A Subtle Cry for Help: Anaemia in Cancer!

A 47-year-old woman walked into my clinic — lethargic, yet carrying herself with the quiet strength of someone who had long been ignored. She handed me her blood test report.

“I’ve always had a haemoglobin level between 13 to 14 g/dL,” she said. “But this year, it dropped to 11.8 g/dL. I feel tired all the time.”She had been brushed off by multiple healthcare providers — her haemoglobin was deemed “not too bad.”

But her concern ran deeper. Her father died of colon cancer at 55. Her sister is currently battling advanced colon cancer. Despite her tiredness being downplayed, she persisted.

Further investigation confirmed iron deficiency anaemia. But her menstrual bleeding was minimal, well-controlled with an intrauterine contraceptive device (IUCD) for the past two years. Her diet was healthy, rich in iron and nutrients. There was no reported change in bowel habits.

Yet, in light of her family history and her unexplained anaemia, we proceeded with a colonoscopy. It revealed early-stage colon cancer — Stage 1.

She had no overt symptoms, just a slight drop in haemoglobin — but it was her own determination that led to a timely diagnosis. She fought for her health when others told her not to worry. That effort will now translate into early treatment and, hopefully, a much better prognosis.

A Broader Reflection

In Malaysia, and across many Asian countries, anaemia is too often dismissed — especially in women approaching menopause. A haemoglobin level of 11 g/dL is not “normal.” Our goal should not be to accept anaemia, but to understand it. The target Hb should be ≥13 g/dL in both men and women.

We must shift the threshold of what we consider "acceptable." Anaemia is not just a benign condition or nutritional issue — it can be the earliest and only sign of cancer. It is often the body’s first and quietest cry for help.

It's time we listen more closely.