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• Cancer Information - How cancer relates to me
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  I have or had cancer

  I am a friend

  I am a caregiver

  I work with people with cancer

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• Cancer Information - Cancer Type
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  Adrenal

  Anal

  Bile duct

  Bladder

  Bone

  Brain and spinal

  Breast

  Breast- Ductal carcinoma in situ (DCIC)

  Breast- HER2 positive

  Breast- Inflammatory

  Breast- Invasive ductal carcinoma

  Breast- Lobular carcinoma

  Breast- Triple negative

  Cancer of Unknown Primary

  Cervical

  Colorectal

  Esophageal

  Eye

  Fallopian Tube

  Gallbladder

  Gestational Trophoblastic Disease

  Hodgkin Lymphoma

  Kidney

  Laryngeal

  Leukemia

  Liver

  Lung

  Melanoma

  Mesothelioma

  Multiple Myeloma

  Nasal/paranasal sinus

  Neuroendocrine/carcinoid

  Non-hodgkin Lymphoma

  Oral

  Ovarian

  Pancreatic

  Parathyroid

  Penile

  Pituitary

  Pharyngeal

  Prostate

  Salivary Gland

  Soft Tissue Sarcoma

  Skin, non-melanoma

  Small Intestine

  Stomach

  Testicular

  Thymus

  Thyroid

  Uterine

  Vaginal

  Vulvar

  Not on the list

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• Cancer Information - If cancer type is not on the list, please write here
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• Other Information - Age range
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  Please select a response Under 20 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 and over Prefer not to answer
• Other Information - Gender
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  Male

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