Pancreatic Cancer: Insights From Clinical Cases

Potential Early Signs of Pancreatic Cancer: Insights From Clinical Cases

Pancreatic cancer can present with symptoms often associated with other illnesses—following the trail of such signs early on could help with early diagnosis

Pancreatic cancer is a highly fatal disease, its early signs often overlooked, resulting in many patients being diagnosed in the advanced stages. To raise public awareness, we have explored actual patient cases to help identify the early signs of pancreatic cancer.

The Elusiveness of Pancreatic Cancer

Due to the elusive nature of its initial symptoms, pancreatic cancer often goes undetected in its early stages. By the time it is diagnosed, the cancer has already spread to surrounding tissues or other organs, making it an advanced-stage disease that cannot be surgically removed. Treatment for advanced pancreatic cancer includes chemotherapy, radiation therapy, and immunotherapy, which aim to manage symptoms and slow cancer progression, but these approaches do not offer a cure. Surgery remains a potential treatment option for pancreatic cancer when it is detected very early, in a localized state.

The combined percentage of all patients living five years after diagnosis is only 12 percent. Patients diagnosed with advanced pancreatic cancer typically survive for around one year post-diagnosis. For those diagnosed before the tumor has grown extensively or spread, the average survival time is three to 3.5 years. About 10 percent of patients who receive an early diagnosis of pancreatic cancer can be cured after treatment.

Early detection of pancreatic cancer is vital for treatment and prognosis.

Case Analyses of Early Symptoms

The following four clinical cases illustrate the potential early signs of pancreatic cancer.

Case 1: Symptoms Resembling Diabetes

Mr. Lee, 58 years old, had previously been diagnosed with Type 2 diabetes and was undergoing treatment. Despite having no family history and maintaining regular lifestyle habits, he suddenly developed symptoms of diabetes, such as excessive thirst, frequent urination, and significant weight loss.

Later, he came to me seeking treatment for lower back pain, hoping to alleviate it through traditional Chinese medicine (TCM) acupuncture. However, during the treatment, I noticed that he had very mild jaundice, so I suggested that he see an internal medicine doctor.

After examination, it was found that Mr. Lee did not have diabetes or a herniated lumbar disc, but rather early-stage pancreatic cancer. His pancreatic tumor was close to the gallbladder, which caused him to develop jaundice.

A review published in BMJ in 2015 found a strong linear dose-response relationship between fasting blood sugar concentration and the incidence of pancreatic cancer in the range of prediabetes and diabetes. For every 0.56 millimoles per liter increase in fasting blood sugar concentration, the incidence of pancreatic cancer increased by 14 percent.

This case emphasizes the need to be vigilant if a middle-aged person suddenly develops symptoms of diabetes without any family history or unhealthy lifestyle habits, as this could be an early sign of pancreatic cancer.

Case 2: Fatigue and Depression

Ms. Wong, 45 years old, was cheerful and enjoyed a harmonious family life with no health issues. However, she began experiencing fatigue and emotional lows, lacking the energy for any activities. At times, she felt deeply saddened, even becoming tearful.

Suspecting she might be experiencing symptoms of depression, she visited a psychiatrist. Upon examination, it was confirmed that she exhibited all the typical signs of depression—reduced appetite, weight loss, fatigue, difficulty concentrating, lack of interest in activities, and insomnia. Therefore, she was prescribed antidepressant medication, however, there was no improvement. She also tried psychotherapy, but the psychiatrist could not identify any specific psychological cause.

Some of Ms. Wong’s symptoms raised our concern. She often experienced abdominal pain, which, although not severe, radiated to the surrounding areas. Additionally, she developed severe acid reflux and experienced bloating in the abdomen.

In such cases, it is important to consider the possibility of other factors causing depression, one of which may be a tumor. The presence of a tumor can lead to the production of inflammatory cytokines. This can, in turn, affect the metabolism of neurotransmitters in the brain, including serotonin and adrenaline, both of which play a role in regulating mood. Furthermore, tumors can activate certain neuroinflammatory cells, leading to a rapid increase in stress response affecting the brain and adrenal glands, thereby raising the risk of depression.

After a series of examinations, Ms. Wong was diagnosed with pancreatic cancer. Fortunately, it was discovered relatively early, and she underwent a partial resection surgery, which successfully treated her cancer.

A study published in the journal Molecular Psychiatry in 2019 indicated that clinically diagnosed depression and anxiety were associated with a higher incidence of cancer, poorer cancer survival rates, and higher cancer-specific mortality rates. Another study suggested that pancreatic cancer patients were most likely to have concurrent depression and anxiety, and there appeared to be a biological connection. In some patients, depression may be a precursor to pancreatic cancer.

