International cooperation to fight cancer's late-stage presentation in low- and middle-income countries.

Cancer is becoming a massive public health burden in low- and middle-income countries (LMIC). 70% of all cancer deaths globally are attributed to LMIC while the incidence proportion is below 60%. The main reason for the higher mortality rate is "late-stage presentation" of patients with stage III or IV diseases when being diagnosed. Main reasons for this are limited (financial) resources, poor knowledge of health service provider about cancer, misbelieves and fear among patients as well as low health literacy rate. During the 1st International Conference on Hospital Partnerships, conducted by the German Agency for International Cooperation (GIZ), cancer specialists from seven LMIC and Germany discussed opportunities, challenges and solutions of the development of cancer services. Two days of in-depths discussion identified five topics to be playing a key role in the effort to reduce the cancer burden in LMIC: Health Policy & Financing, Barriers to Access, Capacity Building, Cancer Registries and Adapted Treatment Guidelines. By using mind-mapping technique, stakeholders, core topics, main and important topics were visualized and interconnections displayed. Many topics can be addressed through international cooperations but political willingness and commitment in the respective countries plays the crucial role. An essential contribution will be to assist policy makers in formulating and endorsing affordable and effective health policies. Another lesson learned from this workshop is the similarity of challenges among the participating representatives from different LMIC. The authors of this letter emphasize on the importance of building international long-term cooperations to advance oncology care on a global scale.

Varied presentations of pancreatic insulinoma: a case report.

An insulinoma is a rare functional pancreatic neuroendocrine tumour that is usually sporadic and solitary. The hallmark is hypersecretion of insulin, which leads to neuroglycopenia symptoms and uncontrolled sympathoadrenal activity. Neuroendocrine tumours can have a varied presentation, with symptoms often ascribed to a different diagnosis, thus delaying correct diagnosis and treatment. We present the case of a 26-year-old female who had a 3-year delay before diagnosing insulinoma after being initially assessed with epilepsy and schizophrenia. The case report below provides a detailed review of the diagnosis, tumour localization, and surgical interventions implemented for the patient during the COVID-19 pandemic.