Previous Thread
Next Thread
Print Thread
Page 1 of 3 1 2 3
#94836 05-02-2009 09:40 PM
Joined: Jan 2009
Posts: 253
Gold Member (200+ posts)
OP Offline
Gold Member (200+ posts)

Joined: Jan 2009
Posts: 253
I've done quite a bit of research since I was diagnosed, but find I still don't quite understand cancer, and have some fundamental questions.

With all the bad news on the forum lately, I wonder what type of head and neck cancer is considered aggressive. Is(are) all types squamous cell-carcinoma aggressive? Is the degree of aggressiveness based on location, different types of squamous cell and/or the immunostains done on the biopsy?

Thanks
Sandy



Sandy 56, BOT SCC Biopsy 1/21/09 Stage 3, T3NXM0.
Finished 3 cycle induction chemotherapy 4/7/09. (Chisplatin, 5-fu and Texotere). Re-staged 4/20/09,(very successful.) Will start Carboplatin/radiation 2 Gy/5 days/7 weeks (Tomotherapy) starting May 4th. Finished 6/22/09.
OCF member/supporter

SandySt. #94841 05-03-2009 04:02 AM
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
Sandy, you are quite the thinker. I am sure there are a lot of us wondering that too. You have asked a verry good question and I for one will watch the forums for the answers that will surely come.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
SandySt. #94844 05-03-2009 04:36 AM
Joined: May 2007
Posts: 666
"Above & Beyond" Member (500+ posts)
Offline
"Above & Beyond" Member (500+ posts)

Joined: May 2007
Posts: 666
SCC just gives you the cell type that has gone bad. I.e. the squamous cells.
It does not tell how these cells arrived at the dark side. (There are many way screwing up a cell, it is a wonder they actually work especially if you consider the numbers and the fact that they must constantly change)
That is to say not all SCC are the same. Some respond to MAB treatments while others do not.
For example; only around 20-30% of breast cancers can respond to herceptin, were a growth factor is over expressed. .... and there are also different ways that a growth factor can get over expressed/overactive too.
Back to SCC, there are chromosomal abnormalities (translocation, detetions etc), but in cancer cells things go haywire because they are not normal anymore. Therefore it may be that some of these abnormalities are a consequence (but not the cause) of a loss of normal cellular control. Some of that you can see with FISH etc but I doubt very much that this is done routinely!
Also, this is just one side then there is also the immune system that may or may not help fighting this.

This is a gross simplification, and I will not even pretend that I am current in this. What you really need is to talk to a cancer geneticist that specializes in SCC.
On the other hand to put is bluntly: it is what it is. The treatment is essentially fairly standard, we are not at the point of (very) individualized medicine.

M

You might be interested in this:
The Journal of Laryngology & Otology (2009), 123 : 266-272 Cambridge University Press



Last edited by Markus; 05-03-2009 04:42 AM.

Partial glossectomy (25%) anterior tongue. 4/6/07/. IMRT start @5/24/07 (3x) Erbitux start/end@ 5/24/07. IMRT wider field (30x) start 6/5/07. Weekly cisplatin (2x30mg/m2), then weekly carbo- (5x180mg/m2). End of Tx 19 July 07.
Markus #94848 05-03-2009 05:40 AM
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
Thanks Markus. You always did have the right answers for me and others.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
SandySt. #94849 05-03-2009 06:24 AM
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2008
Posts: 3,082
Sandy

When I was first diagnosed in August 2007, I was stunned that all the internet sites and hospital web sites consistently described Head and Neck Cancer as "very aggressive" with poor survival rates. Now part of that is due to late discovery so many H&N cancers are stages III and IV - skewing the statistics. Part of the puzzle is genetic, here is a link to a news article exploring "micro-RNA": Genetic markers for Agressive H&N Cancer My wife has always been depressed by the ubiquitous 50% 5 year survival rate that appears in this article also. There was also a very informative general article in Parade magazine today in the Ask Marilyn column about fundamental cancer issue and why a cure is so elusive (it's not a foreign invader like virus or bacteria, it's your own cells gone wild; only one cell needs to survive treatment to have a recurrence; current treatment kills normal cells, etc.) Bottom line is that our cancer is one of the very worst.
One excellent source of information is the OCF feed on news plus the archived articles on the OCF board. Many times a news article that Google pulled for me is explained much better and more accurately on Brian's selection of the news.

