discuss recent advances in VHL therapy. Attendees are encouraged to arrive the night before so that they can meet the speakers in an informal setting.

Von Hippel Lindau disease is an inherited mutation of the VHL gene, which causes tumors to form in areas of the body that contain large numbers of blood vessels. VHL affects one in every 32,000 children born in the United States.

A mutation of the VHL gene can affect several organs of the body and can be expressed differently in every patient and every family.

It's crucial that patients and families living with Von Hippel Lindau disease have their care coordinated by a team of doctors and counselors with expertise in the various aspects of their care. Proper genetic testing, appropriate screening and appropriately timed therapies are all important aspects of any treatment plan for VHL.

prom.jpgBy Val Marshall

Val Marshall's cancer journey began in May 2009 when her son Addison was diagnosed with acute lymphocytic leukemia. A visit to the family doctor for what they thought was a simple high school football injury turned out to be so much more.

Inspired by her son's strength and hope, Val strives to be a voice to help connect other parents on this journey. Her series shares insight into her life as a mom of a typical teenager who just happens to be fighting leukemia.

Addison Marshall Crush Cancer

Get on your dancing shoes, Addie!

That was the "shout out" from the nurses' station last week when Addie was given the all-clear to attend prom.

The "village" at MD Anderson hovered more than PTA moms chaperoning a first date. He was hydrated, poked and prodded for three days. Every member of his medical team helped get his white cells up before the limo arrived on Saturday.

One of the most conservative of oncologists asked Addie how he received the elongated bruise on his arm. His reply, "Bow fishing Saturday night." Wrong answer, try again.

When Dr. N asked about the scratch on his eyelid, Addie explained, "Well, you know, when you grease a watermelon and throw it in a pool and your team has to get it to the other side of the pool?" Wrong answer, try again.

Dr. N politely explained how low his blood counts were and the seriousness of being sick with a possible virus, while battling the symptoms of chemo. I thought it was very professional of him to remain stern until leaving the bedside before shaking his head and chuckling, "Oh, Addison, my boy."

Mendelsohn1.jpgLast year, MD Anderson President John Mendelsohn, M.D., proposed 10 steps that can be taken to ensure cancer deaths decrease more rapidly, the ranks of survivors swell, and an even greater number of cancers are prevented in the first place.

This is the seventh in a series of posts on key actions outlined by Mendelsohn:

7. Increase funding for research.

After growing by nearly 100% from 1998 to 2002, the National Cancer Institute (NCI) budget has been in decline the past four years.

Through budget cuts and the effects of inflation, the NCI budget has lost approximately 12% of its purchasing power. Important programs in tobacco control, cancer survivorship and support for interdisciplinary research have had significant cuts.

by Clay Fulcher

In April, the U.S. Food and Drug Administration approved the use of vandetanib for the treatment of medullary thyroid cancer. Clay Fulcher, a patient of Mimi Hu, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders, participated in the clinical trial of vandetanib at MD Anderson. Fulcher shares his experience.

The first indication that something might be amiss was in 2007.

I was supporting NASA's Hubble Space Telescope program at Johnson Space Center (JSC) in Houston. I was required to have an annual Air Force physical as a scuba diver during astronaut crew training in JSC's Neutral Buoyancy Laboratory.

During my physical, the flight surgeon detected a small lump on my neck and recommended that I see my private physician about it.

Several years earlier, I saw Dr. Ehab Hanna at MD Anderson's Head and Neck Center. At that time, he provided advice and options on dealing with, what turned out to be, a benign growth in my mouth. I contacted his office immediately and received an appointment.

Dr. Hanna quickly determined the source of the swelling was thyroid cancer. He recommended, without undue delay, surgery followed by six weeks of radiation. The post-operative pathology reported the tumor was sporadic medullary thyroid cancer, which had metastasized.

My life changed forever that day.

