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A Guide to Understanding Cancer Cancer
What is Cancer
Cancer is a group of diseases where abnormal cells grow uncontrollably, invading and destroying healthy tissue. It can also spread throughout the body. As one of the world’s leading diseases, cancer remains a major health issue, but advances in screening, treatment, and prevention are boosting survival rates for many types. There are over 200 types of cancer, which can be categorised based on their origin in the body, such as breast cancer or lung cancer. Additionally, cancers can be classified according to the type of cell in which they begin, falling into five main groups.
This type of cancer originates in the skin or the tissues lining internal organs. It encompasses various subtypes, such as adenocarcinoma, basal cell carcinoma, squamous cell carcinoma, and transitional cell carcinoma. Carcinoma
This cancer originates in the body's connective or supportive tissues, which include bone, cartilage, fat, muscle, and blood vessels. Sarcoma
Main Groups of Cancer:
These cancers originate in the cells of the immune system, disrupting the body's natural defense mechanism. Brain and Spinal Cord cancers
Leukaemia
This is a cancer of the white blood cells, originating in the bone marrow and other blood-forming tissues.
This is a cancer of the white blood cells, originating in the bone marrow and other blood-forming tissues. Lymphoma and Myeloma
The Stages of Cancer Most types of cancer are categorised into four stages, ranging from stage 1 to stage 4. Here are some:
Stage 1 Typically, this indicates that the cancer is small and confined to where it originally started.
Stage 2 In this stage, the tumour is typically larger than in stage 1 but has not yet spread to nearby tissues. In some cases, it may involve cancer cells spreading to nearby lymph nodes, though this varies depending on the specific type of cancer.
Stage 3 The cancer is typically more extensive, po- tentially spreading into surrounding tissues and involving nearby lymph nodes with cancer cells.
Stage 4 This stage signifies that the cancer has travelled from its original site to another organ in the body, such as the liver or lungs. This is known as secondary or metastatic cancer.
Why Does Cancer Occur
Cancer arises when certain cells in the body grow uncontrollably and invade other tissues. This can happen almost anywhere since our bodies are composed of trillions of cells. Typically, cells grow, divide, and replace old or damaged cells in an orderly manner. However, when this process malfunctions, abnormal cells multiply and may form tumours. Tumours can be benign (non-cancerous) or malignant (cancerous). Malignant tumours invade nearby tissues and spread to other parts of the body (metastasis), while benign tumours do not spread and often remain harmless. However, large benign tumours can sometimes cause serious issues, especially in sensitive areas like the brain.
Identifying Cancer-Causing Progress and Factors
Biological Processes When it comes to“Cancer”there are various processes and factors that may be linked to the question of“Why does cancer occur?” Here are some of the answers to this question: This transformation involves several biological processes such as abnormal cellular changes. Here’s a detailed explanation of normal cellular processes compared to the processes of transforming into cancerous cells.
Cell Cycle Regulation 1.
Normal cells follow a tightly regulated cell cycle, which includes phases for growth (G1), DNA replication (S), preparation for division (G2), and cell division (M). Checkpoints during the cell cycle ensure that cells only divide when conditions are optimal and DNA is undamaged.
Normal Cellular Processes
DNA Repair Mechanisms 2. Cells have mechanisms to repair damaged DNA. If DNA damage is detected, the cell cycle is halted to allow repair, preventing the propagation of mutations.
Apoptosis (Programmed Cell Death) 3. Apoptosis is a process where damaged or unwanted cells are systematically dismantled and removed without causing harm to the organism. It ensures that cells with severe DNA damage or errors are eliminated.
Self-sufficiency of growth signals 01 Normal cells require signals to specify when they should grow and divide. Cancer cells no longer require exter- nal signals to be stimulated to grow, often having on-off switches that are stuck in the on position.
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Insensitivity to anti-growth signals Cancer cells have lost this function to inhibit excessive cell growth.
Sustained angiogenesis Cancer cells without a new blood supply can’t grow beyond about 1-3mm without outpacing their blood supply.
Hallmark of Cancer
Limitless replicative potential
Evading apoptosis
Apoptosis is a biological self-destruct program that cells have. This automated self-destruct mechanism is turned off in cancer cells.