This suggests that when someone experiences unexplained depression, particularly if accompanied by digestive symptoms and a family history of hereditary diseases, the possibility of having a tumor should be considered.

Case 3: Diarrhea and Constipation

Mr. Wang, 60 years old, had been in good health. However, he recently developed chronic diarrhea, with occasional constipation. The presence of both diarrhea and constipation indicates irritable bowel syndrome, a condition often associated with mood swings and psychological stress. However, Mr. Wang did not report any emotional issues.

Therefore, we advised him to undergo further examination to investigate any other potential issues. During a colonoscopy, a localized obstruction in his intestines was found, caused by a tumor originating from the pancreas. Given the early detection, prompt surgical intervention followed by additional treatments is expected to yield a favorable prognosis.

Chronic gastrointestinal issues should be taken seriously if they persist without improvement. It is particularly crucial to observe if the stool is black, as it could indicate potential bleeding or anemia, warranting closer attention to the possibility of a tumor.

Case 4: Unhealthy Diet

Mr. Zhang was obese due to his longstanding unhealthy eating habits, which included a preference for fried foods, sugary drinks, meats, and sweets, as well as prolonged periods of inactivity. Recognizing the health risks associated with obesity, he decided to improve his diet. After starting a healthier diet, he experienced rapid weight loss. However, he noticed that he had become somewhat underweight after some time. He also experienced a decreased appetite, pronounced fatigue, low mood, and decreased energy levels. Mr. Zhang went to the hospital for tests but found no specific reasons for his symptoms.

After experiencing sudden abdominal cramps, he went to the emergency room, where a CT scan revealed a pancreatic mass, later diagnosed as pancreatic cancer.

One study indicated that obesity may increase the risk of pancreatic cancer through various mechanisms, including inflammation, insulin resistance, and changes in the microbiome.

Long-standing unhealthy habits may increase the risk of developing tumors. Recognizing the need for lifestyle changes sooner rather than later is essential. Of course, other genetic factors should also be taken into consideration.

Symptoms Summary for Potential Pancreatic Cancer

The cases above remind us to stay vigilant about the possibility of pancreatic cancer if the following symptoms arise:

Sudden increases in blood sugar

Unexplained depression

Rapid weight loss

Unexplained fatigue

Abdominal or back pain

Persistent gastrointestinal issues

Early detection and treatment are crucial in fighting pancreatic cancer. I hope this article serves as a helpful reminder to everyone.

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THE CATHOLIC CHURCH AND SANTERIA

How does the Catholic Church feel about Santeria?

Question:

How does the Catholic Church feel about Santeria?

The Roman Catholic Church and Tolerance:

The relationship between Roman Catholicism and identified non-Christian religions is defined in the papal declaration Nostra Aetate as promulgated by Pope Paul VI in 1965. In this declaration, the Pope commands his faithful to follow "in the footsteps of the holy Apostles Peter and Paul" and "maintain good fellowship among the nations." In Nostra Aetate Paul VI also set the Church's policy as clearly anti-discriminatory with regards to race, color, condition of life, or religion.

Answer and Explanation:

The relationship between the Roman Catholic Church and Santeria is complicated, in part because Santeria is not a wholly separate religion but is a syncretic faith that has combined elements of Catholic worship and practice with Nigerian (which were originally Yoruban) beliefs.

Santeria developed in Cuba in the 1500s, when African slaves first brought to Cuba to work the sugar plantations found themselves oppressed not just by colonists but also by the Catholic Church, which had imposed Christianity upon them. To protect their deeply held faith and maintain their practices, the Yoruba melded their orishas (gods, deities) with the saints and included Catholic practices within their own. Thus, the celebration of saints' days became a celebration of both the saint and ancient deity of the Yoruba. A saint's day celebration among Santerians may include the highly orthodox procession through town and the Church mass dedicated to the saint but also a celebration with drumming and animal sacrifice. Today, Santeria is practiced by roughly 13% of the Cuban population, but even those who profess Catholicism may in fact also practice Santeria.

What this relationship--both historically and theologically--between Catholicism and Santeria means is that practically speakin condone Santeria, it also cannot formally condemn Santeria. Two recent popes (Benedict XVI and Francis I) made visits to Cuba and even held masses there, but neither formally met with any leaders of the faith or offered a formal gesture of tolerance. They also did not call for an end to Santeria practices, likely because if they did so Church parishes would shrink.

