Many of us tend to dismiss symptoms such as a burning sensation in the upper abdomen, indigestion after meals or stomach pain as minor issues, especially when the discomfort disappears after taking over-the-counter medication from a pharmacy.
Without undergoing further medical examination at a clinic or hospital, we often self-diagnose the condition as merely “gastritis” or “gas in the stomach”, even when the symptoms occur repeatedly.
Experts warn that such self-diagnosis can be risky as these symptoms may indicate more serious underlying conditions affecting the digestive system, including colorectal cancer, which is difficult to detect, as well as heart attack, gallstones or pancreatitis.
They say this tendency to take symptoms lightly often leads patients to seek hospital treatment only when their disease has already reached an advanced stage.
“In most serious diseases, the main problem is not the symptom itself but how people interpret it,” an expert stressed.
COLORECTAL CANCER
According to consultant general and colorectal surgeon at Tawakkal Specialist Hospital Kuala Lumpur Dr Nurhashim Haron, about 40 to 50 percent of colorectal cancer patients referred to him initially believed they were only suffering from gastritis.
“Patients only come for further checks after symptoms persist. As a result, when they are finally diagnosed, more than 70 percent are already at a late stage… stage three or four,” he told Bernama.
He said colorectal cancer is the second most common cancer in Malaysia after breast cancer.
The Summary of Malaysia National Cancer Registry Report (2017–2021) shows an increasing trend in colorectal cancer cases for both men and women. Among men, the incidence rate rose to 18.8 per 100,000 population, compared to 14.8 per 100,000 in 2012–2016. For women, it increased to 13.7 from 11.1 over the same period.
He also noted a worrying shift in patient age.
“Previously, most patients were between 55 and 65 years old. Now, we are seeing cases as early as their 40s, and even younger,” he said.
Colorectal cancer symptoms vary depending on tumour location and often resemble common digestive issues, making early detection difficult.
He shared a case from about three years ago involving a man in his 40s who initially complained of symptoms resembling gastritis and thought it was “just wind”.
The patient had repeatedly sought treatment at clinics as well as taken pharmacy medication, believing it was a simple digestive problem.
“An endoscopic examination (OGD) carried out in the early stages only showed inflammation in the stomach lining (gastritis). However, a colonoscopy later revealed a tumour in the transverse colon. A CT scan confirmed that the cancer was already at an advanced stage and required aggressive treatment,” he said.
The patient eventually underwent surgery to remove part of his colon and stomach, followed by chemotherapy.
RED FLAGS
Dr Nurhashim, who is also Malaysian Society of Colorectal Surgeons president, said one of the most common mistakes is ignoring changes in bowel habits, which are among the earliest warning signs of intestinal disease.
Symptoms that require attention include changes in bowel frequency, narrower or thinner stools, and changes in stool consistency.
More concerning signs include blood or mucus in the stool, prolonged diarrhoea, chronic constipation, and a persistent feeling of incomplete evacuation (tenesmus).
“However, many patients still assume these symptoms are due to gastritis, stress or diet and choose to wait until the condition worsens,” he said.
He added that embarrassment and fear of invasive screening procedures such as OGD and colonoscopy also contribute to delays in seeking medical help.
TREATMENT
From a clinical perspective, treatment depends on the stage of the cancer and the patient’s condition.
“A treatment plan is decided after colonoscopy, biopsy, CT scans and other tests are carried out. Besides surgery, modern treatment may include chemotherapy, radiotherapy and targeted therapy, especially in advanced or high-risk cases,” he explained.
The goal is not only to remove the tumour but also to reduce recurrence risk and improve long-term survival rates.
Dr Nurhashim said early detection often means surgery alone is sufficient, with a much higher chance of recovery, and in some cases, additional treatment like chemotherapy is not needed.
However, late detection leads to more complex, multi-stage treatment involving surgery, chemotherapy and radiotherapy, as well as long-term monitoring.
SYMPTOMS ALMOST SIMILAR
Meanwhile, consultant general and hepatobiliary surgeon at Bukit Tinggi Medical Centre, Klang, Dr Thamarai Velan, said symptoms caused by gallstones or pancreatitis are sometimes mistaken for gastritis.
“Many patients come in complaining of heartburn, indigestion and abdominal discomfort, which they assume is gastritis. However, in my experience, more than half of such cases are caused by other conditions,” he said.
Gallstone pain is typically sharper, may last from minutes to hours, and is usually concentrated on the right side of the abdomen.
Some patients also experience pain radiating to the back, along with nausea and vomiting. In certain cases, yellowing of the eyes or skin may occur due to bile duct obstruction.
“Many patients usually only return for treatment when the pain becomes more frequent or worse. They often think they are getting better because they are taking medication, but in reality the symptoms only subside temporarily before returning,” he added.
Dr Thamarai also noted a shift in the age profile of patients with digestive system disorders.
“Gallstones used to be more common among middle-aged and elderly individuals. Today, we are seeing younger patients,” he said, attributing it to modern lifestyles, including sedentary habits, rising obesity rates and diets high in fat and low in fibre.
AWARENESS CRUCIAL
He said gallstones can lead to complications such as gallbladder infection (cholecystitis), bile duct blockage causing jaundice, and even pancreatitis, which may become a medical emergency.
If untreated, it may progress to severe infection in the bile duct (biliary sepsis), requiring intensive care treatment. Large gallstones may also increase the long-term risk of gallbladder cancer.
However, not all gallstone cases require immediate surgery, particularly those without symptoms and the gallstones are discovered during routine health screenings.
Dr Nurhashim, meanwhile, stressed that low public awareness remains the biggest challenge in managing colorectal cancer in Malaysia.
“Awareness is crucial. Many patients could be saved if they came earlier. The problem is that they wait too long,” he said.
He added that early medical screening is essential because treatment at an early stage is not only more effective but also simpler, more affordable and has a higher success rate.
Dr Thamarai advised against relying on pharmacy medication to “treat” persistent symptoms without consulting a doctor as such medication often only masks the underlying cause.
“In many cases, symptoms return if the root cause is not identified and treated promptly,” he said.
