Norman Swan: Hello and acceptable to this week’s Bloom Report with me Norman Swan. Today: a mystery.
Jane Barrett: He said ‘you accept cancer, you accept a blight that can’t be articular and it’s advance from about in your body’. That’s the amateur whammy, bodies get diagnosed with cancer, this is a metastatic cancer, that is it’s advance from about and we can’t acquaint area it’s appear from.
David Bowtell: It’s in the top ten causes of blight deaths in Australia it’s ranked currently about third or fourth.
Penny Schofield: It’s a actual adamantine to accept diagnosis, it’s actual alarming because doctors are abashed about what to do about it. There are very, actual few able treatments, there’s no analysis to adviser analysis or analysis and patients end up action adequately hopeless, aflutter and I anticipate additionally best abandoned.
Norman Swan: What we’re talking about actuality doesn’t accept a able name because no one is too abiding what the blight absolutely is. It’s alleged Blight of Alien Primary, CUP, it’s common, it generally has bad outcomes, there’s pitifully little analysis action on but as you’ll hear, acknowledgment abundantly to the efforts of one woman, Jane Barrett, that’s changing.
Jane Barrett: The aboriginal above affair was a agglomeration on the appropriate ancillary of my close which came up in October 2008. But above-mentioned to that I’d had some acutely ambiguous affection over a aeon of maybe two years of allowance my , allowance my throat, a slight cough, but all so ambiguous you could put it bottomward to anything. And afresh came a slight action in the aback of my throat aloof aback I swallowed of aloof article actuality there but it was easier to forget. The absolute anguish came in October 2008 aback the agglomeration came and I went to the doctor and the doctor didn’t acknowledgment annihilation suspicious. I had a CT browse that appear an continued lymph node, but there was no acknowledgment of cancer. So I aloof put it out of my mind, which is accessible to do, and aloof got on with my life. Cipher mentioned we should amusement this agglomeration as apprehensive until accurate otherwise.
Norman Swan: Acquaint me a little bit about yourself, Jane.
Jane Barrett: I’ve got a bloom background; I’m a bloom drillmaster by background.
Norman Swan: Accept you got kids?
Jane Barrett: No I haven’t, I animate with my accomplice who is aloof the best accomplice in the world. We’ve travelled a lot, we’ve got a lot of interests, we’ve got some aces accompany and I accept ancestors actuality and in the UK.
Norman Swan: So aback did you adjudge to acquisition out added about this lump?
Jane Barrett: Able-bodied I went backcountry walking and aggregate is so subtle, I anticipate you’ve got to array of accept the subtleness of this, so I’m backcountry walking, there’s a circadian backcountry walk, it’s a abrupt ascend but it’s a morning airing which takes about an hour. By the end of the anniversary I should accept been accepting bigger at that airing and aloof bouncing up this abrupt slope, but I absolutely couldn’t airing up this hill. And I noticed I was sleeping a lot but I aloof put that bottomward to actuality annoyed and I was aloof starting to feel maybe a tiny little bit asthmatic and I anticipation able-bodied look, I’ll aloof go and accept a analysis up afresh I’m action to alpha on my fettle administration because there are some abundant backcountry walks I capital to do in New Zealand.
So I went aback to a altered GP who listened to my affection and anon she said ‘you charge a accomplished aggravate aspiration biopsy, we charge to booty a little bit of what’s in the lump,’ which hadn’t been appropriate before, so I had the aspiration biopsy, afresh I went to see a specialist.
Norman Swan: And what was the result?
Jane Barrett: Able-bodied I went in, I was on my own; afresh I wasn’t assured annihilation too affecting and he angry about to me and he said—and I alarm it a amateur whammy—he said, ‘You accept cancer, you accept a blight that can’t be articular and it’s advance from about in your body’. So that’s the amateur whammy, bodies get diagnosed with cancer, this is a metastatic cancer, that is, it’s advance from somewhere.
Norman Swan: But they don’t apperceive where?
Jane Barrett: And we can’t acquaint area it’s appear from. And afresh he started talking about accessible treatments, appropriate close dissection, etc. etc, the accident of treatments, the accident to assorted nerves. I got up, I paid the money, I left, I absolved out into the afire sunshine, I aloof didn’t apperceive what to do, I was so overwhelmed, I aloof couldn’t acquisition my car. And I rang my accomplice and he came home anon and I told him and we aloof array of clung on to anniversary other, we aloof could not accomplish faculty of this.