Last edited by Charm2017; 05-03-2009 06:27 AM. Reason: homage to OCF

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2008
Posts: 3,082
Sandy

If you want highly technical exposition of micro RNA and the genetic component of cancer, the OCF site has this excellent article. In looking for this, I was glad to see that OCF uses the 50% survival figure also as I like to be in sync with OCF facts rather than news article distortions. OCF oncogenes and cancer
charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: May 2007
Posts: 666
"Above & Beyond" Member (500+ posts)
Offline
"Above & Beyond" Member (500+ posts)

Joined: May 2007
Posts: 666
I concur,
the article by Croce is an excellent starting point and it is right here at OCF.
M



Partial glossectomy (25%) anterior tongue. 4/6/07/. IMRT start @5/24/07 (3x) Erbitux start/end@ 5/24/07. IMRT wider field (30x) start 6/5/07. Weekly cisplatin (2x30mg/m2), then weekly carbo- (5x180mg/m2). End of Tx 19 July 07.
Markus #94876 05-03-2009 06:51 PM
Joined: Aug 2008
Posts: 96
Supporting Member (50+ posts)
Offline
Supporting Member (50+ posts)

Joined: Aug 2008
Posts: 96
Hi Sandy,
Two reasons the doctors consider my husband's cancer very aggressive (we are on #4 since 2005) are that his is poorly differentiated, which means it grows very quickly. He also has PNI or Peri-neural invasion. I don't know what the percentages are of all SCC having these characteristics, but it would be interesting to find out.
Lori


Lori, cg to H Ron, age 56.
Stage IV Oral SCC-T1N2. Tongue resected and right ND 8/05. Teeth removed, PORT, PEG, IMRT x33, Cisplatin x3. Tx ended 10/05.
Recurrence 7/08 Stage IV. Surgery 8/30/08.
2nd recur. 11/08. 2nd surgery 2/2/09.
3rd recur. 4/9/09. Erbitux wkly. 5/09-?
Ron died 6/6/09.
Lori also passed away 8/20/11, colon cancer
Joined: Sep 2008
Posts: 489
Platinum Member (300+ posts)
Offline
Platinum Member (300+ posts)

Joined: Sep 2008
Posts: 489
Sandy and Lori

They refer to my cancer as an agressive cancer also - it really grows quickly and did not respond to either of the chemo treatments that we tried. i'm going to quiz them about my Erbitux success this next appointment. the rash has started already though and that makes me happy. My last blood work showed a very high white blood count and that is from fighting this infection. I do know that once the biopsy was done, my tumor took on a life of it's own. right now I do not know the exact location of the cancer other than the right side of my neck as opposed to the left side and need to have some scans done so that I know what we have now so that I can tell if I am responding to the Erbitux or not. My plastic surgeon mentioned that someday they will be able to genetically identify each cancer and how to treat them differently instead of trying the same treatments on different cancers. I think that will make a huge difference in successful treatment.

Patty


48
SCC Floor of Mouth 7/06
9/06 Surgery, bilateral neck dissection, 58 nodes clear PT2pN0pMx
35 rad 2006
Recurred 6/08, 1 Carboplatin, 1 Cisplatin
Surgery 9/08 - Total glossectomy, free flap from pectoral muscle, left mandible replaced using fibula
35 IMRT & Erbitux 11/08
4/15/09 recurrence
6/1/09 passed away, rest in peace
Good1 #94880 05-03-2009 08:41 PM
Joined: Jan 2009
Posts: 253
Gold Member (200+ posts)
OP Offline
Gold Member (200+ posts)

Joined: Jan 2009
Posts: 253
Thanks Everyone:
I appreicate the technical paper, but I was hoping for a more pedestran answer. I might have good questions, but I think your giving me too much credit to be able to decipher all the technical info. LOL.

Can someone make a general statement of what the piece was stating? I think I know, but would love someone more knowledgeable than me to explain.

