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Bladder Cancer

Bladder cancer is a form of cancer that begins in the bladder and spreads out of control when cells reach the urine bladder. Cancer cells may form a tumor when they initially appear and spread to other places of the body over time. The kidneys and urethras can also develop urothelial carcinoma (bladder cancer), however the bladder is the most common site.

Signs and Symotoms Of Bladder Cancer.

  • Checking of blood in the urine
  • Frequent urination
  • Painful urination
  • Urinary incontinence
  • Pain in the abdominal area
  • Pain in the lower back

Types of bladder cancer

The type of bladder cell from which cancer develops determines the type of cancer. It could include the following items:

  • Urothelial carcinoma: Earlier it was called transitional cell carcinoma and it occurs in the cells that line the inside of the bladder. When your bladder is full, urothelial cells expand, and when your bladder is empty, they contract.
  • Squamous cell carcinoma: Chronic irritation of the bladder from an infection or long-term use of a urinary catheter, is implicated to squamous cell carcinoma.
  • Adenocarcinoma: Adenocarcinoma originates in the cells of the bladder's mucus-secreting glands.

Period of consulting a doctor

If patients observe discolored urine and are afraid that it may contain blood, they should make an appointment with their doctor right once to have it tested.

Causes

Bladder cancer may be increased by smoking cigarettes and being exposed to chemicals.

Risk factors involved in bladder Cancer

  • Smoking If a person smokes, hazardous chemicals can accumulate in their urine.
  • Increasing age It can occur at any age, most people are diagnosed with bladder cancer older than 55.
  • Being male Bladder cancer is more common in men than it is in women.
  • Exposure to certain chemicals Being around certain chemicals may increase the risk of bladder cancer. Such as chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
  • Previous cancer treatment The anti-cancer medication cyclophosphamide raises the risk of bladder cancer.
  • Chronic bladder inflammation Chronic or recurrent urinary infections or inflammations (cystitis), such as those caused by long-term catheter use, may raise the risk of squamous cell bladder cancer.
  • Personal or family history of cancer It is more likely to occur if one has a family history of bladder cancer.

Bladder Cancer Diagnosis

The following approaches can be used to diagnose bladder cancer:

  • Urinalysis is a process to get into the verge of bladder cancer.
  • Cancerous growth can be examined when the doctor inserts gloved fingers into rectum to feel for lumps that may indicate the symptoms.
  • Cystoscopy is a process that involves the doctor inserting a narrow tube that has a small camera on it through your urethra to see inside your bladder.
  • A biopsy is a process in which the doctor inserts a small tool through your urethra and takes a small sample of tissue from your bladder to test for cancer.

After confirming that you have bladder cancer, your doctor may suggest you some tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body. Tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

Stages of Bladder Cancer

Bladder cancer can be rated out with a staging system that goes from stages 0 to 4 to identify the criticality of how far the cancer has spread. The stages of bladder cancer mean the following:

Bladder cancer in stage 0 hasn't gone beyond the bladder lining.

Stage 1   bladder cancer has spread beyond the lining of the bladder but not to the bladder's muscular layer.

stage 2   In stage 2 bladder cancer, the cancer has spread to the bladder's muscle layer.

Stage 3   bladder cancer has spread to the bladder's surrounding tissues.

Stage 4  Bladder cancer in Stage 4 has spread beyond the bladder to other parts of the body.

Treatment Of Bladder Cancer

Surgical Intervention

The oncosurgeon decides surgical intervention based on the type of cancer. Approaches to bladder cancer surgery might include:

  • Cystectomy- A cystectomy is a surgery to remove all or a part of the bladder that contains a cancerous tumor. During a partial cystectomy, surgeon removes only the portion of the bladder that contains a tumor and during a radical cystectomy; surgeon removes the entire bladder and the surrounding lymph nodes.
  • Transurethral resection of bladder tumor (TURBT). TURBT is a treatment used to identify bladder cancer and remove tumors that have spread to the bladder's inner layers.
  • Neobladder reconstruction. Neobladder reconstruction is a type of surgery that replaces the bladder with a new one. This new bladder allows the patient to urinate by one's own freewill.
  • Ileal conduit. It is the most common type of urinary diversion created after bladder from a piece of intestine that allows the kidneys to drain and urine to exit the body through a small opening.
  • Continent urinary reservoir. It is an internal pouch or reservoir made to hold your urine.