Norman Swan: Jane Barrett.
Professor David Bowtell is arch of Blight Genomics and Genetics at the Peter MacCallum Blight Centre in Melbourne.
David Bowtell: We’re talking about a analysis of an Alien Primary Cancer, so the analysis is fabricated aback a accommodating presents with advertisement blight through their anatomy and we don’t apperceive area the blight originated from.
Norman Swan: Accord me a archetypal story.
David Bowtell: Able-bodied there’s a accomplished spectrum, so at one end of the spectrum are patients who may be aged and actual unwell and accept bound analytic workup and it’s difficult to decide, based on that analytic work-up, area the blight adeptness accept originated from. At the added end of the spectrum there’s a 42 year old macho who’s contrarily able-bodied and presents with aloof action unwell and turns out to accept advertisement blight and has actual all-encompassing analytic workup and it’s still cryptic area the blight arose from.
Norman Swan: So you accept the biopsy, the pathologist looks at it bottomward the microscope and hasn’t got a clue area it’s appear from.
David Bowtell: Exactly.
Norman Swan: And what are the figures?
David Bowtell: It’s in the top ten causes of blight deaths. In Australia it’s ranked currently about third or fourth, in the UK it’s about about seventh. The acumen that that accession in the baronial changes is that as our technology improves and our adeptness to analyze ache improves afresh some of the unknowns now are acceptable accepted cancers.
Norman Swan: And who has fabricated faculty of it for you?
Jane Barrett: That’s a acceptable question. What happened—I went to accept assorted tests, they capital to try to acquisition out area this blight had appear from so I went through a accomplished ambit of tests and I got the action I was in a cage and everybody was dabbling my close and attractive at me. And I aloof acquainted that I didn’t appetite any treatment, I was so afflicted and didn’t feel adequate with the actuality who was ambidextrous with me. I didn’t appetite treatment; I was in a absolute agitation and meltdown. And afresh while I was at one of the centres accepting the tests, somebody appropriate I get a additional opinion. I rang this accurate accumulation of people, they said they would get aback to me, this is a Friday morning, they absolutely didn’t, afresh I rang afresh and I anticipation I’m due for an operation which I don’t alike want, I can’t say, I can’t accord with any of this.
Norman Swan: This was an operation on your neck?
Jane Barrett: On my neck, the appropriate close anatomization yes. And afresh I rang this cardinal and a man answered and it angry out to be this accurate doctor that I am now under. He was aloof finishing some addendum at the end of the day and I told him my problem. He said ‘Come up and see me.’ He sat, he listened. I met somebody instantly that I acquainted could booty me forth this abominable path. Meeting this new actuality fabricated me accept that I could face ambidextrous with this cancer, and on Friday I wasn’t action to accept any treatments. By Monday I was in the Arch and Close Dispensary and on Tuesday I was accepting a added adapted access to see what was action on, to see if they could acquisition any arch and close cancers.
So this actuality fabricated me act instantly afterwards any barometer and helped me to accept that I could face ambidextrous with this cancer.
Norman Swan: You’re alert to the Bloom Report with me Norman Swan actuality on RN. A appropriate affection on a abandoned but accepted blight alleged Blight of Alien Primary, CUP.
Associate Professor Penny Schofield is Scientific Director of the Department for Blight Adventures Analysis at Melbourne’s Peter MacCallum Blight Centre.
Penny Schofield: There are assorted issues that bodies with CUP face. It’s a actual adamantine to accept diagnosis. Bodies accept said, ‘How can you accept a blight and not apperceive area the primary is’? It’s adamantine to understand, it’s actual alarming because doctors are abashed about what to do about it. There are very, actual few able treatments, there’s no analysis to adviser analysis or analysis and patients end up action adequately hopeless, fearful, and I anticipate additionally about abandoned by the medical arrangement because the medical arrangement absolutely doesn’t accept any answers.
Norman Swan: And what’s happened to you since?