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Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD)

CAUSES

The exact cause of attention deficit hyperactivity disorder (ADHD) is not fully understood, although a combination of factors is thought to be responsible.

Genetics

ADHD tends to run in families and, in most cases, it's thought the genes you inherit from your parents are a significant factor in developing the condition.

Research shows that parents and siblings of someone with ADHD are more likely to have ADHD themselves.

However, the way ADHD is inherited is likely to be complex and is not thought to be related to a single genetic fault.

Brain function and structure

Research has identified a number of possible differences in the brains of people with ADHD from those without the condition, although the exact significance of these is not clear.

For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger.

Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.

Groups at risk

Certain people are also believed to be more at risk of ADHD, including people:

who were born prematurely (before the 37th week of pregnancy) or with a low birthweight

with epilepsy

with brain damage – which happened either in the womb or after a severe head injury later in life.

If your problems are recent and did not occur regularly in the past, you're not considered to have ADHD. This is because it's currently thought that ADHD cannot develop for the first time in adults.

Other possible treatments

There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there's no strong evidence these work, and they should not be attempted without medical advice.

Diet

People with ADHD should eat a healthy, balanced diet. Do not cut out foods before seeking medical advice.

Some people may notice a link between types of food and worsening ADHD symptoms. If this is the case, keep a diary of what you eat and drink, and what behaviour follows. Discuss this with a GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial for people with ADHD, although the evidence supporting this is very limited.

It's advisable to talk to a GP before using any supplements, because some can react unpredictably with medicine or make it less effective.

You should also remember that some supplements should not be taken long term, as they can reach dangerous levels in your body.

Tips for parents

If you're the parent of a child with ADHD:

be sure your GP or specialist helps you understand the difference between ADHD and any other problems your child may have

think about who else needs to know about your child's ADHD, such as their school or nursery

find out the side effects of any medicine your child takes and what you need to look out for

getting to know people at local support groups can stop you feeling isolated and help you to cope

Exercise

Make sure your child gets lots of physical activity during the day. Walking, skipping and playing sport can help your child wear themselves out and improve their quality of sleep.

Make sure they're not doing anything too strenuous or exciting near to bedtime.

Read our physical activity guidelines for children and young people, which includes information on getting active, and how much activity you and your child should be doing.

Eating

Keep an eye on what your child eats. If your child is hyperactive after eating certain foods, which may contain additives or caffeine, keep a diary of these and discuss them with a GP.

Bedtime

Stick to a routine. Make sure your child goes to bed at the same time each night and gets up at the same time in the morning.

Avoid overstimulating activities in the hours before bedtime, such as computer games or watching TV.

Night time

Sleep problems and ADHD can be a vicious circle. ADHD can lead to sleep problems, which in turn can make symptoms worse.

Many children with ADHD will repeatedly get up after being put to bed and have interrupted sleep patterns. Trying a sleep-friendly routine can help your child and make bedtime less of a battleground.

Help at school

Children with ADHD often have problems with their behaviour at school, and the condition can negatively affect a child's academic progress.

Speak to your child's teachers or their school's special educational needs co-ordinator (SENCO) about any extra support your child may need.

Adults with ADHD

If you're an adult living with ADHD, you may find the following advice useful:

if you find it hard to stay organised, then make lists, keep diaries, stick up reminders and set aside some time to plan what you need to do

let off steam by exercising regularly

find ways to help you relax, such as listening to music or learning breathing exercises for stress

if you have a job, speak to your employer about your condition, and discuss anything they can do to help you work better

if you're at college or university, ask about what adjustments can be made to support you, such as extra time to complete exams and coursework

talk to a doctor about your suitability to drive, as you'll need to tell the Driver and Vehicle Licensing Agency (DVLA) if your ADHD affects your driving

contact or join a local or national support group – these organisations can put you in touch with other people in a similar situation, and can be a good source of support, information and advice

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CANCER : WHAT YOU MUST KNOW

What is cancer ?

Cancer is a disease which occurs when changes in a group of normal cells within the body lead to uncontrolled, abnormal growth forming a lump called a tumour; this is true of all cancers except leukaemia (cancer of the blood). If left untreated, tumours can grow and spread into the surrounding normal tissue, or to other parts of the body via the bloodstream and lymphatic systems, and can affect the digestive, nervous and circulatory systems or release hormones that may affect body function.

Cancer tumours can be divided into three groups: benign, malignant or precancerous.