Most cells will automatically stop growing beyond a certain point. Cancer cells continue to grow without any inhibition.
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Tissue invasion and metastasis
Cancer cells put out molecular signals that attract new blood vessels to the cancer from outside, providing a new mechanism for the support needed to grow, to invade into surrounding tissues and spread to other parts of the body.
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Genetic Factors Some individuals inherit genetic mutations that predispose them to certain cancers. These inherited mutations can significantly increase the risk of developing cancer. Since cancer is a genetic disease, it tends to affect three main types of genes in a person’s body.
Tumour suppressor genes These genes are like the vigilant guardians of our cells, working tirelessly to prevent the uncontrolled growth that leads to cancer. These genes act as the brakes on cell division, ensuring that cells only divide when necessary and repairing DNA damage to keep genetic information intact. When tumour suppressor genes function correctly, they halt the proliferation of potentially cancerous cells and initiate cell death if damage is irreparable. However, when these genes are mutated or deactivated, the cellular brakes fail, allowing cells to grow uncontrollably and form tumours. Think of tumour suppressor genes as the unsung heroes maintaining order in our bodies, preventing the rise of cancerous chaos.
DNA repair genes
Proto-oncogenes They are like the superheroes of our cells' DNA, playing crucial roles in normal cell growth and division. These genes act as regulators, ensuring cells grow and divide at the right times, keeping our bodies functioning properly. However, when these genes undergo mutations or are over-activated, they can transform into oncogenes - villainous counterparts that drive uncontrolled cell growth, leading to cancer. Think of proto-oncogenes as the benevolent forces maintaining balance in the cellular world, but with the potential to turn rogue under certain conditions, sparking the chaos of cancer.
These are the meticulous mechanics of our cells, constantly at work to maintain the integrity of our genetic blueprint. These genes produce proteins that detect and fix errors in DNA, which can occur from everyday environmental exposure or during normal cell division. By repairing damaged DNA, they prevent mutations that could lead to cancer and other diseases. Imagine DNA repair genes as an elite team of technicians, ensuring that our cellular machinery runs smoothly and accurately, safeguarding our health by keeping our DNA in top condition. When these repair mechanisms fail, the risk of genetic chaos and disease, including cancer, increases.
Environmental Factors Environmental factors such as lifestyle choices, diet, and exposure to carcinogens
play a significant role in cancer development. Carcinogens such as tobacco smoke, ultraviolet (UV) radiation, and certain chemicals cause DNA damage that can lead to mutations in critical genes controlling cell growth and division. Unhealthy lifestyle choices, including poor diet, lack of physical activity, and excessive alcohol consumption, can further exacerbate these risks by weakening the body’s ability to repair DNA damage and maintain normal cellular processes.
Together, these factors increase the likelihood of genetic mutations that disrupt cell regulation, leading to the uncontrolled growth characteristic of cancer.
Cancer cells differ from normal cells in several ways: They grow without
Unlike normal cells, cancer cells invade nearby areas and spread throughout the body. Cancer cells evade the immune system, sometimes even tricking it into aiding their growth. Additionally, cancer cells rely on different nutrients and produce energy differently, enabling rapid growth.
signals, ignoring cues to stop dividing or to undergo programmed cell death (apoptosis). They attract blood vessels to tumours, providing oxygen and nutrients while removing waste. They also accumulate multiple chromosomal changes and often have an abnormal number of chromosomes.
Who is Susceptible to Cancer Cancer can strike anyone. Here are the common risk factors:
Cancer-causing Substances Whether lurking in the air we breathe, the food we eat, or the products we use, these substances pose a stealthy threat to our health. The chemicals in our environment can trigger mutations that pave the way for cancer to take root.
Age As we age, our risk of cancer increases due to the accumulation of genetic mutations over time. The longer we live, the more exposure our cells have to potential damage from environmental factors and lifestyle choices, making age a significant risk factor for developing cancer.