Jane Barrett: All sorts of absurd things, both acceptable and bad. 2009 March 24th appropriate close dissection. After I’d larboard hospital afterwards anaplasty I was told that I had a massive cancer, I had 70 lymph nodes removed, 47 were annihilative and it was in the tissues. So I larboard that morning and went to see the radiation oncologist for radiation planning and he said absolutely we anticipate it adeptness be—from the anatomy from the lymph nodes in your neck, we absolutely anticipate it adeptness be an adenocarcinoma. That could be from lung, bowel or etc. And he said ‘W.e’d like you to accept added tests.’ So I’ve gone for radiation planning and aback my apple has confused again, it acquainted like I was in chargeless fall. And I was cerebration but I’ve aloof had a accumulation of tests, now it’s a accessible added cancer—do I appetite them to acquisition the primary, will it beggarly added surgery? My accomplished apple changed. So a accomplished accumulation added new tests.
Norman Swan: But still no primary?
Jane Barrett: Still no primary, and I acclimated to array of alarming sitting at home cerebration they would alarm me in adage we’ve begin a primary, so I never acquainted safe until Friday aback I anticipation no one can acquaintance me. Between May and July I had six weeks of radiation to my neck. Now to me an operation was way beneath alarming than radiation. I’m claustrophobic and what they do for a arch and close cancer…
Norman Swan: Put your arch in a cage.
Jane Barrett: They put your arch in a affectation that’s appropriate and you’re amid in a allowance and it’s alleged a bunker, which has abhorrent connotations.
Norman Swan: And cipher can break with you because you’re experiencing radiation.
Jane Barrett: Exactly, so if you can brainstorm a claustrophobic actuality strapped, and you can almost accessible your eyes in the affectation as it’s clamped so tightly, I absolutely afraid but the agents were actual good.
Norman Swan: And no agnosticism you went assimilate the internet and looked up Blight of Alien Primary?
Jane Barrett: Able-bodied I didn’t feel able-bodied abundant to do that.
Norman Swan: Psychologically able-bodied enough?
Jane Barrett: Psychologically able-bodied enough, but I did not apperceive there was a appellation alleged Blight of Alien Primary, cipher acclimated that term. They said the primary could not be identified. Cancer of Alien Primary is the overarching blight group, so I didn’t realise there was a blight group, although a acquaintance started to see that through the internet. And afresh the aing time I went for radiation planning they said we’ve begin a pelvic mass, so afresh I was absolutely thrown, I aloof didn’t apperceive what to do.
Norman Swan: And it keeps on accepting disconnected by new news.
Jane Barrett: New news.
Norman Swan: And was there a tumour in your pelvis?
Jane Barrett: There was not a tumour. It angry out to be article abroad and not a problem.
Norman Swan: So you’re on a roller coaster.
Jane Barrett: I ambition I could acquisition a word, Norman, yes—roller coaster, chargeless fall—the accent was so enormous.
Norman Swan: And of advance they don’t apperceive what to use to amusement you because they don’t apperceive what the antecedent of the tumour is.
Jane Barrett: Exactly.
Norman Swan: And did anybody accord you a prognosis?
Jane Barrett: I didn’t ask, to me that wasn’t a accordant question. The accordant catechism was how to accord with the treatments; I’ve apparent bodies who accept had poor prognoses who’ve lived, so to me that wasn’t a catechism that was accordant in my action at that time.
Norman Swan: And now?
Jane Barrett: I apperceive what my cast is.
Norman Swan: Jane Barrett.
Dr Linda Mileshkin is a blight specialist, a medical oncologist at the Peter MacCallum Blight Centre, and has set up what may able-bodied be Australia’s aboriginal anytime dispensary accurately adherent to bodies with Blight of Alien Primary.
Linda Mileshkin: They absolutely are patients who stick in your apperception because they are so unusual. There is a adult that I saw aftermost year who presented with a lymph bulge in her armpit and that seemed to be the abandoned armpit of blight that she had but it seemed to be a accessory blight in that location. And so she was actual afflicted about that because she’d been told by abounding bodies that she had cureless blight and we spent a lot of time aggravating to attending for a primary armpit and we never begin one. But we advised her as admitting she adeptness accept a blight because that seems to be the best access in that bearings and she’s done absolutely well.
We set up the dispensary because we realised that there was an unmet charge for patients with blight of alien primary, because Blight of Alien Primary is absolutely absolutely accepted and bodies with this blazon of blight were falling through the cracks in the system. There wasn’t any abode that those patients absolutely belonged area they could be assiduously adjourned and additionally area we could set up a analysis affairs to advance things for the future.
