how rare is nasopharyngeal cancer
Although Epstein‑Barr virus (EBV) infection has been suggested as a necessary cause of undifferentiated … The annual incidence of NPC in the UK is 0.3 per million at age 0–14 years, and 1 to 2 per million at age 15–19 years. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx, most commonly in the postero-lateral nasopharynx or pharyngeal recess (fossa of Rosenmüller), accounting for 50% of cases.NPC occurs in children and adults. In later stages, radiation may be combined with surgery to remove lymph nodes where the cancer has spread. Nasopharyngeal carcinoma (NPC) is a very rare cancer found in the nasopharynx. ... BeiGene Unveils Results From Late-Stage Tislelizumab In Nasopharyngeal Cancer. Nasopharyngeal carcinoma is a unique head and neck cancer with unbalanced endemic distribution. Nasopharyngeal cancer is cancer of the nasopharynx. … Nasopharyngeal cancer is a type of throat cancer that develops when cancer cells grow in the nasopharynx, the upper part of the throat behind the nose. Nasopharyngeal cancer is seen much more frequently in areas of Northern Africa and Southeast Asia. Treatment does not vary based on histologic subtypes. The nasopharynx is the upper part of the pharynx (throat) behind the nose. Your age and overall health. It cannot be seen. The nasopharynx is located at the very back of the nose near the Eustachian tubes (Figure). Primary sinonasal nasopharyngeal-type undifferentiated carcinoma (PSNPC) is an even more rare tumor than any of the above. The types of symptoms that people have from a sarcoma depend on where it starts. ClinicalTrials.gov lists trials that are related to Nasopharyngeal carcinoma. HPV is thought to cause 70% of oropharyngeal cancers in the United States. Nasopharyngeal cancer is generally treated with radiation or radiation with chemotherapy. Nasopharyngeal cancer is rare, though it … The risk of developing a second liver cancer was estimated to 0.85 standardised But in some cases, changes to nasopharyngeal cells can cause nasopharyngeal cancer. In most parts of the world, Nasopharyngeal Cancer is quite rare. Cancer Research UK is a registered charity in England and Wales (1089464), Scotland (SC041666), the Isle of Man (1103) and Jersey (247). This type of cancer is very rare in the UK but it is more common in some ethnic groups, for example people of Chinese origin. Use the menu to see other pages.Sarcomas can start in any part of the body. This means that the cancer cells look and act like normal cells and the tumour grows slowly. There are a number of symptoms that could be a sign of nasopharyngeal cancer, including a lump in the neck or hearing loss (usually on one side). Who Gets Nasopharyngeal Cancer? Most people with nasopharyngeal cancer (NPC) notice a lump or mass in the neck that leads them to see a doctor. Nasopharyngeal cancer occurs above the back of the throat and directly behind the nose in an area called the nasopharynx. This affection is highly predisposed to nodal and distant metastasis. There is less than 1 case of nasopharyngeal cancer per 100,000 people in the US. Nasopharyngeal cancer is a rare cancer in most part of the world, but commonly seen in natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. Kim\'s label Sidus HQ released a statement revealing the latest news about his health. Approximately 133,354 new patients were reported worldwide in 2020, with the high rates occurring in Southeastern Asia. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical … The nasopharynx connects nasal cavity and the throat, and allows the air you breathe … Registered address: 2 Redman Place, London, E20 1JQ. Although it is not a type of cancer, it may be associated with certain blood cancers like multiple myeloma. It is part of the passageway for the air from the nose to travel to the lungs. In the United States, the disease affects one in 100,000 people annually. Incidence is higher in the Chinese and Tunisian populations. Bladder, breast, nasopharyngeal, non-small cell lung, ovarian and pancreatic cancer, lymphomas and inflammatory bowel disease. The rare type of headache and neck cancer is nasopharyngeal carcinoma. Distant metastases were the main treat … 2 Clinical presentation of NPC is related to the … Radiotherapy is the cornerstone of treatment, frequently combined with chemotherapy. Advertisement. There were 129,000 new cases in 2018. Nasopharyngeal carcinoma (NPC) is a malignant tumour that generally presents at late stages, with a five year survival