The Body Image Therapy Service (BITS) at MD Anderson is a program designed to help patients adjust to body image- and appearance-related changes resulting from cancer and its treatment. This service is available to patients being seen in the Center for Reconstructive Surgery and Head and Neck Center.

michellefingeret.jpgMichelle Cororve Fingeret, Ph.D., assistant professor in MD Anderson's departments of Behavioral Science, Head and Neck Surgery and Plastic Surgery, answers questions about the BITS program and how survivors can work to improve their body image.

How does the program address each survivor's body image issues?
It's a very individualized program for patients. I meet with each patient one-on-one. When they come into the therapy program, I first try to understand what kinds of body image concerns they are having and how these issues are impacting their lives.

Based on that information, I design a treatment plan that helps them become more accepting of their body changes and gets them back to doing activities they used to enjoy and have been avoiding.

I don't expect them to get to the point where they feel great about how they look. I want patients to understand that there are going to be aspects of their appearance they do not like and to be accepting of this fact. I also work to help patients focus on other aspects of their body and appearance that they appreciate and enjoy. The point is not to have body image concerns interfere with one's daily life.

By Lindsey Garner, MD Anderson Staff Writer

Angela Gass photo.jpg"At one point in my therapy, I came to a very big conclusion -- cancer had taken enough from me," Angela Gass says.

Now 36, she has spent 12 years fighting cancer, which claimed one-third of her tongue and three-fourths of her jaw, leading to body image issues.

"It had taken my ability to eat, speak clearly and be confident about my appearance," Gass says. "I decided that I wasn't going to let it take anything else. Instead of focusing on the things that I had lost, I put my energy into all the things that I am: a wife, mother, woman and survivor."

Understanding body image
"Body image is very subjective and personal. It is not just about physical appearance. Body image involves perceptions, feelings and thoughts about the entire body and its functioning," says Michelle Cororve Fingeret, Ph.D., assistant professor in MD Anderson's departments of Behavioral Science, Head and Neck Surgery and Plastic Surgery.

Cancer can affect body image by:

  • Changing physical appearance
  • Changing how the body functions
"A strong emotional component undercuts both the physical and functional body changes associated with cancer and its treatment," Fingeret says.

By Lindsey Garner, MD Anderson Staff Writer

rosemary.jpgParsley, sage, rosemary and thyme. To many, these spices are common recipe ingredients or lyrics from a popular 1960s Simon and Garfunkel song.

But research shows that these spices are much more than what they seem. They have the potential to prevent and treat cancer.

Bharat Aggarwal, Ph.D.
, professor in the Department of Experimental Therapeutics at MD Anderson, led a 2009 research study on the use of spices in cancer prevention and treatment. The study covers 41 common dietary spices, including one that shows promise in treating skin cancer -- rosemary.

Combating a common cancer
According to the Skin Cancer Foundation, skin cancer is the most common form of cancer in the United States, with more than 3.5 million cases diagnosed annually.

A 2006 study at the University of Rajasthan in Jaipur, India, tested rosmarinic acid (RosA), a phenolic compound in rosemary, on mice with stage II skin cancer. RosA was shown to suppress tumorigenesis, the formation of new tumors.

In addition, Aggarwal's study showed that rosemary, along with the other 40 spices studied, suppressed and blocked pro-inflammatory pathways in cancer cells. Inflammation is linked to common symptoms in cancer patients, such as depression, fatigue, neuropathic pain, metastases and tumor growth.

By Dean Lee, M.D., Ph.D., assistant professor, Pediatrics, Cell Therapy Section

dean anthony.jpgPediatric brain tumor research has made some important advances recently. Articles on pediatric brain cancers regarding genomic sequencing, hedgehog pathways, p53 degradation and EGFR signaling have shown up this year in a variety of respected scientific publications.

One editorial on this progress proclaimed "The Time Has Come for Many Things in Medulloblastoma." Translating those advances to clinically proven therapies is, as always, the hard part.

As you may have heard or seen, IBM's supercomputer, Watson, made an impressive showing recently on the "Jeopardy" game show, beating two previously undefeated champions. Watson was able to answer trivia questions by applying pattern recognition to analyze the question and sort it into key data components. Then, the computer quickly interrogated multiple large databases to select the most likely answer to that question.