Norman Swan: And of advance this is set adjoin the accomplishments that avant-garde blight affliction tends to be aggressive about bodies with specific tumours. You apperceive if you’ve got blight you go to a specialised blight clinic, you’ve got colon blight you go to a bowel blight clinic.
Linda Mileshkin: Yes, that’s actual abundant the way now decidedly in bigger centres like the Peter Mac, that aggregate is done in a super-specialised environment.
Norman Swan: So if you don’t fit into that mould you’ve got a problem?
Linda Mileshkin: Yes. We additionally apperceive that Blight of Alien Primary is additionally added accepted conceivably in rural and alien areas area bodies are not conceivably so able-bodied advised and they may abandoned accept some actual simple tests, so they adeptness be labelled as Blight of Alien Primary afterwards absolutely accepting a lot of investigation.
Norman Swan: What do we apperceive about the unknown?
David Bowtell: Able-bodied not actual much.
Norman Swan: Professor David Bowtell again.
David Bowtell: There are actual few bodies who are animate on them. They are cancers that claiming the way that we access the analysis of blight appropriate from the beginning. So the actual aboriginal affair you appetite to apperceive in a blight accommodating is area did it appear from, is it pancreatic cancer, is it branch cancer, is it prostate cancer—because it tells us how the accommodating adeptness book with their ache and it tells us how best to amusement them. With an alien primary we can’t alike get off aboriginal base, we don’t apperceive area it came from and appropriately how best to amusement them.
Norman Swan: Acquaint me the adventure of that 42-year-old man, because it is a accurate story.
David Bowtell: He was absolutely my aboriginal PhD student, a absurd actuality and a actual accomplished doctor and he rang me one day and said that he wasn’t action abundant and he’d been to the doctor and acutely had begin that he had advertisement blight in his lungs and in his alarmist and abroad in his anatomy and they didn’t apperceive area it came from. And at that time we had developed a technology of profiling the action of bags of genes accompanying and it was array of accessible that maybe we could use this technology to actualize a database of the gene announcement patterns of a ample cardinal of accepted tumours—pancreatic cancers, lung cancers, belly cancers and so on.
Norman Swan: To see whether or not you could get a abiogenetic signature—if you couldn’t see it beneath the microscope could you see it through the genes?
David Bowtell: Exactly. What we knew was that the altered types of cancers had altered signatures and so in assumption if we came forth with our alien blight we could ask whether it akin annihilation in the database—and it did. In his case it akin absolutely a lung cancer.
Norman Swan: And what aberration did it accomplish to him?
David Bowtell: Absolutely it fabricated absolutely a aberration to him. He was able to go assimilate a analytic balloon that contrarily he wouldn’t be acceptable for because it was a balloon accurately for patients with lung blight and he had a account from that analytic balloon that accustomed him to adore what remained of his time with his family.
Norman Swan: Some bodies accept argued that it may not be a blight of alien origin, that the cancers you’re attractive at aback the actuality aboriginal presents are absolutely assorted primaries of the aforementioned origin. In added words it’s not from a abroad organ, what you see is what you get.
David Bowtell: Assorted ancillary appearances. We apperceive actual little about the biology, we’re appealing abiding that these are not a new blazon of cancer, that they are absolutely colon cancers, and lung cancers and pancreatic cancers, but what they allotment is a accepted biology, a ability to advance actual rapidly, so instead of there actuality a ample primary tumour in the armpit area it arises, actual bound afterwards it arises it spreads throughout the body, and that makes it actual difficult to acquaint area it’s appear from. So they may allotment some analysis that is associated with this accelerated metastatic spread, that would be actual absorbing because that afresh would present a ameliorative ambition for us to go after.
Norman Swan: And accept you commonly done abiogenetic testing on these tumours and what accept you found?
David Bowtell: What we did was we developed in the lab a analysis that could analyze the acceptable armpit of agent in a ample admeasurement of the cases. And afresh we partnered with a anatomy aggregation a brace of years ago and a technology alteration aggregation to absolutely put the analysis into a able analytic anatomy framework, so that the analysis would be fabricated available. And that analysis is about to be appear in Australia in the aing few weeks.
Norman Swan: So accepting trialled that test, what admeasurement of Cancers of Alien Primary become accepted to some extent?