Chemotherapy

  • Chemotherapy in the bladder (intravesical chemotherapy) - To treat cancers that are restricted to the lining of the bladder.
  • Chemotherapy for the whole body (systemic chemotherapy) ‐ A primary treatment to increase the chance for a cure in a person having surgery to remove the bladder.
  • Radiation therapy - It is done to destroy cancer cells
  • Immunotherapy- It is done to trigger the body's immune system to fight cancer cells, either in the bladder or throughout the body.
  • Targeted therapy-It is done to treat advanced cancer when other treatments haven't helped

Prevention

Although there's no guaranteed way to prevent bladder cancer, but following are the steps which can be taken to reduce the risk.

  • Don't smoke.If you smoke, then consult with your doctor for medications and other methods which may help you to quit.
  • Take caution around chemicals.If you work with chemicals, follow all safety instructions to avoid exposure.
  • Choose a variety of fruits and vegetables.Choose a diet rich in a variety of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce your risk of cancer.

Survival Rate

According to the research, five-year survival rates by stage are the following:

  • The five-year survival rate for people with stage 0 bladder cancer is around 98 percent.
  • The five-year survival rate for people with stage 1 bladder cancer is around 88 percent.
  • The five-year survival rate for people with stage 2 bladder cancer is around 63 percent.
  • The five-year survival rate for people with stage 3 bladder cancer is around 46 percent.
  • The five-year survival rate for people with stage 4 bladder cancer is around 15 percent.

Breast Cancer

Breast cancer is the most common cancer in women leading to even death in women.

What are the signs and Symptoms of Breast Cancer

The classical sign of breast cancer is a lump in the breast or an armpit in the breast. in addition, other common signs include:

  • An inverted or sunken nipple
  • A significant rash around the nipple
  • Changes seen around the skin on the nipple or breast like scaling or flaking
  • Consistent pain in the breast or armpit
  • Redness of the breast skin
  • Discharge from a nipple (possibly containing blood)
  • A prominent change in the size and shape of the breast

most lumps in breast are non-cancerous, therefore, it is suggested that a woman should visit a doctor for an examination on noticing a lump in her breast.

Stages of Breast Cancer

An oncosurgeon defines the stages of any cancer on the basis of severity or to what extent the cancer has spread in the body. Similarly,the size of the tumour in breast and the extent it has spread to other parts of the body defines the staging in breast cancer.

Stage 0:  This is the earliest stage of breast cancer,called as ductal carcinoma in situ (DCIS). In this stage, the cancerous cells are limited to within the ducts and have not spread to the surrounding tissues.

Stage 1:  The tumour becomes 2 centimetres in size at this stage, however, the cancerous cells have not affected any lymph nodes.

Stage 2:  The size of the tumor remains up to 2 cm in size but it starts spreading to several lymph nodes whereas in a few cases, the tumour is larger than 5 cm and does not spread to surrounding lymph nodes.

Stage 3:  By this stage, the size of tumour reaches up to 5 cm but it spreads to several lymph nodes.

Stage 4:  This is the stage where the cancer cells have spread to distant organs including the bones, liver or lungs.

Risk factors

The exact cause of breast cancer is unknown but following are a few risk factors making it more likely to occur:

1. Age

The risk of breast cancer increases with increasing age in women.

2. Genetics

The chances of developing breast cancer increase if there is a family history of having breast cancer, t. That's the reason women having a family history of breast, ovarian, fallopian tube, or peritoneal cancer are recommended to seek genetic screening

3. History of breast lumps or cancer

Those women who have had breast cancer previously and were treated are still at more risk to have it again in comparison to those women who have no history of the disease. Also women having some types of noncancerous lump in the breast increases the chance of developing cancer later in life.

4. Dense breast tissue

Women with dense breasts are likely to develop breast cancer so it is highly recommended for all women to seek a regular cancer screening.

5. High level of Estrogen

Oestrogen level is high in women who start their menstrual cycle earlier or entering menopause at a later than average age.Extended exposure to estrogenin such women increases the risk of breast cancer.

6. Body weight

Women who become overweight after menopause may have higher chances of developing breast cancer.

7. Alcohol consumption

Excessive alcohol consumption may contribute to the development of breast cancer.