Last week, the folks at IBM presented Watson to the public at a special seminar at Rice University with the explicit purpose of discussing the potential real-life applications of such computers.

By Lucy Richardson, MD Anderson staff writer

hand-massage2.jpgLymphedema is the accumulation of fluid in the body tissue. It occurs because the body is either producing too much fluid, or the lymphatic system is incapable of fully removing the fluid that is normally produced.

Cancer patients can develop lymphedema either from the cancer itself or as a side effect of the treatment.

It occurs commonly in women who have had breast cancer surgery with removal of lymph nodes, followed by radiation therapy. However, it is not uncommon for patients treated for prostate cancer, uterine cancer, bladder cancer, and even head and neck cancers to develop lymphedema.

Lymphedema can appear weeks, months or even years after the initial surgery. It may also occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.

mendelsohn6.jpgLast year, MD Anderson President John Mendelsohn, M.D., proposed 10 steps that can be taken to ensure cancer deaths decrease more rapidly, the ranks of survivors swell, and an even greater number of cancers are prevented in the first place.

This is the sixth in a series of posts on key actions outlined by Mendelsohn:

6. Accelerate the pace and improve the efficacy of clinical research.

Clinical trials are the essential step in moving research discoveries from the laboratory to patients with cancer. Clinical trials are complicated, lengthy and expensive, and they often require large numbers of patients.

Further steps must be taken to ensure that clinical trials are designed to measure the effects of new agents on the intended genetic and molecular targets, in addition to outcomes and toxicities.

By Milind Javle, M.D., associate professor, Department of Gastrointestinal (GI) Medical Oncology, MD Anderson
Cancer Center

Recently, a clinical trial published in the New England Journal of Medicine has offered new hope for patients suffering from pancreatic cancer.

This trial enrolled over 300 patients with advanced cancer of the pancreas, who were treated with either the standard chemotherapy with gemcitabine or with a four-drug chemotherapy combination called FOLFIRINOX.

A five-month improvement in survival was noted with FOLFIRINOX; this regimen also delayed cancer progression. This study is important because for the first time a drug combination has been shown to extend survival of pancreatic cancer patients by a significant degree over that offered by gemcitabine, alone.

By Laura Nathan-Garner and Ashley Davis, MD Anderson Staff Writters

focusedonheath.jpgAm I getting enough vitamin D? That's the question a lot of people are asking these days.

Well, here's some good news. In most cases, the answer is yes.

But take note: the recommended amount of vitamin D recently increased. The Food and Nutrition Board now suggests that most adults adult get 600 IUs (international units) of vitamin D each day instead the previous 400 IUs per day.

Why do we need vitamin D? Well, it's the main building block for maintaining bone health. Without it, you can develop thin and brittle bones. Vitamin D also can boost your immune system to help fight off germs, bacteria and diseases, including certain cancers.

How can you make sure you're getting your recommended fill of this vital nutrient?
Although you probably think of sunshine when you think of vitamin D, sitting out in the sun to get your vitamin D could actually increase your risk of skin cancer. So, MD Anderson experts suggest playing it safe and getting your daily dose of vitamin D through the foods you eat.

Scott Evans, M.D., turned his frustration into a finding.

All too often, Evans, an assistant professor in the Department of Pulmonary Medicine at MD Anderson, has seen leukemia patients experience pneumonia in their initial treatments. This is the case in at least 40% of leukemia patients he sees, and a large number of them don't survive it.

One patient, in particular, comes to mind.

A young East Texas man in his early 30s was responding well to his treatments, until he contracted pneumonia. Before long, he was in intensive care, where he died.

By: Will Fitzgerald, MD Anderson Staff Writer

On a bright and warm morning, several patients and designers from the MD Anderson Cancer Center Children's Art Project (CAP) traveled to the Houston Garden Center where they painted two new spring-time designs.  Complete with easels, plenty of colorful paint and inspiring surroundings, the children created a large red butterfly and a scene of beautiful tulips.