Thanks
Sandy



Sandy 56, BOT SCC Biopsy 1/21/09 Stage 3, T3NXM0.
Finished 3 cycle induction chemotherapy 4/7/09. (Chisplatin, 5-fu and Texotere). Re-staged 4/20/09,(very successful.) Will start Carboplatin/radiation 2 Gy/5 days/7 weeks (Tomotherapy) starting May 4th. Finished 6/22/09.
OCF member/supporter

Good1 #94881 05-03-2009 08:46 PM
Joined: Jan 2009
Posts: 253
Gold Member (200+ posts)
OP Offline
Gold Member (200+ posts)

Joined: Jan 2009
Posts: 253
Patty:
I have read several articles on "truly" individual treatment plans. I believe it their goal.

Sandy



Sandy 56, BOT SCC Biopsy 1/21/09 Stage 3, T3NXM0.
Finished 3 cycle induction chemotherapy 4/7/09. (Chisplatin, 5-fu and Texotere). Re-staged 4/20/09,(very successful.) Will start Carboplatin/radiation 2 Gy/5 days/7 weeks (Tomotherapy) starting May 4th. Finished 6/22/09.
OCF member/supporter

SandySt. #94890 05-03-2009 10:50 PM
Joined: Feb 2007
Posts: 1,940
"OCF across the pond"
Patient Advocate (1000+ posts)
Offline
"OCF across the pond"
Patient Advocate (1000+ posts)

Joined: Feb 2007
Posts: 1,940
personally i don't think it matters a damn what all the papers and articles say.Facts and figures give you an overview of recurrence and survival rates,the bottom line is it only matters if it happens to you.Rob had SCC.At the time of diagnosis he was given a 90% chance of surviving 10 years based on the information available,ie examination,scans and pathology and histology.He had 67 lymph nodes removed which showed no sign of disease.His scans were clear for spread outside of the diseased area.7 months later after surgery and radiotherapy he was dead.His scans showed invasion of the lungs,and his recurrance was described as the most aggressive the surgeon had seen,and yet they had no indication that this was how his disease would progress.I had many online buddies whos origonal diagnosis was much worse than Robs and they are still here living full lives with no problems,one in particular who was being treated for a recurrence after 9 years out.He is now back at work,and fit and well again.Why?

I have come to the conclusion its a lottery,Rob thought it was genetic as all the males in his family including his father had developed cancer in their 50's but none of them had the same cancer.My sister in law lost her mother to ovarian cancer ,her father to oral cancer and bowel cancer,and her sister to breast cancer age 42,she herself has been treated for carcinoma in situ of the cervix since she was 20 and has recently had a hysterectomy because the staging moved up to three,she is 47.

Oral cancer survival rates are always quoted poorly because of ignorance,lack of information,late diagnosis,and lack of research and publicity funding....the cinderella of cancers.Being proactive in your treatment is a great thing,but time spent trawling the internet for reasons why is not the best way of moving forward and onward and hopefully away from your diease.Sqeezing every last moment you have on this earth living your life to the full is.


Liz in the UK

Husband Robin aged 44 years Dx 8th Dec 2006 poorly differentiated SCC tongue with met to neck T1N2cM0 Surgery and Radiation.Finished TX April 2007
Recurrence June/07 died July 29th/07.

Never take your eye off the ball, it may just smack you in the mouth.
Cookey #94891 05-03-2009 11:56 PM
Joined: May 2007
Posts: 666
"Above & Beyond" Member (500+ posts)
Offline
"Above & Beyond" Member (500+ posts)

Joined: May 2007
Posts: 666
Liz is right
for a individual patient 90% cure rate does not mean a damn thing if you happen to belong to the 10%.
As far as individual treatment plans go.. if you take a step back you see that what is currently done it is fairly standard, despite all the cool ideas/hype.... just look at our signature lines. Eventually we will be there that genetic test will help to optimize treatment. For example could/should you use Erbitux etc.
For the sake of argument lets assume we can already do these tests.. where do all the new individualized drugs come from? I concede that some of the drugs may be old stuff.... but there just are not that many.
The quoted paper (OCF) is perhaps not that basic. This reflects how intricate the issue really is. There are many things going on..... and even if you understand all or most of this (and there is more) it will not really help you because the treatment variations are fairly minor.