1. Benign tumours are not cancerous and rarely threaten life. They tend to grow quite slowly, do not spread to other parts of the body and are usually made up of cells quite similar to normal or healthy cells. They will only cause a problem if they grow very large, becoming uncomfortable or press on other organs - for example a brain tumour inside the skull.

2. Malignant tumours are faster growing than benign tumours and have the ability to spread and destroy neighbouring tissue. Cells of malignant tumours can break off from the main (primary) tumour and spread to other parts of the body through a process known as metastasis. Upon invading healthy tissue at the new site they continue to divide and grow. These secondary sites are known as metastases and the condition is referred to as metastatic cancer.

3. Precancerous (or premalignant) describes the condition involving abnormal cells which may (or is likely to) develop into cancer.

Cancer staging

The classification of cancer by anatomical extent of the disease, i.e. stage, is essential to patient care, research and cancer control. The UICC TNM staging system is the common language adopted by oncology health professionals to communicate on the cancer extent for individual patients. Once the stage of cancer is known and understood, this is often a basis for deciding appropriate treatment and individual prognosis. It can also be used to inform and evaluate treatment guidelines, and constitutes vital information for policy-makers developing or implementing cancer control, prevention plans and research.  

The TNM classification focuses on the anatomical extent of the tumour and is determined by assessing the following categories:  

· T describes the size of the main (primary) tumour 

· N describes whether the cancer has spread to the nearby lymph nodes

· M describes whether the cancer has metastasised (spread from the primary tumour to another part of the body)

Managing and treating cancer 

Your treatment depends on the type of cancer, where your cancer is, how big it is, whether it has spread, and your general health. The general types of treatments include: surgery, chemotherapy, radiotherapy, hormone therapy, immunotherapy, and gene therapy. 

Surgery

If a cancer has not metastasised (spread), surgery can remove the entire cancer which may completely cure the disease. Often, this is effective in removing the prostate or a breast or testicle.

Radiotherapy

Radiation treatment or radiotherapy uses high-energy rays to reduce a tumour or destroy cancer cells as a stand-alone treatment and in some cases in combination with other cancer treatments.

Chemotherapy 

Chemotherapy uses chemicals to interfere with the way cells divide - damaging of DNA - so that cancer cells will destroy themselves. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasised because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukaemia and lymphoma. 

Immunotherapy 

Immunotherapy uses the body's own immune system to fight the cancer tumour. Immunotherapy may treat the whole body by giving an agent that can shrink tumours.

Hormone therapy 

Several cancers have been linked to some types of hormones, including breast and prostate cancer. Hormone therapy works to change hormone production in the body so that cancer cells stop growing or are killed completely.

Gene therapy 

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell destroys themselves. However, gene therapy is new and has not yet resulted in any successful treatment 

Survivorship 

Survivorship focuses on health and the physical, psychological, social and economic issues affecting people after the end of the primary treatment for cancer, including people who have no disease after finishing treatment, people who continue to receive treatment to reduce the risk of the cancer coming back and people with well controlled disease and few symptoms, who receive treatment to manage cancer as a chronic disease. 

Survivorship care includes issues related to follow-up care, the management of late side-effects of treatment, the improvement of quality of life and psychological and emotional health. Survivorship care includes also future anticancer treatment where applicable. Family members, friends and caregivers should also be considered as part of the survivorship experience. 

Palliative care 

Palliative care runs throughout a patient’s journey from diagnosis to cure or end of life, and is designed to relieve symptoms and improve a cancer patient’s quality of life. It can be used to respond to troubling symptoms such as pain or sickness, and also to reduce or control the side effects of cancer treatments. In advanced cancer, palliative treatment might help someone to live longer and to live comfortably, even if they cannot be cured.

Key Cancer Facts

Cancer is the second-leading cause of death worldwide.

10 million people die from cancer every year.

More than 40% of cancer-related death could be preventable as they are linked to modifiable risk factors such as smoking, alcohol use, poor diet and physical inactivity.

Almost at least one third of all deaths related to cancer could be prevented through routine screening, and early detection and treatment.

70% of cancer deaths occur in low-to-middle income countries.

Millions of lives could be saved each year by implementing resource appropriate strategies for prevention, early detection and treatment.

The total annual economic cost of cancer is estimated at US$1.16 trillion.

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THE REVIEW 17.01.2024

I took some time to review the learning and teaching( or a part of the debates) we had on this forum yesterday. A debate  borne out of a misunderstanding of a statement which was explained later to even mean the opposite of the apparent viewpoint they were being engaged by some people ie. .*destruction  of a myth* meaning a finality of the truth in  a belief system.A misunderstanding of this concept.