Program for 2011 copy.jpgMD Anderson Cancer Center and the National Brain Tumor Society are teaming up to present the Together in Hope Conference. This conference is designed to answer questions about the newest research on the causes and treatment of brain tumors, and strategies for dealing with issues faced by brain tumor patients, their loved ones and caregivers.

General sessions will highlight information on pathology, surgery, the latest treatment strategies, as well as complementary therapies and what current research advances can mean for future therapies.

Workshop sessions organized into four tracks will allow attendees to tailor the educational experience to their specific needs. A consulting room will be staffed by experienced health professionals for one-on-one sessions.

Participants also can refresh and refocus in support groups, or stop by the wellness room to experience massage therapy.

Caregiver Pam Epstein from Omaha, Neb., shares her experience with the last Together in Hope conference and talks about what she hopes to gain at this year's event.

mendelsohn4.jpgLast year, MD Anderson President John Mendelsohn, M.D., proposed 10 steps that can be taken to ensure cancer deaths decrease more rapidly, the ranks of survivors swell, and an even greater number of cancers are prevented in the first place.

This is the fifth in a series of posts on key actions outlined by Mendelsohn:

5. Train providers of cancer care and future researchers.

As baby boomers retire, current shortages in the supply of physicians, nurses and technically trained support staff needed to provide expert care for patients with cancer are projected to increase. This problem will be further exacerbated in three years, when nearly 40 million individuals are added to the insurance rolls.

DePinhoSmall.jpgThe University of Texas System Board of Regents today named Ronald A. DePinho, M.D., as the sole finalist for the presidency of MD Anderson Cancer Center.   

The board announced the decision during a meeting in which candidates were interviewed for the post. Each candidate recently met several constituent groups within the cancer center's community as part of a series of campus visits.

DePinho is the director of the Belfer Institute for Applied Cancer Science at the Dana-Farber Cancer Institute and professor of medicine (genetics) at Harvard Medical School. DePinho, a member of the Institute of Medicine of the National Academies and fellow of the American Academy of Arts and Sciences, previously held numerous faculty positions at the Albert Einstein College of Medicine in New York.

Read the full news release from The University of Texas System

Identifying, removing and analyzing a few select lymph nodes often tells the tale

newer.jpgA 38-year-old woman comes to her dermatologist with a mole on her right upper back that has begun to itch and bleed. Examination shows that the mole has irregular borders and varied coloration. A biopsy reveals that it's a melanoma, 2.8 mm deep and with ulceration. There were no clinical signs or symptoms indicating that the melanoma had metastasized. A surgical oncologist recommends wide excision of the primary tumor site and a sentinel lymph node biopsy.

This case, paraphrased, opens an invited article in the May 5 issue of the New England Journal of Medicine by two MD Anderson surgeons. It provides a clinical update on a surgical lymph node biopsy technique that facilitates evaluation of possible microscopic spread of melanoma and indicates who needs further treatment.

MD Anderson was one of the first institutions to use sentinel lymph node biopsy, 20 years ago for melanoma and expanding into other cancer types.

"Sentinel lymph node biopsy allows us to obtain more information in the setting of less invasive surgery than our historical approach," says Jeffrey Gershenwald, M.D., co-author with Merrick Ross, M.D., both professors in the Department of Surgical Oncology. "And this allows a more personalized approach to surgery for our patients."

After a long and successful career in broadcast journalism in Houston, North Texas and Oklahoma, Judy Overton joined MD Anderson in 2008 as a senior communications specialist. Her husband, Tom, was treated at MD Anderson for renal cancer. He died in April 2007. Judy's occasional posts will cover aspects of the cancer experience from the caregiver's perspective. Read more posts in this series

massage.jpgTom valiantly endured a second round of Interleukin 2 treatments shortly after New Year's Day 2005. After the second dose, he experienced extreme chills. Once, he threw up a smoothie a friend had brought him.

That day, I took a break and returned to find him in a dreamy state after a dose of Demerol. When I said, "You don't seem to be taking this as well this time," Tom snapped back, "Don't talk like that."