8. Exposure to radiation

Undergoing radiation therapy for a different cancer treatment may be another risk factor to develop breast cancer later in life.

9. Hormone treatment

According to certain studies, oral contraceptives or hormone replacement therapy may increase the risk of breast cancer in women.

Diagnosis of Breast Cancer

Following is a list of certain essential diagnostic tests and procedures done to diagnose breast cancer and determine the size of a tumour, to what extent it has spread and whether it is invasive or non-invasive.

Breast examination: The Oncosurgeon checks the breasts for the lumps and associated signs & symptoms.

Mammogram: This is a type of X-ray that is done to produce images that help t to rule out any lumps or abnormalities in the breast.

Ultrasonography: It helps the specialist to differentiate between a solid mass and a fluid-filled cyst leading to an accurate diagnosis.

MRI: MRI is used as a screening tool for those women who are at higher risk of breast cancer.

Biopsy: A biopsy is done by extracting a sample of tissue from the breast which is sent to the laboratory to analyse whether the cells are cancerous.

Treatment options for Breast Cancer:

Treatment for breast cancer depends on various factors, such as:

  • The type and stage of the cancer
  • Age of the patient
  • The patient's sensitivity to hormones
  • Overall health of the patient

Various treatment options include:

  • 1.  Surgery
  • 2.  Radiation Therapy
  • 3.  Targeted drug therapy
  • 4.  Chemotherapy
  • 5.  Hormone therapy

Surgery

The oncosurgeon decides surgical intervention based on the type of cancer. Types of surgeries involved in breast cancer are:

  • Mastectomy: In this procedure the onco surgeon removes the lobules, ducts, fatty tissue, nipple, areola, and some skin around the breast. While in some cases of breast cancer, the lymph nodes and muscle in the chest wall are removed as well.
  • Lumpectomy: In this type of surgical procedure removal of the tumour is done alongwith removal of a small healthy tissue around it. The surgeon ensures this procedure helps stop the spread of cancer to other parts of the body. Lumpectomy is suggested in cases where the tumour is small and can be separated easily from its surrounding tissue.
  • Sentinel node biopsy: This type of biopsy is done in those cases when breast cancer reaches the sentinel lymph nodes, which are the first nodes to which a cancer can spread causing it to spread into other parts of the body through the lymphatic system.
  • Axillary lymph node dissection: This procedure is performed by the surgeon in cases where the cancer cells are found in the sentinel nodes. The procedure consists of removal of several lymph nodes in the armpit which can prevent the cancer from spreading to other parts of the body.
  • Reconstruction: After breast removal surgery, reconstruction of the breast is done with the aim to help the patient coping with the negative psychological effects of breast removal.

Breast reconstruction can be done at the same time as performing a mastectomy or later. In addition, breast implants can be placed to give a natural look to the breast.

Radiation therapy

Radiation therapy is given to the patient a month after surgery. Controlled doses of radiation destroy the remaining cancer cells targeting the tumour.

Chemotherapy

Chemotherapy drugs destroy the cancer cells preventing the risk of recurrence or spread.

Hormone blocking therapy

Hormone blocking therapy is considered as the only option for those cases who are not suitable candidates for surgery, chemotherapy, or radiotherapy.

Results after treatment of Breast Cancer

Similar to other medical conditions, early detection and treatment usually lead to a positive outlook, works in breast cancer treatment too.

Results are directly proportional with the cancer staging, a patient treated at an early stage 0 or 1, has upto 99% survival rates as compared to the patients getting treatment at advanced stages 2, 3, 4.

What is Colon cancer

Colon cancer is also called colorectal cancer since it combines colon cancer and rectal cancer, it begins in the colon present in the large intestine or in the rectum.

Colon cancer typically affects older adults; however, it can affect people of any age. It begins as small and noncancerous polyps that develop inside the colon, which can develop as colon cancers. Over a period of time it is suggested to undergo regular screening and if any polyp is identified, it can be removed surgically before these convert into cancer.

