Catching cancer early often allows for more treatment options. DATE: Can Alcohol Increase Your Risk of Developing Ovarian Cancer? An ultrasound can provide an estimate of the size of amass, as well as help to determine whether it's asimple cyst, a complex cyst, or solid. This can help them determine if a tumor is present and if its cancerous. High levels of CA-125 in your blood can be a sign of cancer. But some people have a slightly higher risk of developing the condition. It'simportant to be familiar with the signs and symptomsand to talk to your doctor if you have any risk factors for the disease. Am Fam Physician; 93(8):676-81. Dr. Steven Anatol Vasilev is an ovarian cancer expert double board-certified in gynecologic oncology and obstetrics/gynecology. To find it, go to the AppStore and type signNow in the search field. But ovarian cancer is not silent. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Diagnosis and management of ovarian cancer. These specialists diagnose, analyze, and treat ovarian cancers. z?2}*"B wE,=C.k`6mrZ+_a6effR,-1}h4f_ endstream endobj 59 0 obj 194 endobj 37 0 obj << /CropBox [ 36 36 576 756 ] /Parent 30 0 R /Contents 44 0 R /Rotate 0 /MediaBox [ 0 0 612 792 ] /Resources << /ColorSpace << /CS0 43 0 R /CS1 42 0 R >> /ExtGState << /GS0 54 0 R /GS1 55 0 R >> /Font << /TT0 40 0 R /TT1 39 0 R /TT2 46 0 R /TT3 47 0 R /TT4 50 0 R >> /XObject << /Im0 56 0 R /Im1 57 0 R >> /ProcSet [ /PDF /Text /ImageC ] >> /Type /Page >> endobj 38 0 obj << /Ascent 905 /CapHeight 1000 /Descent -211 /Flags 32 /FontBBox [ -665 -325 2000 1006 ] /FontFamily (T>) /FontFile2 53 0 R /FontName /MKBLAH+ArialMT /FontStretch /Normal /FontWeight 400 /ItalicAngle 0 /StemV 88 /Type /FontDescriptor /XHeight 1000 >> endobj 39 0 obj << /BaseFont /MKBLAH+ArialMT /Encoding /WinAnsiEncoding /FirstChar 32 /FontDescriptor 38 0 R /LastChar 148 /Subtype /TrueType /Type /Font /Widths [ 278 0 0 0 0 0 0 0 333 333 0 0 278 333 278 0 556 556 556 556 556 556 556 0 0 556 278 0 584 0 0 0 0 667 0 0 722 667 0 0 722 278 0 0 0 0 722 0 667 0 0 667 611 0 0 944 667 667 0 278 0 278 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 556 333 500 278 556 500 722 500 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 333 333 ] >> endobj 40 0 obj << /BaseFont /Arial-BoldItalicMT /Encoding /WinAnsiEncoding /FirstChar 32 /FontDescriptor 41 0 R /LastChar 122 /Subtype /TrueType /Type /Font /Widths [ 278 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 611 0 0 0 667 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 556 0 0 611 556 0 0 0 278 0 0 278 0 611 611 0 0 389 556 333 0 0 0 0 0 500 ] >> endobj 41 0 obj << /Ascent 905 /CapHeight 1000 /Descent -211 /Flags 96 /FontBBox [ -109 -212 1079 905 ] /FontFamily (\rm) /FontName /Arial-BoldItalicMT /FontStretch /Normal /FontWeight 700 /ItalicAngle -15 /StemV 135.84 /Type /FontDescriptor /XHeight 1000 >> endobj 42 0 obj [ /ICCBased 52 0 R ] endobj 43 0 obj /DeviceGray endobj 44 0 obj << /Filter /FlateDecode /Length 49 0 R >> stream But ovarian cancer doesnt have its own screening test. Weve invested more than $5 billion in cancer research since 1946, all to find more and better treatments, uncover factors that may cause cancer, and improve cancer patients quality of life. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. "If her motivation was truly just money, it would seem odd that she would then go and spend money on medical supplies and treatment.". Researchers are working on possible screening tests, but for now, theres no single test being used to detect ovarian cancer. Bladder, Breast, and Colorectal Cancer- Treatment Summary Table Kidney, Lung, Ovarian, and Prostate Cancer - Treatment Summary Table. Tests for Ovarian Cancer. Specialist. This information can help your cancer care team select better treatments and understand your risk factors for other health complications. Get the details here. Formidable employer power, Jacky and his boyfriend were 'flatmates' for years until his mother found out about the truth, 'Momentous occasion': Spears taken by Captain Cook in 1770 to be returned home, This youth worker can't talk about youth crime without mentioning the kids sleeping in nearby public toilet blocks, Prince Harry and Meghan told to vacate UK home, Australian family sue Vegas company over Grand Canyon chopper flight crash, Murder trial hears man whose body was found in freezer stole live-in partner's disability pension, 'The biggest mistake of our lives': US fertility clinic sued for using embryo with deadly cancer gene, Pedestrian killed after being struck by car on major Darwin road, 'I pretty much cried all day': Devil in one of the last 'disease-free' populations found with facial tumour. Its slightly more common in Native American and white populations than in people who are Black, Hispanic or Asian. Get access to thousands of forms. Will I be able to work during my treatment? It is usually the first test performed to evaluate an ovarianmassand does not cause radiation exposure. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/ovarian-cancer-screening. This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced. If you have specific questions about ovarian cancer survival rates, talk with your healthcare provider. June 1, 2010 Go to the Chrome Web Store and add the signNow extension to your browser. I know my family would be fine my friends and other people important to me would make certain of that. But knowing your biological family history can help you prepare for any heightened risk of developing ovarian cancer. Search thousands of physician, PA, NP, and CRNA jobs now. Due to the fact that many businesses have already gone paperless, the majority of are sent through email. Defence barrister Michael Hibble said a clinical assessment found Wieland was likely suffering from factitious disorder, also known as Munchausen syndrome, and genuinely thought she was sick. https://www.uptodate.com/contents/search. The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Easily find the app in the Play Market and install it for eSigning your cancer diagnosis paperwork. Overview. The more serious the condition, the higher the number. A 2018 guideline from the U.S. Preventive Services Task Force stated that the risks of possible screening tests are too great to make a case for the potential benefits. According to the American Cancer Society, more than 21,000 people in the United States will be diagnosed with ovarian cancer in 2022. 26(1):43-51. A Pap test can detect cervical cancer. If ovarian cancer is found, you will likely begin treatment right away. A California couple is suing a fertility clinic claiming that doctors mistakenly transferred an embryo that tested positive for a deadly cancer gene and then tried to cover it up. Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. Follow our step-by-step guide on how to do paperwork without the paper. Because of its cross-platform nature, signNow is compatible with any device and any operating system. Dr. Steven Anatol Vasilev is an ovarian cancer expert double board-certified in gynecologic oncology and obstetrics/gynecology.". Why are doctors sued and politicians arent? And due to its multi-platform nature, signNow can be used on any gadget, desktop computer or mobile phone, irrespective of the operating system. Rony Kampalath, MD, is board-certified in diagnostic radiology and previously worked as a primary care physician. Below are six commonly reported silent signs of ovarian cancer that a person may miss or ignore. I would record my goals here, and celebrate each one as it is reached. These are usually early stage tumors and usually do not grow back after surgery. This can make early detection difficult. The answer is simple - use the signNow Chrome extension. Research from 2021 emphasizes the importance of treatment by a GO to increase overall survival among women with ovarian cancer. During this surgery, the oncologist will likely remove the uterus, ovaries, and fallopian tubes. Signs and symptoms of ovarian cancer. Healthline Media does not provide medical advice, diagnosis, or treatment. Advertising revenue supports our not-for-profit mission. In addition to imaging studies and a physical exam, blood work can be helpful for assessing some aspects of ovarian cancer. If youve received an ovarian cancer diagnosis, you may want to ask your healthcare provider questions such as: A cancer diagnosis is scary, no matter the type. Observation is key after ovarian cancer treatment. They also produce hormones, like estrogen and progesterone. 2019; doi:10.3322/caac.21557. If you or a loved one has ovarian cancer, you may also feel sad, frustrated or hopeless. New York State Department of Health Though the below mostly concerns your physician, it may be helpful as you work to understand what treatment options may be appropriate for you. I know you will do the same. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ)Health Professional Version. Learn more about what to look for and when to be concerned. information and will only use or disclose that information as set forth in our notice of Here you'll find in-depth information on specific cancer types including risk factors, early detection, diagnosis, and treatment options. Your risk might be high if the genes that increase the risk of breast and ovarian cancers run in your family. Diagnosis and Management of Adnexal Masses. The doctor tests this sample to see if it is cancerous. Ensures that a website is free of malware attacks. (2020). And then I would get on with my life, living it as normally as I could. 1. The biopsy is taken and sent to a pathologist to determine if it is cancerous, and if so, the type. In this cancer staging system, the least severe is the lowest number. If you own an iOS device like an iPhone or iPad, easily create electronic signatures for signing a cancer diagnosis paperwork in PDF format. 1. Sometimes ovarian cancer causes a higher level of CA 125 in the blood. PO Box 509, Albany, NY 12201-0509 0000001657 00000 n I do know this. The exact cause of ovarian cancer isnt yet known. (2012). With you, cancer has invaded our inner circle, and we all share your shock and despair. information highlighted below and resubmit the form. A surgeon will also remove or make note of any suspicious-looking nodules or other masses. Ovarian cancer also arises in related organs, such as the fallopian tubes and peritoneum, the tissue that protects organs in the abdomen. RDW tends to be high and MPV low with ovarian cancer. Late detection puts many people diagnosed with ovarian cancer at a disadvantage because of how quickly it has spread by this time. 0000003597 00000 n The best editor is directly at your fingertips offering you a wide range of advantageous tools for submitting a How To Make Fake Cancer Report Khrw3. Toss A, et al. Take one day at a time while you fight this disease, be grateful for each completed day, look forward to the next one. Getting in touch with others who are going through the same thing can help you process the difficult emotions that often come with a cancer diagnosis. Hereditary ovarian cancer: Not only BRCA1 and 2 genes. JAMA. Since the doctor is feeling for your ovary beneath fatty tissue, the exam is less accurate in identifying a mass in people who are overweight or obese. Get access to thousands of forms. Using the scope as a guide, along with additional ports to hold instruments, the surgeon can assess the cancer, perform staging biopsies and, in some circumstances, remove ovarian tumors. International Journal of Gynecological Cancer. There are several reasons early ovarian cancer detection and diagnosis isnt more common. For this reason, the condition is often difficult to diagnose in the early stages. Tworoger SS, et al. It may take its toll, but there is no shame in it, no reason to hide. (2015). Ovarian Cancer Stages. Review/update the At times, a needle biopsy (in which a needle is inserted through the skin) may be considered, but it's thought that if ovarian cancer is present, this could result in what's known asseeding (the spread of the tumor). I would answer to the best of my ability any questions I have about life, death and spirituality, seeking help and advice where I need it. American Society of Clinical Oncology. Symptoms associated with ovarian cancer. Select the document you want to sign and click. Whats the Survival Rate for Stage 4 Ovarian Cancer? It's important to note that a Pap smear alone (without a bimanual exam), is helpful in detecting cervical cancer but not ovarian cancer. A 2012 study explained the symptoms of ovarian cancer as follows: If any of these symptoms are persistent or you experience them for more than 12 times per month, make an appointment with your doctor so you can get to the bottom of whats happening in your body. Early-stage ovarian cancer is usually asymptomatic. Use them. Changes in your eating habits, getting full early and losing your appetite. Detecting ovarian cancer at stage 1 means treatment can start sooner. Just as there is no screening test for ovarian cancer, there is no single test that can diagnose ovarian cancer, either. Sometimes ovarian cancer causes a higher level of CA 125 in the blood. Ovarian torsion occurs when an ovary becomes twisted around its supporting tissues. signNow has paid close attention to iOS users and developed an application just for them. Treatment Summary Tables. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. Other less common symptoms include fatigue, back pain, pain during sex, and changes in the menstrual cycle. We acknowledge Aboriginal and Torres Strait Islander peoples as the First Australians and Traditional Custodians of the lands where we live, learn, and work. fake ovarian cancer diagnosis letter Create this form in 5 minutes! They may recommend additional tests, including: Providers may use several imaging tests, including: Blood tests look for a substance called CA-125. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. Though most ovarian cysts are benign, some are cancerous. Within the practice of radiology, he specializes in abdominal imaging. This test looks forevidence of metastases (spread) anywhere in thebody and is helpful in discriminating between scar tissue and cancer. In sentencing, Magistrate Viviana Keegan ordered Wieland pay back more than $29,000 to victims of the fraud. Biggs WS, Marks ST. She will be eligible for parole in February 2021 after serving six months in prison. Changes in your eating habits, getting full early and losing your appetite. Treatment consists of surgery and adjuvant chemotherapy. Ovarian cancer: Still possible after hysterectomy? Epithelial ovarian cancer is the more common type. Verywell Health's content is for informational and educational purposes only. Find out why this happens, how to recognize the symptoms, and more. Printing and scanning is no longer the best way to manage documents. If you wish to share the cancer diagnosis letter with other people, you can easily send it by electronic mail. Find the extension in the Web Store and push, Click on the link to the document you want to eSign and select. (2018). Highest customer reviews on one of the most highly-trusted product review platforms. But that doesn't happen in everyone with ovarian cancer. With the collaboration between signNow and Chrome, easily find its extension in the Web Store and use it to eSign cancer diagnosis paperwork right in your browser. No one knows exactly what is going to happen with you. A PET scanis a functional imaging test that measures tissue activity. The whole procedure can last a few moments. At the American Cancer Society, we have a vision to end cancer as we know it, for everyone. You can react to new situations earlier, giving your doctors better chance of helping you through crises. colon cancer than the siblings of patients without polyps." For patients diagnosed at age R60 with no parental history of colorectal cancer, the relevant line in the personalized letter is revised to state: "Because you have had an adenoma, your siblings may be more likely to get colon cancer than the siblings of patients without polyps." Learn about the symptoms, treatment options, and outlook for ovarian cysts and ovarian. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. My Account, Forms in Help us end cancer as we know it,for everyone. Imaging tests can help identify a small ovarian mass and further evaluate a mass that's felt on exam. This content does not have an English version. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Ovarian cancer risk factors include: Theres also an increased risk of developing ovarian cancer as you grow older. document a fraudulent battle with terminal ovarian cancer in 2018. . Journal of Ovarian Research. A doctor's letter to a patient with newly diagnosed cancer A doctor's letter to a patient with newly diagnosed cancer Dr. Martin Young Physician June 9, 2011 Dear "Robin," Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease. Get to know your disease from reputable sources. Patni R. (2019). Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. a swollen tummy or feeling bloated pain or tenderness in your tummy or the area between the hips (pelvis) no appetite or feeling full quickly after eating an urgent need to pee or needing to pee. By Steven Vasilev, MD Get connected to a strong internet connection and start completing forms with a fully legitimate eSignature within minutes. Select the area you want to sign and click. Let's take a closer look at 7 silent warning signs of ovarian cancer that are often ignored or overlooked. Mobile devices like smartphones and tablets are in fact a ready business alternative to desktop and laptop computers. An ultrasound can also detect free fluid in the pelvis, which is often seen with advanced tumors. The diagnostic tests most often used include: If these tests suggest ovarian cancer may be present and if a biopsy confirms the tumor is cancerous your doctor may also order tests to determine if the cancer has spread beyond the ovaries. Imaging tests and surgery can help determine if cancer has spread to lymph nodes or other regions of the body. other information we have about you. Unfortunately, by the time most patients with ovarian cancer see a doctor, 70% to 80% are already at stage III or IV. During these appointments, your provider may go through any possible symptoms and do an exam. As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. I would make my marriage the best that I could with whatever time I have left. AskMayoExpert. Sometimes, your provider may order imaging tests, typically a CT scan. You may opt-out of email communications at any time by clicking on 0000007786 00000 n It can also help them see if the cancer has spread beyond the ovary. information is beneficial, we may combine your email and website usage information with Theres no way to prevent ovarian cancer completely. The oncologist may request additional testing. ACOR.org is a good starting point. Carlson KJ. TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else". ), (https://www.cdc.gov/cancer/ovarian/basic_info/index.htm). Ovarian cancer is cancer that develops in one of the two ovaries, small glands in the female reproductive system. Stage 4 Endometriosis vs. Endometrial Cancer: Effect on the Uterus, Ovarian Cancer Facts and Statistics: What You Need to Know, 11 Types of Ovary Pain and Treatment Options, Neoplasm Types and Factors That Cause Them, Single and combined use of red cell distribution width, mean platelet volume, and cancer antigen 125 for differential diagnosis of ovarian cancer and benign ovarian tumors, Diagnosis and Management of Adnexal Masses, https://www.cancer.net/cancer-types/ovarian-fallopian-tube-and-peritoneal-cancer/stages-and-grades, Screening for Ovarian Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force, Single and Combined use of Red Cell Distribution Width, Mean Platelet volume, and Cancer Antigen 125 for Differential Diagnosis of Ovarian Cancer and Benign Ovarian Tumors, Clinical Use of Cancer Biomarkers in Epithelial Ovarian Cancer: Updated Guidelines From the European Group on Tumor Markers, https://www.cancer.gov/types/ovarian/hp/ovarian-epithelial-treatment-pdq. The five-year relative survival rate for localized ovarian cancer that has not spread outside the ovaries is 93%. (https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq), (https://www.acog.org/Patients/FAQs/Ovarian-Cancer?IsMobileSet=false), (https://www.womenshealth.gov/cancer/ovarian-cancer/ovarian-cancer-risk-factors), (https://ghr.nlm.nih.gov/condition/ovarian-cancer#inheritance), Visitation, mask requirements and COVID-19 information. "She had no control of how generous the Townsville community would be in relation to the donations. Memorial Sloan Kettering Cancer Center. Be mindful of any symptoms you may be having and tell your provider about them. Single and Combined use of Red Cell Distribution Width, Mean Platelet volume, and Cancer Antigen 125 for Differential Diagnosis of Ovarian Cancer and Benign Ovarian Tumors. Cleveland Clinic is a non-profit academic medical center. With signNow, you can eSign as many documents daily as you need at a reasonable price. Brilhante AVM, et al. To get a broad picture of the differences between stages, these can be broken down into: The full FIGO,named for the International Federation of Gynecology and Obstetrics, is a surgical staging system that uses Roman numerals for stages (to estimate the prognosis) and letters forsubstages (which help guide treatment options). 