Care for the caregiver

Whether due to the pain or the painkillers, sharp comments like that sometimes threw me off balance.

And it's at such moments that I encourage caregivers to schedule some time for themselves.

By Michelle Moore, MD Anderson Staff Writter

After graduating from college, I found myself in what I call a "post-grad" crisis. It's the time in your life where you ask yourself things like "How can I make a difference?" and "What matters?" Those were the kinds of questions weighing on my mind before I came on board as an intern in the Communications Office at MD Anderson, 10 months ago.

Today, I am four months into my new position as an official employee at this institution. And, while the answers to these questions are constantly evolving, I am now very sure that I am on the right track.

70 years and counting

What was meant to be only a six-week summer internship turned into a six-month internship. Why? Because I simply fell in love with this outstanding institution and everything it represents.

I feel so honored to be celebrating MD Anderson's 70th year, in spite of the fact that this institution was established almost 50 years before I was even born.

It doesn't matter if you've been here 20 years or 20 days -- you can't help but feel a sense of pride in all that MD Anderson has done and continues to accomplish.

By Dana Lee, Proton Therapy Center Staff

mothersday.jpgIt's been more than nine months since Melanie Curtis has been back to her Cummings, Ga., home. She just happened to be visiting her daughter, Julie Estep, and her family in Birmingham, Ala., when she got some shocking news.

The 36-year-old mother of two had a brain tumor and needed immediate surgery to remove the pressure in her brain. That day marked the beginning of a journey they never imagined they would be taking -- mom and daughter fighting cancer hand-in-hand.

Julie seemed to be the picture of health. Even with two young boys, she found the time to eat healthy, visit the gym four to five times a week, and run marathons on the weekends. So when she began feeling migraine-like symptoms, she dismissed them as hormonal changes.

When the headaches persisted, she had an MRI, which revealed hydrocephalus, an abnormal accumulation of cerebrospinal fluid in the cavities of the brain. Julie was in surgery the very next day to relieve the pressure in her brain. Following surgery, she received the diagnosis: a rare pineal brain tumor.

Julie and her mother were overwhelmed by the diagnosis but they leapt into action, researching experts. Then they found MD Anderson.

mendelsohn3.jpgLast year, MD Anderson President John Mendelsohn, M.D., proposed 10 steps that can be taken to ensure cancer deaths decrease more rapidly, the ranks of survivors swell, and an even greater number of cancers are prevented in the first place.

This is the fourth in a series of posts on key actions outlined by Mendelsohn:

4. Address the needs of cancer survivors.

Today there are 11 million Americans who have survived cancer for more than five years -- either free of disease, or in some cases living with their disease under control.

How Are You?

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gail.jpgWhat do you say when someone asks you how you're doing? What's the correct way to respond? Do they really want to know or is this just a rhetorical question?

Most of us do this all the time. We pass colleagues in the hallway, we run into friends at the store, we see acquaintances at a meeting. It's just natural. We say, "How are you?"

But since I've been in treatment for cancer, I'm never quite sure how I should respond to this question. Do they really want to know or is this just polite chit chat?

Do they want me to tell them how I'm truly feeling -- that my latest medicine makes my legs hurt, that my feet ache and that I'm so very tired? Are they actually interested in the fact that my lips are chapped and that my skin feels stretched across my face?

gailpolo1.jpgPolo, which has been referred to as the "Game of Kings," was probably first played by nomadic warriors more than 2,000 years ago. Imagine what those warriors would have thought about the annual Polo on the Prairie tournament that has been played on the Musselman Brothers' Lazy 3 Ranch near Albany, Texas, for the past 25 years.

As a first-timer at the event, I was amazed at the entire spectacle. From Friday evening's delightful fish fry on a beautiful green lawn to the real-deal polo game and barbecue dinner on Saturday, Polo on the Prairie was a weekend of tradition for many supporters of MD Anderson.

This was a landmark year for Polo because it turned 25. Over the years, the event has spread the news of MD Anderson's top-rated patient care and research and has also honored those whose lives have been touched by cancer.

terry.jpgTerry Arnold was diagnosed with a right inflammatory breast cancer (IBC) in August 2007 and a left contralateral tumor soon after. She underwent weeks of chemotherapy, radiation treatment and eventually a double mastectomy. She completed treatment in June 2008.