M


Partial glossectomy (25%) anterior tongue. 4/6/07/. IMRT start @5/24/07 (3x) Erbitux start/end@ 5/24/07. IMRT wider field (30x) start 6/5/07. Weekly cisplatin (2x30mg/m2), then weekly carbo- (5x180mg/m2). End of Tx 19 July 07.
SandySt. #94895 05-04-2009 04:16 AM
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
Sandy, I am with your train of thought. Some of this I understand and others I just can't get thru my thick skull. I'm like Lit tler Denny Dumb Dumb, LOL I just shake my head and smile a DUH smile.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
SandySt. #94940 05-05-2009 10:51 AM
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2008
Posts: 3,082
Sandy

Sorry, I thought you wanted more technical infomation when I posted those links. I used to specialize in doing plain english translations of medical terms decades ago so I forget how daunting they appear at first. For example the opening quote of the ocogene article [quote]Tumors often possess cytogenetically different clones that arise from the initial transformed cell through secondary or tertiary genetic alterations. This heterogeneity contributes to differences in clinical behavior and responses to treatment of tumors of the same diagnostic type. Apart from the initial clone and subclones, tumors can also contain progenitor cancer cells, all of which constitute a spectrum of cells with different genetic alterations and states of differentiation. These populations can differ in sensitivity to chemotherapy, radiotherapy, and other treatments, making clinical management difficult. For these reasons, the initiating steps in the development of cancer are of considerable clinical importance and are a priority in the development of rational cancer treatment[/quote]can be summarized as: Cancer tumors constantly change their cells' genetic makeup in series of steps that makes it hard to predict how even the same types of cancer will react to treatment. Until we know those various steps, we will not have a "rational" cancer treatment.
Now I love the medical admission that the current treatment of cut, burn and poison for all cancers is not rational but it is all we have.
My understanding is that a cancer is "aggressive" when it is resistant to treatment, reoccurs or spreads. Prostate cancer is usually not aggressive and males can live to 90 with it with no ill effects as is is slow growing. Watch and wait is an accepted therapy for such cancers. When I asked back in 2007 what if I just waited and again in 2009, all three doctors said I would die within a year of a very painful death. That is an aggressive cancer. Unfortunately most if not all head and neck cancers are aggressive. Simply the nature of the beast. Some cancers react wonderfully to treatment, like the type Lance Armstrong had - relatively easy to "cure". Not so much for ours. Various medical articles have described oral cancer as "insidious", "catastrophic", etc due to the major life impairments that even successful treatments cannot avoid since it involves our head and neck which cannot be amputated. We all cope with the new normal as best we can.


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
You have me laughing again Charm LOL


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
EzJim #94946 05-05-2009 11:25 AM
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
I sure remember when cookey and rob were going thru the troture. I used to jus sit sn wonder ow they could handle it. I felt so bad for them.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
EzJim #94947 05-05-2009 11:29 AM
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
I have my 16 lb sledge and am about to fine tune this damn wireless keyboard and mouse. I type bad enough, but when I know I hit the keys ans they don't show, it,s get even time. Must be time to use the wired one and flatten this scrap.


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
EzJim #94953 05-05-2009 04:39 PM
Joined: Jul 2007
Posts: 939
"Above & Beyond" Member (500+ posts)
Offline
"Above & Beyond" Member (500+ posts)

Joined: Jul 2007
Posts: 939
Jim,

Check your unit that is plugged into the computer...sometimes it gets interference when its in a bad place and causes the keyboard to keep from registering. Also..possibly you need new batteries??



Deb..caregiver to husband, age 63 at diagnosis, former smoker who quit in 1997.
DIAGNOSIS: 6/26/07 SCC right tonsil/BOT T4N0M0
TREATMENT START: 8/9/07 cisplatin/taxol X 7..IMRT twice daily X 31.5.
TREATMENT END: 10/1/07
PEG OUT: 1/08
PORT OUT: 4/09
FOLLOWUP: Now only annual exams. ALL CLEAR!