0000001344 00000 n Common ovarian cancer treatments include: After youve completed ovarian cancer treatment, your healthcare provider will want to see you regularly for observation. Current practices on genetic testing in ovarian cancer. What Should You Ask Your Doctor About Ovarian Cancer? Learn more. Chemotherapy is also a common treatment. Centers for Disease Control and Prevention. A few possible causes (there are many) may include the following: A biopsy is used to determine the type and grade of a tumor. Carcinomatosis (widespread areas of tumor), Omental cake (thickening of the omentum, the fatty layer that lies over the abdominal organs), Fat stranding (swelling in abdominal fatty tissues). Updated 01/19/18. Wieland cried and hugged family members before being led from the court in handcuffs. Despite iPhones being very popular among mobile users, the market share of Android gadgets is much bigger. (2020). Start writing a book. Use its powerful functionality with a simple-to-use intuitive interface to fill out What does a Sample letter for cancer diagnosis look like online, e-sign them, and quickly share them without jumping tabs. 2018;11(1):10. doi:10.1186/s13048-018-0382-3. Lucy Wieland used social media and blog posts to document a fraudulent battle with terminal ovarian cancer in 2018. I know they will welcome you with open arms. Imaging tests can show whether a pelvic mass is present, but they cannot confirm that the mass is a cancer. How To Make Fake Cancer Report Khrw3 is up-to-date and correct. Get your online template and fill it in using progressive features. After its signed its up to you on how to export your cancer diagnosis letter: download it to your mobile device, upload it to the cloud or send it to another party via email. There are three variants; a typed, drawn or uploaded signature. 0000034376 00000 n Oncologists often specialize in a specific type of cancer such as breast cancer or colon cancer. Pelvic exam: This checks for an enlarged ovary or signs of fluid in the abdomen. But figures alone do not tell the whole story. Approximately 13,770 women will die of the disease during the year. American Cancer Society. They leave a legacy behind that we all should learn from and try to copy. Founded in 2004 byKevin Pho, MD, KevinMD.com is the webs leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories. Search for the document you need to eSign on your device and upload it. It is the name and contact details of the doctor who wrote this letter. U.S. Preventive Services Task Force. Choose our eSignature tool and forget about the old times with security, efficiency and affordability. 0000005613 00000 n & Estates, Corporate - Single and combined use of red cell distribution width, mean platelet volume, and cancer antigen 125 for differential diagnosis of ovarian cancer and benign ovarian tumors. Also,lymph nodesmay be described as enlarged. Start completing the fillable fields and carefully type in required information. What is the survival rate of ovarian cancer? This is because the early symptoms of this cancer can be difficult to detect. We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our 3rd party partners) and for other business use. Bleeding after hysterectomy: What can I expect? Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. A number of tests and procedures may be used to diagnose ovarian cancer, including a pelvic exam;imaging tests, such as transvaginal ultrasound, CT, or MRI; and blood tests, such as CA-125. Persistent abdominal (belly) bloating Bloating is the most commonly reported symptom in. Had bronchoscope and told no biopsy done. Imaging tests. Because of this, providers use blood tests in combination with other tests to diagnose ovarian cancer. But not all providers agree on this advice. All rights reserved. Follow the step-by-step instructions below to eSign your cancer diagnosis letter template: Select the document you want to sign and click Upload. Research. During a search, police seized a bottle labelled as fertility medication, but which actually contained an antibiotic used to treat urinary tract infections. Include the date to the sample using the Date function. Get free updates delivered free to your inbox. Technology, Power of Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease. Wadsworth Center trailer << /Size 60 /Info 31 0 R /Encrypt 35 0 R /Root 34 0 R /Prev 157700 /ID[<3c5576594ae9b25027798d73c63a1037><121be6f3942678520a99f3a168d4fdb1>] >> startxref 0 %%EOF 34 0 obj << /Metadata 32 0 R /Pages 30 0 R /Type /Catalog /PageLabels 28 0 R /PageLayout /SinglePage /OpenAction 36 0 R /ViewerPreferences << /DisplayDocTitle true >> /Outlines 27 0 R /PageMode /UseNone >> endobj 35 0 obj << /Filter /Standard /R 3 /O (-_iH'+SJ7GD6@) /U (CbA' PR ) /P -1340 /V 2 /Length 128 >> endobj 36 0 obj << /S /GoTo /D [ 37 0 R /FitH -32768 ] >> endobj 58 0 obj << /S 93 /O 202 /L 218 /Filter /FlateDecode /Length 59 0 R >> stream
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