The signs and symptoms of colorectal cancer

Patients do not show any symptoms in the early stages of colon cancer, the symptoms appear depending on the cancer's size and location in the large intestine. These symptoms may include the following:

  • Persistent constipation or diarrhoea.
  • Bleeding per rectum or blood oozes out with stool.
  • Excessive discomfort in abdomen such as cramps, gas or pain which remains persistent
  • Feeling of incomplete emptying of bowel
  • Weight loss
  • Weakness
  • Excessive bodily fatigue
  • Vomiting

In case colon cancer spreads to other parts of the body, Patients may experience the following symptoms in addition to the abovementioned:

  • Difficulty in breathing
  • Swollen Hands or feet
  • Persistent headache
  • Blurred vision
  • Jaundice
  • Frequent Bone fractures

Dr.Arvind Kumar,Delhi advises patients experiencing early signs to undergo screening before these signs worsen.

The causes of Colorectal cancer

The exact causing factor for colorectal cancer is not known, following risk factors are considered responsible to contribute to the development of colorectal cancer.

  • Gene mutations When a cell's DNA changes or is damaged that is called gene mutation.In such scenario,cells divide to grow abnormally develop a tumour.
  • Precancerous growths Abnormally grown cells accumulate in the lining of the colon leading to small and non-cancerous polyps development which can be converted to cancerous tumour later in life.

Risk factors contributing to the development of colorectal cancer are as follows:

  • Older age. People older than 50 are at more risk of developing colorectal cancer.
  • Personal history of bowel diseases
  • Colorectal cancer may be associated with certain food habits which are low in fiber and high in fat & calories such as red meat and processed food.
  • People with a previous history of polyps or colorectal cancer are at a greater risk of recurrent colon cancer in the future.
  • Inflammatory and chronic conditions of the intestine such as ulcerative colitis increase the risk of developing colon cancer.
  • Family history of colon cancer is likely to develop colorectal cancer.
  • People with a sedentary lifestyle are at more risk of developing colon cancer.
  • People with diabetes or insulin resistant people are more likely to develop colon cancer.
  • Overweight people are at higher risk to develop colon cancer when compared with people having normal weight.
  • Smoking can increase the risk of colon cancer.
  • Excessive consumption of alcohol increases the risk of colon cancer.

Diagnosis of colorectal cancer

Certain investigations are recommended by the specialists to screen patients with either early signs or no signs of colon cancer or noncancerous colon polyps.Identifying colon cancer at its earliest stage helps the oncosurgeon to manage the case with a good success rate.

Like other medical conditions, screening for colon cancer initiates with a medical and family history of the patient followed by a physical examination. Essential tests, which are recommended to rule out the colon cancer are as follows:

  • Blood tests. Blood tests are required to look for the overall health of the patient including kidney and liver function tests.
  • X-ray
  • CT scan provides a detailed image of the colon.
  • Colonoscopy. It is a procedure that is done with the help of a long and flexible tube attached with a small camera. Using a colonoscopy, the specialist is able to see inside the colon and rectum.If anything unusual is detected the doctor can remove a tissue from abnormal areas and is sent to a laboratory for further analysis.

Stages of Colon cancer

Stage 1.  This is the early stage of the cancer, where the cancer has penetrated the lining of the colon or rectum but has not spread to the walls of surrounding organs.

Stage 2.  At this stage, the cancer has spread to the walls of the colon or rectum and has not spread to the lymph nodes or surrounding tissues.

Stage 3.  The cancer has spread to the lymph nodes but not to other parts of the body.

Stage 4.  This is the most advanced stage and critical one, as at this stage, the cancer has spread to other distant organs, such as the liver or lungs.

Treatment options for colorectal cancer

Surgery for early-stage colon cancer

  • Polypectomy: Surgical intervention is done to remove the small and non- cancerous polyp.
  • Endoscopic mucosal resection. In this surgical procedure,the surgeon removes larger polyps using a colonoscopy.
  • Laparoscopic surgery. Laparoscopy is useful in such cases where the polyps that cannot be removed during a colonoscopy procedure are removed through laparoscopy surgery.