Passed away 1/7/17 RIP Bill
Joined: Mar 2002
Posts: 4,918
Likes: 67
OCF Founder
Patient Advocate (old timer, 2000 posts)
Offline
OCF Founder
Patient Advocate (old timer, 2000 posts)

Joined: Mar 2002
Posts: 4,918
Likes: 67
The ability to separate the really aggressive disease from the regular versions is discussed in this recent OCF news posting. If you subscribe to the OCF RSS news feed you would be getting this story automatically. For those of you that don
t here it is

http://oralcancernews.org/wp/2009/05/new-diagnostic-advance-seen-for-head-throat-cancer-2/


Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
Joined: Jun 2007
Posts: 5,260
Patient Advocate (old timer, 2000 posts)
Offline
Patient Advocate (old timer, 2000 posts)

Joined: Jun 2007
Posts: 5,260
debandbill. There are new batteries in it and The only thing possibly in line where interfernce could occur is my outside dusk to dawn 13 watt lite. This happenS all the time so it can't be the lite. I just went back and put 14 letters in that it missed LOL I'll try it a few more days and check things out Thanks for the advice tho


Since posting this. UPMC, Pittsburgh, Oct 2011 until Jan. I averaged about 2 to 3 surgeries a week there. w Can't have jaw made as bone is deteroriating steaily that is left in jaw. Mersa is to blame. Feeding tube . Had trach for 4mos. Got it out April.
--- Passed away 5/14/14, will be greatly missed by everyone here
Joined: Jan 2009
Posts: 253
Gold Member (200+ posts)
OP Offline
Gold Member (200+ posts)

Joined: Jan 2009
Posts: 253
Charm:
Thank you very much for deciphering the scientific language for me. I was asking for personal reasons, but also for general knowledge. The reason is that although my tumor was very large, it has not spread to other areas. But reading the signatures on the forum with smaller tumors seem to have a lot more involvement. I was just trying to figure out the difference. I really wasn't "trawling" the internet.

Thank you again for taking the time to convert the info to common language. Sandy



Sandy 56, BOT SCC Biopsy 1/21/09 Stage 3, T3NXM0.
Finished 3 cycle induction chemotherapy 4/7/09. (Chisplatin, 5-fu and Texotere). Re-staged 4/20/09,(very successful.) Will start Carboplatin/radiation 2 Gy/5 days/7 weeks (Tomotherapy) starting May 4th. Finished 6/22/09.
OCF member/supporter

SandySt. #95031 05-07-2009 09:30 AM
Joined: Sep 2006
Posts: 1,357
Likes: 5
"OCF Canuck"
Patient Advocate (1000+ posts)
Offline
"OCF Canuck"
Patient Advocate (1000+ posts)

Joined: Sep 2006
Posts: 1,357
Likes: 5
Always good to have more info Sandy. I always think my "odds" are 50/50. Either it is back, or it isn't!

Donna


Donna,69, SCC L Tongue T2N1MO Stg IV 4/04 w/partial gloss;32 radtx; T2N2M0 Stg IV; R tongue-2nd partial gloss w/graft 10/07; 30 radtx/2 cispl 2/08. 3rd Oral Cancer surgery 1/22 - Stage 1. 2022 surgery eliminated swallowing and bottom left jaw. Now a “Tubie for Life”.no food envy - Thank God! Surviving isn't easy!!!! .Proudly Canadian - YES, UNIVERSAL HEALTH CARE IS WONDERFUL! (Not perfect but definitely WONDERFUL)
Page 1 of 3 1 2 3

Link Copied to Clipboard
Top Posters
ChristineB 10,507
davidcpa 8,311
Cheryld 5,264
EzJim 5,260
Brian Hill 4,918
Newest Members
Kpwin, Boost iV Miami, dcrowman, Yuka, monkeytoes
13,361 Registered Users
Forum Statistics
Forums23
Topics18,265
Posts197,179
Members13,362
Most Online1,788
Jan 23rd, 2025
OCF Awards

Great Nonprofit OCF 2023 Charity Navigator OCF Guidestar Charity OCF

Powered by UBB.threads™ PHP Forum Software 7.7.5