Alcohol Often seen as a social companion, carries a lesser-known risk, it is a potential contributor to cancer. Regular consumption can increase the likelihood of developing various types of cancer, including those of the mouth, throat, liver, and breast. Understanding this link underscores the importance of moderation in enjoying life's pleasures while safeguarding long-term health. Some believe that substances such as resveratrol found in red wine may have anticancer effects, but there is no proof that drinking red wine lowers cancer risk.
Immunosuppression Whether due to medical treat- ments or certain conditions, weakens the body's natural defenses against cancer. This compromised immune response can allow cancer cells to proliferate unchecked.
Diet It plays a pivotal role in cancer risk, serving as both a shield and a sword. A balanced diet rich in fruits, vegetables, and whole grains provides essen- tial nutrients and antioxidants that can help protect against cancer. Conversely, diets high in processed foods, red and processed meats, and sugary drinks may increase the risk, fuelling inflammation and promoting obesity - a known risk factor for several types of cancer.
Chronic Inflammation Inflammation is a natural response that prompts damaged tissue to heal, kicking off a process where chemicals signal white blood cells to repair and rebuild. Normally, once healing is complete, inflammation subsides. However, in cases of chronic inflammation, this healing response persists without cause or end. The reasons for prolonged inflammation vary from lingering infections to immune system glitches or conditions like obesity. Over time, chronic inflammation can harm DNA, potentially paving the way for cancer. For instance, individuals with chronic inflammatory bowel diseases like ulcerative colitis or Crohn's disease face elevated risks of developing colon cancer.
Hormones Wield a dual-edged sword in cancer risk. While essential for regulating bodily functions, imbalances or excesses can fuel cancer growth. For example, elevated estrogenic levels have been linked to breast and uterine cancers. Understanding and managing hormone levels through lifestyle choices and medical interventions can play a crucial role in reducing cancer risk, emphasizing the importance of hormonal balance in maintaining overall health.
Infectious Agents These agents can stealthily elevate cancer risk by inserting their genetic material into our cells or triggering chronic inflammation. Some examples include viruses like HPV, HIV and Hepatitis B which can lead to cervical and liver cancers, respectively.
Obesity This isn't just about extra weight, it's a complex risk factor for cancer. Excess body fat can disrupt hormone levels, promote chronic inflam- mation, and create an environ- ment that encourages cancer cell growth.
Radiation While pivotal in medicine and technology, it can also pose a silent threat to health by damaging DNA and potentially triggering cancerous changes in cells.
Tobacco Often glamourised yet insidious, is a potent risk factor for cancer. Its smoke contains thousands of harmful chemicals that can damage DNA and trigger cancerous changes in cells.
UV-Rays A source of warmth and vitality, harbours a hidden danger: ultraviolet (UV) radiation. Prolonged exposure to UV rays can damage skin cells' DNA, increasing the risk of skin cancer. Even though skin cancer is more common among people with a light skin tone, people of all skin tones can develop skin cancer, including those with dark skin.
When to Seek Professional Help
Recognising signs of cancer early is crucial although some come without any symptoms at all. However early detection can significantly improve treatment outcomes and quality of life, making timely consultation with healthcare professionals is essential in addressing potential health concerns effectively. Some symptoms can be difficult to be discussed about, for example a lump on your testicle or vaginal bleeding. But even if it can be the most embarrassing encounter, it is important to get the symptom checked.
General Symptoms
• A sore or ulcer in your mouth that lasts longer than 3 weeks, or you develop red or white patches in your mouth. • A hoarse voice that does not get better. • Difficulty swallowing or chewing, or a feeling that something is stuck in your throat. • Blood in urine, stools, or vomitus. • Coughing up blood. • Bruises when you have not hurt yourself. • Vaginal bleeding between periods, after sex or after the menopause. • Blood in your semen. Unexplained bleeding or bruising
• How long it has been there. • If it is getting bigger. • If it is painful or uncomfortable. Lumps or swelling
Pain
• Pain in any part of the body without any reason and you do not know what is causing it.
• Severe tiredness for no obvious reason. Fatigue
Weight loss
Fevers or infections
• Without trying to. • And have not changed your diet or how much physical activity you do.
• Lasts a long time. • Keeps coming back. • Causes regular heavy sweating, enough to soak your bedclothes, especially at night.