Through the efforts of IBC ambassador Terry Arnold, State Comptroller Susan Combs, State Senator Joan Huffman and State Representative Carol Alvarado, the Texas State Senate and House of Representatives will be hearing resolutions to bring awareness to inflammatory breast cancer.

On Wednesday, May 4, the resolution will be heard at the state capital in Austin.

To stand on the steps of the capital in my home state for a cause is not unfamiliar to me. However, standing there wanting to draw attention to something as intimate as the loss of my breasts to a rare and highly fatal cancer is a horse of a different color.

The journey begins
Please allow me to start at the beginning of a journey that has brought me to this place, a place beyond advocacy, but to a fight for life -- my life and the lives of many other women.

It was the summer of 2007. Too much of anything is usually not a good thing. With so much rain, combined with the heat, nothing was growing, or so I thought. Not lumps, but sheets were growing, in my right breast, a rare and fatal form of breast cancer. I was just as helpless to do anything about it as those little tomato plants dying in my garden.

On Sept. 11, 2007, I was diagnosed with something I had never heard of, inflammatory breast cancer. Looking back, I view it as my own personal 9/11. I must have seemed an unusual patient to the staff at MD Anderson's IBC clinic. I was scared, but excited to be there.

By Will Fitzgerald, MD Anderson staff writer

It was a big day for MD Anderson at Thursday's legislative session in Austin. To mark the institution's 70th anniversary, two members of the Texas Legislature presented a resolution recognizing MD Anderson for its remarkable achievements in cancer care that span seven decades.

Sen. Rodney Ellis and Rep. Sarah Davis, both of Houston, introduced the resolution that was well received in both chambers. On the Senate floor, nine members delivered remarks about the significant pride they feel in having such an institution based in the State of Texas.

Sen. Troy Fraser, whose district is in the Texas hill country, called MD Anderson a "Texas treasure" and spoke of the Children's Cancer Hospital's rehabilitation ski trip to Utah, which he has attended and supports every year.Additionally, Lieutenant Governor David Dewhurst said he thought the number of senators speaking on the resolution was a record.

Deborah F. MacFarlane, M.D., professor in the Department of Dermatology at MD Anderson
answers questions about Mohs surgery as treatment for some skin cancers.

macfarlane.jpgWhat types of cancer is Mohs surgery used for?

Mohs is most often used for those patients with basal or squamous cell carcinomas that appear in areas of the body where tissue conservation is especially important. This includes tumors on the face, head or neck, fingers and genitals.

How accurate and effective is the Mohs procedure?

The Mohs technique uses precise tissue mapping to examine horizontally oriented sections of the tumor. During surgery, the tumor is mapped and tracked stage by stage so that we maximize the amount of tumor removed and minimize the amount of normal tissue removed. With each stage, we test 100% of the peripheral and deep tissue margins until it is clear, so we can guarantee approximately 98% to 99% of the time (for previously untreated tumors) that the tumor won't come back. This way we are able to leave minimal defects of scars.

mohs.jpgMore than 20 years ago, Florence Beck's bridge partner looked across the table at her and played a card that may well have saved Beck's life.

"She said, 'You have a skin cancer on your cheek. Go see a dermatologist,'" Beck recalls. "Since she was a registered nurse, I paid attention to her advice."

Beck did, indeed, have a skin cancer -- the first of many over the coming years. As a matter of fact, she has had so many removed that she's not sure of the exact number. Her best guess is 12: two squamous cell cancers and 10 basal cell cancers. The majority of them have been removed with Mohs surgery by Deborah Mac Farlane, M.D., professor in the departments of Dermatology and Plastic Surgery at MD Anderson.

In Mohs surgery, thin layers of tissue are shaved off and examined immediately under a microscope. If the tissue is cancer free, the procedure is complete. If cancer cells remain, the process continues until the sample is cancer free.


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