rate below 50%. Still, cutaneous metastasis is rarely seen. Nasopharyngeal carcinoma is more common in Southeast Asia and is frequently, but not always, caused by Epstein-Barr virus (EBV). rare hormonal/endocrine cancers, such as phaeochromocytoma. What can increase the risk of this cancer? The nasopharynx is located at the very back of the nose near the Eustachian tubes (Figure). We want to share our experience about the treatment choice. There may be lumps on both sides of the neck towards the back. Nasopharyngeal carcinoma is relatively rare but has an exceptionally high incidence in southern China, approaching more than 20 times greater than that of most populations . This rare blood cell cancer is characterized by an excess of abnormal white blood cells in the bone marrow. rare skin cancers, such as melanomas. ... Nasopharyngeal carcinoma < 0.5. […] Nasopharyngeal carcinoma (NPC) typically presents to ophthalmologists with one or more cranial nerve palsies. I still had 33 doses of radiation therapy and more chemotherapy to go. Risks and causes of nasopharyngeal cancer Anything that can increase your risk of getting a disease is called a risk factor. Registered company in England and Wales (4325234) and the Isle of Man (5713F). The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). ournal of Cancer Science herapy Case Report Volume 13:6, 2021 Abstract Introduction: The most common sites for distant nasopharyngeal carcinoma metastases are the bone, lung, and liver. it is also called nasopharyngeal carcinoma. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. This is called oropharyngeal cancer. 2021 May ... St. John Providence Health Systems Webber Cancer Center, Warren, Michigan. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies. Nasopharyngeal cancer can occur at any age, but it's most commonly diagnosed in adults between the ages of 30 and 50. Nasopharyngeal carcinoma (also known as NPC) is a rare tumor of the head and neck which originates in the nasopharynx. Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat connecting the back of the nose to the back of the mouth (the pharynx). Nasopharyngeal cancer (NPC) is quite rare. Periparotid recurrences are rare after definitive IMRT for nasopharyngeal carcinoma. With over 6,500 members inside and outside Europe, ESTRO supports all the Radiation Oncology professionals in their daily practice: … The technical modality of radiotherapy is complex in this disease, which is located in the vicinity of numerous organs at risk. Coronavirus and cancer We know it’s a worrying time for people with cancer, we have information to help. It is a rare cancer in the UK. Nasopharynx is located at the base of the skull, above the … Nasopharyngeal cancer begins with a genetic mutation in the squamous cells, or superficial lining, of the nasopharynx. Nasopharyngeal cancer is a relatively rare head and neck cancer known to more frequently affect people of Asian descent. Fortunately for him, the cancer was still in its initial stages, so drug treatment and radiation therapy started almost immediately. In detail, a total of 95 targets of miR-21 were recorded to be associated with NPC. However, doctors and researchers have begun to understand … Nasopharyngeal cancer (or nasopharyngeal carcinoma) begins when certain genetic mutations or environmental factors cause the normal, squamous cells along the lining of the nasopharynx to grow uncontrollably, attack other surrounding cells, and metastasise, or spread onto other areas of the body via the lymph system, tissue, or the bloodstream. In some parts of China there are as many as 21 cases per 100,000 people. The incidence of nasopharyngeal carcinoma (NPC) exhibited an evident geographical variation, which is endemic in southeast Asia, North Africa, Middle East, and Arctic, with a male preponderance. Symptoms. Treatment options depend on: The cancer’s type and stage. Nasopharyngeal carcinoma is more common in Southeast Asia and is frequently, but not always, caused by Epstein-Barr virus (EBV). Nasopharyngeal cancer is much more common in Asia, especially southeast China, the Mediterranean, and Africa than it is in the United States. Nasopharyngeal carcinoma (also known as NPC) is a rare tumor of the head and neck which originates in the nasopharynx. The underlying mechanisms behind this remarkable geographic distribution remain unclear. Nasopharyngeal cancer is a rare cancer of nasopharynx that can affect any person at any age. 1.04 Topoisomerase I … ... Myelosuppression, skin cancer (rare), oedema (rare), hallucinations (rare), seizures (rare) and pulmonary toxicity (rare). It usually takes years after being infected with HPV for cancer to develop. Nasopharyngeal cancer is cancer of the nasopharynx. Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide, but it is endemic in a few areas including Southern China, Southeast Asia, North Africa and the Arctic. Nasopharyngeal carcinoma (NPC), or nasopharynx cancer, is the most common cancer originating in the nasopharynx, most commonly in the postero-lateral nasopharynx or pharyngeal recess (fossa of Rosenmüller), accounting for 50% of cases.NPC occurs in children and adults. Although nasopharyngeal cancer is rare in the general U.S. population, it is significantly more likely to occur in refugees from Southeast Asia who have come to the United States in the past 25 years. Nasopharyngeal cancer is a relatively rare head and neck cancer known to more frequently affect people of Asian descent. HPV can infect the mouth and throat and cause cancers of the oropharynx (back of the throat, including the base of the tongue and tonsils). Rare in the United States, nasopharyngeal cancer is fairly common in parts of Asia and North Africa. Nasopharyngeal cancers are a rarity in France. They're caused by the cancer spreading to lymph nodes in the neck, causing them to swell. It is treated by radiotherapy and chemotherapy. Nasopharyngeal cancer is a rare type of cancer that starts in the upper throat area behind the nose. Nasopharyngeal carcinoma is more common in Southeast Asia and is frequently, but not always, caused by Epstein-Barr virus (EBV). Nasopharyngeal Cancer survivor Hello David, I hope you are doing ok, I found out I had this cancer back in October of 2009, I went through all teratments, Chemo and radiation. Nasopharyngeal cancer (NPC) is quite rare. In most parts of the world (including the United States), there's less than one case for every 100,000 people each year. This cancer is much more common in certain parts of South Asia, the Middle East, and North Africa. In some parts of China there are as many as 21 cases per 100,000 people. Rare types of nasopharyngeal cancer can also develop. After 7 months of treatment, Bin thanked the fans who prayed for him by writing a letter. It starts in the nasopharynx, the upper part of the throat behind the nose and near the base of skull. However, it is more common in certain parts of Asia (particularly Southern China), North Africa and far North Canada. Nasopharyngeal carcinoma is a rare tumor arising from the epithelium of the nasopharynx. This throat cancer can be difficult to detect early: the location of the nasopharynx makes it difficult to examine and symptoms of NPC often mimic other conditions. Rare in the United States, nasopharyngeal cancer is fairly common in parts of Asia and North Africa. They say it's advanced local and I'm not entire sure what that means in terms of prognosis but it has … It is much more common in regions of Southern China, including Hong Kong where the incidence is up to 25 cases per 100,000” says Dr. Prendes. Nasopharyngeal cancer usually causes lumps in your neck. A retrospective cohort study of nasopharyngeal adenocarcinoma: a rare histological type of nasopharyngeal cancer. How common is nasopharyngeal cancer? It begins behind the nose in the top of your neck. Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide, but it is endemic in a few areas including Southern China, Southeast Asia, North Africa and the Arctic. rare brain tumours, such as meningioma. Nasopharyngeal carcinoma is more common in Southeast Asia and is frequently, but not always, caused by Epstein-Barr virus (EBV). The nasopharynx is the portion that connects the nose with the pharynx (throat). There are no simple tests or blood tests that can detect this cancer early. In a Chinese analysis, 3% of . [ 5, 6] Also, the designation of a pediatric rare tumor is not uniform among international groups, as follows: Nasopharyngeal cancer is most common in people who live in southern China and southeast Asia or in those whose families came from those areas—it’s rare in other groups Nasopharyngeal cancer usually causes lumps in your neck 70-72 Endemic regions in China and southeast Asia, the Mediterranean, and … Because this cancer is rare and has no distinguishing symptoms, it may take time to detect and diagnose a tumor. If left untreated, nasopharyngeal cancer can spread (metastasize) to other parts of the body and lead to death. What causes