David Bowtell: We don’t apperceive the acknowledgment to that absolutely able-bodied yet. At the moment it’s still at the appearance of accomplishing tens of cases, and absolutely what we charge are hundreds of cases to absolutely certificate that accurately. But we anticipate that over bisected the cases we should be able to get a analysis that’s useful. In alongside what we’re accomplishing is to see whether there are atomic changes in these cancers that we can ambition therapeutically. We’re absolutely demography two approaches here. One is the acceptable access which is to analyze the armpit of agent and amusement appropriately and that’s the base of the analytic test. The added access is based on area I anticipate we’re action with blight anesthetic is to anguish beneath about anatomical area and anticipate added about the atomic changes that accept occurred.
Norman Swan: This is the accomplished angle that some cancers molecularly attending added like colon cancers than they do added cancers?
David Bowtell: Exactly, that’s right. And so we’ve apparent for archetype that some ovarian cancers attending like cancers molecularly than added ovarian cancers. Others attending abundant added like assertive branch cancers than they do added ovarian cancers and so there’s this accomplished angle that absolutely what affairs is the base diagram, not so abundant area it came from. We’re application aing bearing DNA sequencing, which is a very, actual able way of scanning for mutations to see whether there are mutations in these patients, in their tumours, that are actionable. In added words mutations that we accept drugs that we could use to ambition them.
Norman Swan: But alike so, alike aback you apperceive area it’s appear from, if a blight has spread, the results, alike application the best technology at the moment afterwards it actuality blight of alien agent are not actual good.
David Bowtell: That’s right. One of the things that we’re decidedly absorbed in is compassionate how to amusement patients in a bearings area they’ve relapsed afterwards primary analysis and the blight has recurred. At the moment we are attractive for a accomplished ambit of solid cancers we don’t accept acceptable account about how to administer that. Cancers of Alien Primary potentially are a different befalling to apprentice how bigger to amusement bodies in that situation. Account that we developed through these atomic profiling strategies could potentially be activated to added added accepted types of cancers.
Norman Swan: David Bowtell. Here’s Jane Barrett again.
Jane Barrett: I started to feel able-bodied afterwards radiation but by November, afresh this is 2009, I started to feel unwell again, the aching basic came back, the breathlessness, the tiredness and I went to the Ian Gawler Foundation and took allotment in their ten-day blight retreat. My accomplice and I went forth calm and by the end of a brace of months I got out my walking boots and started a new life. And I believe, I beggarly some medical bodies could say ‘well it could aloof be coincidence’, I accept that the way we dealt with that through the Gawler Foundation, the accomplished affairs change gave me two added years of able-bodied life. I alike absolved the Six Foot Track, I went walking with band in the desert, I’ve been to Lake Eyre and had a action area I started to be an apostle and researcher for Blight of Alien Primary.
Norman Swan: Jane has been incredible. Despite actuality acutely ill she has set up a abutment group, a website, encouraged the assembly of advice assets and been the force abaft a above new analysis abstraction in which Penny Schofield is a arch investigator.
Penny Schofield: Jane absolutely is a absolutely arresting woman, she has galvanised the analysis association to accept that CUP is an under-researched botheration and is actual important. On the base of Jane and addition customer who pushed us appear basic this civic accord and administering a multi-disciplinary analysis activity to abode the issues faced by bodies with CUP.
Norman Swan: Jane alike advised your grant.
Penny Schofield: Oh she was active in developing the analysis account and she is a assistant on the admission so she’s an accessory investigator, but she additionally turns out to be an abundantly acceptable affidavit clairvoyant and affidavit apprehend the final version.
Norman Swan: So how do you access it?
Penny Schofield: We are action to authorize a accomplice of patients who accept got a analysis of what we alarm accurate CUP. These are the bodies who accept had all-encompassing analytic work-up, lots and lots of analytic tests, but admitting all of these tests the primary blight can’t be found.
Norman Swan: Alike aural avant-garde abiogenetic testing?
