That's a more common conversation than you'd think — and a good one to have, because stomach cancer in Malaysia tends to be caught later than it should be.
What is stomach cancer, exactly?
The term "stomach cancer" is often used loosely to describe cancer of either the stomach itself, or the lower oesophagus — the food pipe leading into it. Both develop when abnormal cell growth occurs in the lining of these organs, and both can present with overlapping symptoms.
In Malaysia, stomach cancer ranks as the 6th most common cancer among men and the 10th most common among women. A longstanding concern is that Malaysian patients tend to be diagnosed once the disease has already progressed to a later, harder-to-treat stage — which is exactly why regular screening matters, particularly for those with known risk factors.
What raises your risk?
Some risk factors are simply part of who you are and can't be changed. Others come down to lifestyle choices you have real control over.
Non-Modifiable
- Male gender — men face higher risk than women; one theory points to a possible protective effect of oestrogen on the stomach lining
- Age over 60 — cumulative cellular damage over time raises cancer risk generally
- Family history — having a first-degree relative with stomach cancer increases personal risk
Modifiable
- Smoking — regular smokers are roughly twice as likely to develop stomach cancer
- H. pylori infection — this common bacterium alters the stomach's chemical environment in ways that predispose to cancer
- Diet — smoked, salted, and pickled foods contain nitrate compounds linked to cancerous changes in the stomach lining
What symptoms should you watch for?
Stomach cancer symptoms tend to be frustratingly vague early on — which is exactly why screening matters more than waiting for symptoms to appear. Still, it's worth knowing what to look out for:
Unintentional weight loss or poor appetite
Cancer cells consume energy and alter metabolism, often suppressing appetite — leading to weight loss even without any change in activity or diet.
Early satiety
A growing tumour can reduce the stomach's capacity to expand, leading to a feeling of fullness after only small amounts of food.
Difficulty swallowing
When the cancer arises near the junction with the oesophagus, a growing mass can make swallowing difficult, often felt as something "stuck" in the throat.
Heartburn or indigestion
Persistent reflux (GERD) is itself a recognised risk factor for stomach cancer, and the two can be difficult to distinguish without further investigation.
Nausea or vomiting
A tumour obstructing the stomach or the passages leading into or out of it can interfere with normal digestion, causing persistent nausea.
Anaemia
Bleeding from the stomach lining can show up as low red blood cell counts on routine bloodwork — or, if more severe, as black, tarry stool or vomiting blood, alongside dizziness, breathlessness, or fatigue.
What tests can detect stomach cancer?
Several tools are available, and the right combination depends on individual risk factors and symptoms — your doctor can help determine which makes sense for you.
Routine blood tests
Can reveal anaemia, which may be an early indirect sign of bleeding from a stomach lesion — particularly useful when compared against previous results over time.
Upper Endoscopy (EGD)
A camera passed through the food pipe to directly examine the stomach lining for suspicious areas, with biopsy taken if anything abnormal is found.
Endoscopic Ultrasound
Goes a step further than standard endoscopy, using high-frequency sound waves to detect early-stage cancer or affected lymph nodes with greater precision.
PET / CT Scan
Used to check whether cancer has spread beyond the stomach to other organs such as the liver. Not typically used for initial screening due to cost and availability.
The key takeaway: Stomach cancer symptoms are often subtle or absent until the disease is more advanced. If you have risk factors — a family history, are over 60, smoke, or have persistent reflux — a conversation with your doctor about screening is well worth having, even if you feel entirely well.
Dr Cha Kar Huei
Consultant General Surgeon (Gastrointestinal, Bariatric & Robotic Surgery), Hospital Picaso