nasopharyngeal carcinoma in children? Liver cancer is a rare type of cancer which starts in the liver. This throat cancer can be difficult to detect early: the location of the nasopharynx makes it difficult to examine and symptoms of NPC often mimic other conditions. Nasopharyngeal cancer is the 18th most commonly occurring cancer in men and the 22nd most commonly occurring cancer in women. The lumps are usually not tender or painful. This region is known as the larynx. “Nasopharyngeal cancer is very rare in the United States and Western Europe, with an incidence of only 0.5 – 2 cases per 100,000 people each year. 1 Radiotherapy is the cornerstone of nasopharyngeal carcinoma treatment, due to its high sensitive to radiation. This cancer is much more common in certain parts of South Asia, the Middle East, and North Africa. In the United States where nasopharyngeal cancer (NPC) is rare, and doctors do not ask for routine screening for this type of cancer. Both genetic and environmental factors have contributed to the development of nasopharyngeal carcinoma. Nasopharyngeal cancer is rare, though it … Anything that can increase your risk of getting a disease is called a risk factor. The underlying mechanisms behind this remarkable geographic distribution remain unclear. It is located above the back of the throat just behind the nose. NPC i.e. In the United States, nasopharyngeal cancer is extremely rare. In the UK, about 260 people are diagnosed with nasopharyngeal cancer each year. Nasopharyngeal cancer is most common in people who live in southern China and southeast Asia or in those whose families came from those areas—it’s rare in other groups. Different cancers have different risk factors. Having one or more of these risk factors doesn't mean you will definitely get that cancer. Nasopharyngeal cancer is a rare type of head and neck cancer. It was found that the target genes are involved in vital biological processes in cancer. Guo. Fewer than one in every 100,000 people in the U.S. gets this type of cancer, according to the American Cancer Society. cancers that usually only affect adults, such as cancers of the digestive system, the thyroid and the adrenal gland. Cancer starts when cells begin to grow out of control. Nasopharyngeal cancer is a rare form of malignant cancer that occurs in the nasopharynx. (See the image below.) NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical … Founded in 1980, ESTRO, the European SocieTy for Radiotherapy & Oncology, is a non-profit and scientific organisation that fosters the role of Radiation Oncology in order to improve patients’ care in the multimodality treatment of cancer. The top 20 countries with the highest rates of nasopharyngeal cancer in 2018 are given in the tables below. Rare tumors: Retinoblastoma, nasopharyngeal cancer, and adrenocorticoid tumors Pediatr Blood Cancer. Therefore, they may provide new insights into nasopharyngeal pathogenesis and bring about novel targets for … emphasized that, although nasopharyngeal carcinoma is a rare malignancy in most of the world, its incidence rate in China is 3.0 per 100,000 people. The cancer is … W.W. Liu. The tissues in this area are mucous membranes, which produce fluids to keep them moist. Optic neuritis: a rare manifestation of nasopharyngeal carcinoma. (Screening tests are tests for cancer in people who have no symptoms.) If you have a look at the statistics of nasopharyngeal cancer in different regions of the United States and other surrounding countries of the world, you will find only one case among 100,000 people calculated on a yearly basis. It arises in the nasopharynx — the upper section of the pharynx, behind the nose. This type of cancer is called nasopharyngeal carcinoma (NPC). The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). In general, mortality related to nasopharyngeal cancers has improved in the last decade owing to early detection and advances in treatment. Most often, nasopharyngeal cancer starts in the epithelial cells that line the inside of the nasopharynx. They include tumors or malformations of the vascular (blood-carrying) system, such as angiofibromas and hemangiomas, and benign tumors of minor salivary glands within the nasopharynx. Rationale: Thyroid metastasis from nasopharyngeal carcinoma is rare. Search for more papers by this author. The size of the tumor. This form of cancer is extremely rare in the United States and Canada. This cancer is called a carcinoma because it begins in the cells that line the throat and nose. laflor / Getty Images. Amyloidosis is a rare disorder. Salt-cured foods. Nasopharyngeal cancer (NPC) is a type of throat cancer that forms in the nasopharynx, which is the upper part of the throat behind the nose. This cancer is commonly diagnosed in people who are about 55 years of age, however, it can occur in people of any age. The mean age of nasopharyngeal carcinoma diagnosis has been 11 … If you would like to chat, send me an email and I will share my experience. It is more common in parts of Asia, the Arctic region, North Africa, and the Middle East. Date: 08 Feb 2012. In the UK, about 260 people are diagnosed with nasopharyngeal cancer each year. However, it is more common in males than females, and, within the United States, more common in those with Asian or Pacific Islander heritage. Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat connecting the back of the nose to the back of the mouth (the pharynx). So hang in there, you will be fine. Breast cancer is the most common cancer in the UK – one in eight women develop the disease at some stage in their lifetime. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. View our full-size infographic about breast cancer Breast cancer is rare in men, with around 400 new cases diagnosed each year in the UK, compared with 54,724 new cases in women in 2017 * . Both PSNPC and SNUC have been reported to be associated with Epstein-Barr virus (EBV) but the two are considered two different entities. Leptomeningeal metastases LM in undifferentiated nasopharyngeal carcinoma are rare. Date: 08 Feb 2012. NPC mainly begins in epithelial cells, which are found throughout the body, and line the nasopharynx. The nasopharynx is the upper part of the pharynx (throat) behind the nose. It accounts for approximately 1% of all childhood malignancies. Childhood nasopharyngeal carcinoma is more common in adolescents than in younger children. Authors: Michalis V. Karamouzis. A company limited by guarantee. ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Each issue is carefully selected to provide a combination of high quality original research, informative editorials and state-of-the-art reviews. 5 Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland. Nasopharyngeal cancer is a relatively rare head and neck cancer known to more frequently affect people of Asian descent. Nasopharyngeal cancer is a rare form of cancer that affects the nasopharynx, a region in the throat located behind the nasal cavity and soft palate. Nasopharyngeal cancer is a rare form of head and neck cancer. Department of Head and Neck Surgery, Cancer Center of Sun Yat‐sen University, Guangzhou, China. "Though rare, this is the first report of nasopharyngeal cancer being caused by the HPV epidemic. This is … Nasopharyngeal carcinoma among the children has been rare accounting for only 1% of all pediatric malignancies. The incidence rate of this cancer is only 0.44 per 1 lakh people per year. Whereas almost all adult nasopharyngeal cancers are carcinomas, only 35-50% of nasopharyngeal malignancies are carcinomas in children. Nasopharyngeal carcinoma is a rare type of cancer that occurs in the nasal cavity and the pharynx, the upper part of the throat behind the nose. Benign nasopharyngeal tumors are fairly rare and tend to develop in children and young adults. Getting diagnosed. Different factors increase or decrease the risk of oral cavity and nasopharyngeal cancers. Among the children there was a higher rate of undifferentiated histology. Nasopharyngeal cancer is a rare type of cancer that affects the part of the throat connecting the back of the nose to the back of the mouth (the pharynx). Nasopharyngeal carcinoma is a rare malignancy in most parts of the world but is endemic in southern China and Southeast Asia. Z.M. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). 1 The incidence rate of NPC for males in Taiwan is 7.7 to 8.8 per 100 000 person-years, 2- to 3-fold higher than that of females. This kind of cancer is rare, with fewer than one in 100,000 people in North America diagnosed with the disease each year. Nasopharyngeal cancer is a type of head and neck cancer. The majority of nasopharyngeal cancers are nasopharyngeal carcinoma (NPC), which is the most common cancer in the nasopharynx. In 2017, 237 cases of nasopharyngeal cancer were diagnosed in the UK*. People with sarcoma may experience the following symptoms or signs. ... Nasopharyngeal cancer is cancer that starts in the nasopharynx. Nasopharyngeal carcinoma (also known as NPC) is a rare tumor of the head and neck which originates in the nasopharynx. Nasopharyngeal carcinoma - Symptoms and causes - Mayo Clinic Less than 1 out of 100,000 people are diagnosed with this condition every year. It accounts for approximately 1% of all childhood malignancies. Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx. In most parts of the world (including the United States), there's less than one case for every 100,000 people each year. Nasopharyngeal cancer is very rare in the UK. Nasopharyngeal cancer is rare in the United States. At the time, I was undergoing nine weeks of very strong chemotherapy for stage IV nasopharyngeal carcinoma, a rare type of head and neck cancer and skull base tumor. Nasopharyngeal carcinoma (NPC) is a tumor arising from the epithelial cells that cover the surface and line the nasopharynx. Topics: Head and neck cancers . 68, 69 It is rare in adolescents and children, accounting for < 1% of childhood cancers. A diet high in salt-cured fish may also be a risk factor. Although nasopharyngeal cancer is rare in the general U.S. population, it is significantly more likely to occur in refugees from Southeast Asia who have come to the United States in the past 25 years. Once diagnosed, the malignancy has great potential for cure. The tumors develop in this area. These tumors do not spread to other parts of the body and are usually not life-threatening. Nasopharyngeal carcinoma is a rare tumor arising from the epithelium of the nasopharynx. Nasopharyngeal swabs are commonly done in the medical field for a multitude of reasons, and they recently have been an essential component of widespread testing to control the spread of COVID-19. Nasopharyngeal carcinoma (NPC) is a historically rare malignancy with an incidence of less than one per 100,000 person-years and is most predominantly found in males indigenous to Southeast Asian countries .Due to the anatomic location of the nasopharynx and its direct connection to adjacent head and neck structures, patients with NPC may present with a … Nasopharyngeal papillary adenocarcinoma is a low-grade cancer of the nasopharynx. rare cancers in the head and neck area, such as nasopharyngeal cancer. This form of cancer affects approximately one in 100,000 people in the United States each year, which makes it extremely rare. The Centers for Mendelian Genomics program is working to discover the causes of rare genetic disorders. Because amyloidosis is rare, it has been difficult to study. In discussing the importance of their work, Mai et al. The condition can develop at any age and can even affect children. Infection with Epstein-Barr virus, a type of herpesvirus, is one of the most common causes of nasopharyngeal cancer. For more information about applying to the research study, please visit their website. Nasopharyngeal cancer. Although cancer in children is rare, it is the second most common cause of childhood mortality in developed countries. It is far more common in men compared with women, and while the risk of nasopharyngeal cancer will increase with age, it affects children as well as adults. Rare tumors: Retinoblastoma, nasopharyngeal cancer, and adrenocorticoid tumors Samir Patel, Jennifer Vogel , Kristin Bradley, Paul J. Chuba, Jeffrey Buchsbaum, Matthew J. Nasopharyngeal carcinoma is cancer that occurs in the nasopharynx, located behind your nose and above the back of your throat. Cancer that develops in the nasopharynx is called nasopharyngeal cancer. It is a rare cancer in the UK. There are a number of symptoms that could be a sign of nasopharyngeal cancer, including a lump in the neck or hearing loss (usually on one side). You see your GP if you have symptoms. They can refer you for tests or to see a specialist. Hey folks, I was searching for forums and support groups as I got diagnosed recently with nasopharyngeal cancer (squamous cell carcinomA). Nasopharyngeal Carcinoma – a rare but potentially curable disease. Nasopharyngeal cancer is a rare type of head and neck cancer, occurring in about 2,000 people in the United States every year.In some parts of the world, where it … Topics: Head and neck cancers . Nasopharyngeal Carcinoma – a rare but potentially curable disease. The nasopharynx is the upper part of the pharynx (throat) behind the nose. Saba covered a wealth of information about nasopharyngeal cancer. Nasopharyngeal cancer is so rare that a headache alone is highly unlikely to be a result of the presence of a nasal tumor. 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