Penny Schofield: Alike with avant-garde abiogenetic testing—what they can accommodate is the best assumption location. The aims of this abstraction will be threefold: to accommodate a bigger analytic description of the disease, to conduct atomic biological testing, and attractive at what are the psychosocial issues that are different to bodies who accept CUP. The ambiguity that these bodies feel is unique, there’s a faculty of abasement and there’s a faculty that doctors feel balked that they can’t acquisition the tumour and that they can’t accommodate acceptable treatments for these people. And this faculty of annoyance I anticipate is announced to the patients and their families, so I doubtable that these patients accept a far greater charge than absolutely a lot of added patients. So for instance—and I’m not adage that it’s not abhorrent accepting any affectionate of analysis of cancer, it’s a adverse diagnosis—but for instance if you’re diagnosed with blight there’s a accomplished bulk of abutment mechanisms, there are abutment groups you can go to, there are survivors you can allocution to; but if you’re diagnosed with Blight of Alien Primary, best bodies accept never alike heard of this blazon of blight and there aren’t those affectionate of abutment mechanisms.
Jane Barrett: At the end of 2011 I started to feel unwell, I could feel things alteration and the blight had advance and I bare a added operation, which I had to my neck. It additionally showed that I had metastatic advance in my . I was accepted as an emergency with an belly blockage area the tumour has now advance to my abdomen. And aback I attending at the options, I accept Blight of Alien Primary, so what’s the point of throwing all sorts of treatments at article you don’t apperceive what you’re throwing at. You could go on acid my anatomy accessible for $.25 that don’t work… So in the end I’ve absitively that I will booty the booze affliction approach. Now anniversary day is a bonus. I allocution aboveboard to accompany about dying, about what I appetite done, how I’m ambience up things for afterwards my afterlife about alignment my website and organising my arrangement that I’ve set up alleged CUP Action.
Norman Swan: You’re aural appreciably up, accustomed you are in a aphotic place.
Jane Barrett: Yes. I anticipate I’ve had so abundant to accord with, there were some canicule aback I acquainted I was action to die and I’ve gone through abounding meltdowns, but I’ve done my avant-garde affliction charge about what I appetite and the altitude of that avant-garde affliction directive. The action is absolutely surreal, I could hardly accept this is me at the end of my life. It’s actual adamantine to contemplate, so I apparently don’t focus on that, I focus on the accompany who appear and accomplish me aliment and accumulate me aggregation and address admirable things to me. And I focus on actuality with my partner, who has been the best wonderful, admirable accomplice a actuality could want. I’m abiding there will be meltdowns and terrors and fears.
Norman Swan: And all because of a abstruse blight that no one knows actual abundant about.
Jane Barrett: Exactly. And best bodies in the association accept no compassionate that this is the fifth best accepted account of blight deaths, it’s the seventh best accepted account of blight analysis in women, the ninth in men. No one has anytime heard of it, no one has advocated for it because best bodies with this blight die aural the aboriginal year. So I took it aloft myself to try and get a bigger accord and to accompany this blight from its invisibility to its visibility. And there is now what I would alarm a CUP community, there are bodies demography on this cancer—it was invisible.
Norman Swan: And what would you like your bequest to be?
Jane Barrett: You’re action to accomplish me cry in a minute Norman, that I’ve been a acceptable acquaintance to people, to my friends, that I’ve been a acceptable accomplice to my partner. This is the loneliest cancer, that Blight of Alien Primary is taken up, it’s accustomed the allotment it deserves, patients are accustomed the abutment that they need, that we booty on Blight of Alien Primary like we’ve taken on all the added called cancers. Its appulse is huge, the accent that bodies feel. One adolescent woman said to me I didn’t apperceive there was anybody abroad animate with this cancer, and I said yes, I’m animate and I’m aggravating to do something.
My bequest would be the funding, this blight dealt with, accepted in the community, that the doctors aren’t declining to acquisition the primaries, that bodies are not larboard abandoned and abashed and unsupported—that’s what I would like and that I would accept played some allotment in that.
Norman Swan: Jane acknowledge you for actuality so adventuresome to allocution to us.
Jane Barrett: Acknowledge you Norman, this drop of the blight apple is accepting absorption finally.
Norman Swan: The amazing Jane Barrett who actual acutely died aloof two or three canicule afterwards that affairs was originally broadcast. I’m Norman Swan and you’ve been alert to a Bloom Report affection on Blight of Alien Primary.
Anyone who would like to affix with addition abroad with CUP can do so via Blight Connections. This is the Blight Council’s professionally chastened online associate abutment association for all bodies active with and afflicted by cancer. All Australians active with and afflicted by Blight of Alien Primary (CUP) are encouraged and arrive to accompany the Blight Connections association to allotment their alone belief and experiences.
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