Surgery for an advanced colon cancer

  • 1.  In cases of advanced cancer, the oncosurgeon ensures to relieve a blockage of the colon or other conditions with an aim to improve the symptoms such as a blockage, bleeding or pain.
  • 2.  In addition, in the cases where the cancer has invaded the liver or lung, surgery may be recommended to remove the cancer.
  • 3.  While if the cancer has spread to the colon, following surgical procedures are recommended:
  • Partial colectomy. In this procedure, the Oncosurgeon removes the part of the colon containing the cancer using laparoscopy.
  • Ostomy. This surgical procedure involves creating a way for waste to excrete through the patient's body. It is carried out by making an opening in the wall of the abdomen from a portion of the remaining bowel excreting the stool into a bag that is fitted securely over the opening.
  • Colostomy. The procedure is done when a patient does not benefit from Ostomy procedure.
  • Lymph node removal. Surgeon removes the surrounding lymph nodes during colon cancer surgery.

Chemotherapy

Chemotherapy kills cancer cells using certain specific medicines.

Chemotherapy, if given before surgery, might shrink a large cancer so that it is easier for a surgeon to perform the surgery but if the cancer is larger or has spread to the lymph nodes, chemotherapy for colorectal cancer is typically given after surgery to damage any remaining cancer cells in the body and help reduce the risk of cancer recurrence.

Radiation therapy

Radiation therapy destroys the cancer cells using powerful energy sources.

Targeted drug therapy

This type of therapy focuses on particular abnormalities present within the cancer cells and blocks these abnormalities destroying the cancer cells.

Immunotherapy

Immunotherapy is a treatment that uses a patient's immune system to fight cancer.

Cervical Cancer

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Gall Bladder Cancer

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Head and Neck

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Kidney cancer

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Lung cancer

Lung cancer begins in the lungs and is known to be the leading cause of cancer deaths in both women and men.

Signs and symptoms of lung cancer

Lung Cancer shows signs and symptoms when the disease is in an advanced stage. Several signs and symptoms of lung cancer are as follows:

  • Persistent cough that does not go away with time
  • Blood oozes out while coughing
  • Pain in the chest
  • Breathing issues like shortness of breath
  • Changes in voice like hoarseness in voice
  • Weight loss
  • Bone and joint pain
  • Constant headache that does not go with time

Types of lung cancer

Lung cancer is categorised based on the appearance of lung cancer cells under the microscope,there are two types of lung cancer, which are:

  • Small cell lung cancer. This type of cancer occurs in heavy smokers.
  • Non-small cell lung cancer. This type of cancer is an umbrella term for several types of lung cancers including squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Causes of lung cancer

Smoking is known to be the main causing factor contributing to the development of lung cancers. Both smokers and those who are exposed to passive smoke are at a risk of developing lung cancer.

Risk factors for lung cancer

Apart from smoking, there are a few other risk factors for developing lung cancer, those are:

  • Exposure to passive smoking
  • Family history of lung cancer
  • Exposure to radon gas
  • Exposure to asbestos and other carcinogens

Diagnosis of lung cancer

  • Imaging tests. X-ray of lungs is done to rule out an abnormal mass or nodule in the lungs.
  • CT scan helps find small lesions in lungs that may not be detected in an X-ray.
  • Sputum cytology. Sputum is examined under the microscope to find out the presence of lung cancer cells.
  • Biopsy. A sample of abnormal cells from the lungs is extracted and sent to the laboratory for a detailed analysis.
  • Bronchoscopy. People who are above 50 years old and have smoked heavily for several years are recommended to go for bronchoscopy.

Stages of lung cancer

Once lung cancer is diagnosed in a patient,the stage of cancer is determined to know the extent the cancer has spread. various tests and investigations are done to determine the stage of lung cancer.

As in other cancers, stages of lung cancer are also categorised in the range of 0 to 4, where 0 indicates that cancer is limited to the lung only with no expansion to the surrounding organs and tissues while stage 4 indicates cancer has spread to other parts of the body including liver.

Treatment options for lung cancer

Lung cancer surgery

Treatment plan for lung cancer is based on a number of factors, such as your overall health, the type and stage of your cancer.

Surgery

Common procedures to remove lung cancer include:

  • Wedge resection is the surgical removal of a small section of lung containing the tumour along with a margin of healthy tissue.
  • Segmental resection is surgical removal of a larger portion of affected lung.
  • Lobectomy: is the surgical removal of the entire lobe of one lung.
  • Pneumonectomy: removal of entire lung

Radiation therapy

Radiation therapy is performed using high-powered energy radiations to destroy cancer cells. Radiation therapy can be used before surgery or after surgery. In addition, It is combined with chemotherapy in cases where surgery is not an option.