In the debate it was disappointing to observe some writers or resource persons not being open and direct with information they claim to be in possession.This goes against every law in Education and learning.

This University was initiated because I saw the need for a  place people will in the real spirit of educationists and specialists in didatics give information and impact learning freely and selflessly. This is the spirit of this academy which the operators in all levels are doing great.

A teacher is a person who first and foremost wants to see what he teaches flourish, that is his first payment.  It is  a sentiment you must have or cultivate  to be happy to teach. It is an honourable and heavy to bear sentiment which not everyone is  able to understand and draw the happiness therefrom .No Wonder our ‘poor’ primary and junior school teachers still remain happier  than us when we have even become doctors,lawyers, architects engineers, etc

In conclusion ,I call on most of us that have resource materials to be more generous with them and make them available during teaching without putting students in much suspension and doubts by leaving many gaps, you will  still  be quoted even if it is not yet in a paperback we are already on that level.

Thanks

Charles O Chukwubike 

The VC / Online Moderator 

Nenweonlineuni@gmail.com

DR JAMES EBERE OKORIE ; (ASSOCIATE PROFESSOR)

*NOL- UNIVERSITY* RECEPTION IN HONOR OF *JAMES EBERE OKORIE*, PhD.

Dear University Community,

The Vice- Chancellor, and,  the Board, have received the formal announcement of the advancement of Dr. James Ebere Okorie to the prestigious rank of Associate Professor by the University of Uyo, Akwa Ibom State, Nigeria.

 Dr. Okorie, you all surely remember, is also a faculty at our university - the NOL-U.

By this promotion, the University of Uyo recognizes the specialized knowledge and expertise of Dr. Okorie in Criminology, his core academic department, as evidenced by his scholarly research outputs, and his engaging teaching skills, as attested to by a cross section of his present and former students.

The NOL-U takes pride in the proven success of Dr. James Ebere Okorie in the following regards:

1. As a demonstration of our unwavering support to our faculty and a colleague here at the University;

2. As an external validation of the high quality of academics, and the students they are nurturing for future deployment for service of our human society whether here at home, or overseas destinations.

The University authorities hereby direct its Community to virtually align themselves in a  celebratory mood to honor Assoc. Prof. James Ebere Okorie in recognition of his success.

Accordingly, the University authorities further direct our community members to continue to drop heartwarming congratulatory messages by the central message board at the university. You can also sweep by his home, or by his office at the University for a congratulatory handshake and perhaps a drink from a bottle of Hennessy sponsored by the University.

On behalf of the University, Congratulations, Assoc. Prof. James Ebere Okorie!

Sincerely,

Dr. Fidel C Nwabueze-Ogbo

Director, Academic Programs, *NOL-U* 

Charles O. Chukwubike

Vice-Chancellor, *NOL-U*

'MATTERS ARISING ' by: Chukwubike O Charles

Chukwubike O Charles 

There was an issue that came up yesterday which I want to make my personal opinion on.

Dr Leo's presentation of another probable meaning or interpretation of the proverb was an academic exercise and is exactly why we are here especially in a ‘tone” language as ours where one thing could mean twenty.

A critical analysis or thinking of postulations is what the school prepares us for and are also the foundation of development in science and arts. 

In medical school we are not just taught how to pull out babies from women or “yank stubborn" ones from the womb. We are thought  and encouraged to query those systems and methods and these invariably helped in the development of science. I think I've read one of Dr.Chukwualis' papers on this for example.

We have many wrong or inappropriate ways and thoughts which we perceived or received wrongly from our parents or society that shaped our lives and that these critical analysis have addressed . Look at the time it is still taking us to understand that cold pack is more appropriate when we hit our toes on a rock than the age long *miri ọkụ with essential balm or Aboniki combination* which is wrong! 

That most convulsions in babies come from and with high body temperature and that one of the fastest remedies is to lower the body temperature,instead of the *élú akụ* (nshiku system that was passed to us) which we use to massage the baby's body and which works the opposite because it closes the skin pores and insulates it thereby trapping the heat inside the baby due to no passage of oxygen and water from the skin and hair roots already blocked with the oil or other fats we used . These are some of the wrong notions critical thinking and research in science continue to develop.

This is why we are here and this is why we are encouraged to listen to every opinion. This is different from what we call “blind arguments” in the street.

Good morning all 

Charlie.mbc@gmail.com