Chemotherapy

Chemotherapy drugs are given through a vein in a patient's arm or taken orally to destroy the cancer cells. A combination of drugs is given over a period of weeks or months, with breaks in between allowing the patient to recover from side effects of chemotherapy.

Targeted drug therapy

Targeted drug treatments block abnormalities in cancer cells causing cancer cells to die.

Immunotherapy

Immunotherapy uses a patient's immune system interfering with the process of how cancer cells attack one's immune system.

Neuroendocrine Cancer

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Ovarian Cancer

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Endocrine Cancer

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Pancreatic Cancer

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Prostate Cancer

Lorem ipsum, dolor sit amet consectetur adipisicing elit. Reiciendis laudantium inventore, dolore recusandae, eos qui saepe quibusdam voluptate eaque voluptas eveniet magnam architecto est sint aperiam, eligendi ipsa esse eius quae veniam. Eius nostrum natus, voluptate nesciunt, est, fugit sed atque quaerat repellat quae voluptatem recusandae! Dolorem, repudiandae. Ullam quam molestiae vitae placeat culpa tempora nesciunt recusandae voluptas excepturi cupiditate eveniet numquam quod, consequatur eligendi, aliquid et. Minima, repellendus inventore. Laboriosam temporibus provident rem animi exercitationem distinctio officiis facilis cupiditate recusandae iure, voluptates deserunt ullam quam mollitia libero accusamus perferendis ea. Mollitia error quis ipsum exercitationem cumque! Repellat, culpa iste.

Stomach Cancer

Lorem ipsum, dolor sit amet consectetur adipisicing elit. Reiciendis laudantium inventore, dolore recusandae, eos qui saepe quibusdam voluptate eaque voluptas eveniet magnam architecto est sint aperiam, eligendi ipsa esse eius quae veniam. Eius nostrum natus, voluptate nesciunt, est, fugit sed atque quaerat repellat quae voluptatem recusandae! Dolorem, repudiandae. Ullam quam molestiae vitae placeat culpa tempora nesciunt recusandae voluptas excepturi cupiditate eveniet numquam quod, consequatur eligendi, aliquid et. Minima, repellendus inventore. Laboriosam temporibus provident rem animi exercitationem distinctio officiis facilis cupiditate recusandae iure, voluptates deserunt ullam quam mollitia libero accusamus perferendis ea. Mollitia error quis ipsum exercitationem cumque! Repellat, culpa iste.

Thyroid Cancer

Lorem ipsum, dolor sit amet consectetur adipisicing elit. Reiciendis laudantium inventore, dolore recusandae, eos qui saepe quibusdam voluptate eaque voluptas eveniet magnam architecto est sint aperiam, eligendi ipsa esse eius quae veniam. Eius nostrum natus, voluptate nesciunt, est, fugit sed atque quaerat repellat quae voluptatem recusandae! Dolorem, repudiandae. Ullam quam molestiae vitae placeat culpa tempora nesciunt recusandae voluptas excepturi cupiditate eveniet numquam quod, consequatur eligendi, aliquid et. Minima, repellendus inventore. Laboriosam temporibus provident rem animi exercitationem distinctio officiis facilis cupiditate recusandae iure, voluptates deserunt ullam quam mollitia libero accusamus perferendis ea. Mollitia error quis ipsum exercitationem cumque! Repellat, culpa iste.

Uterine Cancer

Lorem ipsum, dolor sit amet consectetur adipisicing elit. Reiciendis laudantium inventore, dolore recusandae, eos qui saepe quibusdam voluptate eaque voluptas eveniet magnam architecto est sint aperiam, eligendi ipsa esse eius quae veniam. Eius nostrum natus, voluptate nesciunt, est, fugit sed atque quaerat repellat quae voluptatem recusandae! Dolorem, repudiandae. Ullam quam molestiae vitae placeat culpa tempora nesciunt recusandae voluptas excepturi cupiditate eveniet numquam quod, consequatur eligendi, aliquid et. Minima, repellendus inventore. Laboriosam temporibus provident rem animi exercitationem distinctio officiis facilis cupiditate recusandae iure, voluptates deserunt ullam quam mollitia libero accusamus perferendis ea. Mollitia error quis ipsum exercitationem cumque! Repellat, culpa iste.

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