Symptoms That Affect Different Parts of the Body
Problems with eating and digestion
Swelling in the tummy (abdomen)
Mouth or throat problems
• A sore or ulcer in your mouth that lasts longer than 3 weeks, or you develop red or white patches in your mouth. • A hoarse voice that does not get better. • Difficulty swallowing or chewing, or a feeling that something is stuck in your throat.
• Do not feel like eating as much as you normally do which continues. • Feel full quickly when you eat, and the feeling continues. • Get indigestion or heartburn most days, or if it is very painful or getting worse.
• Bloated or swollen tummy that lasts for quite a long time, there could be other reasons to it but some symptoms can be for some types of cancer.
Persistent cough or breathlessness
• Pain when passing urine. • Blood in urine. • Weak flow, or you need to strain to start passing urine. • Micturate or urinating more often than usual. • The need to pass urine more urgently. Difficulty urinating
• Altered bowel habits. • Traces of blood in your stool, on the toilet paper or in the toilet. Bowel changes
• Have a cough that is not getting better or is getting worse. • Feel out of breath for no reason. • Have breathlessness that is getting worse. • Have a chest infection that does not get better or that keeps recurring. • Cough up blood.
Symptoms That Affect Different Parts of the Body
Breast, chest, or nipple discoloration
• An unexplained rash. • An itch that will not go away. • Yellowing of the skin and the whites (conjunctiva) of the eyes. • A new or changing mole. Symptoms affecting the skin
Headaches
• Pain and heavy headed- ness when you wake up at night. • Head pains that worsen in the morning. • Feeling sick. • Change in eyesight.
• A sign of lump in the breast is the most
common signs of breast cancer, but others could include changes to the look or feel of your breast, chest, nipple, or armpit.
Testis and penis problems
Vulva and vaginal problems
• A lump or sore on the penis. • Swelling or lump in the groin. • Dull ache, pain or heaviness in the scrotum. • Problems developing an erection. • Pain or bleeding during ejaculation.
• Bleeding after menopause. • A lump, swelling or sore in the vulva or vagina • A swelling or lump in the groin. • Itching, burning or soreness in the vulva or vagina. • Thick or raised red, white, or dark patches of skin of the vulva. • A mole on the vulva that changes shape or colour. • Unusual vaginal discharge, such as watery, blood-stained or smelly discharge. • Heavier or more painful periods than usual. • Bleeding between periods, and after sex.
A Family’s Reaction Towards the Diagnosis of Their Loved One
When a loved one is diagnosed, families often face a cascade of intense emotions, such as shock, fear, helplessness, and profound sadness. These initial reactions can disrupt family dynamics as members struggle to process the news and adjust to their new reality. Emotionally, families may experience a roller coaster of feelings, mirroring those of the patient. Anxiety about the future, grief over the potential loss, and guilt about not being able to "fix" the situation can weigh heavily on family members. The emotional burden can lead to stress and, in some cases, depression or anxiety disorders within the family. Socially, the diagnosis often brings families closer together, creating a support network for the patient. However, it can also strain relationships, as roles and responsibilities shift. Primary caregivers may feel overwhelmed, siblings might feel neglected, and children may struggle to understand the changes. Communication becomes crucial, yet it can be challenging as everyone copes differently.
Psychologically, families must navigate the uncertainty and fear of losing a loved one, which can be an ongoing source of stress. However, this period also offers an opportunity for growth and resilience. Families often find new strengths, develop deeper connections, and prioritize what truly matters in life. Healthcare providers can support families by offering counselling, resources for caregiving, and strategies for effective communication. By addressing the psychosocial needs of the entire family, they can help foster a supportive environment that benefits both the patient and their loved ones.
Where to Seek Professional Help Oncologists are often seen as the cornerstone of
cancer treatment, yet they are distinct from surgeons. While both play crucial roles in a patient's journey, oncologists are primarily physicians who specialise in diagnosing and treating cancer through various non-surgical means such as chemotherapy, radiation therapy, and targeted therapy. They collaborate closely with a diverse team of specialists, including surgeons, radiologists, and pathologists, to develop the most effective treatment plans tailored to each patient's unique case. This multidisciplinary approach ensures comprehensive care, integrating the expertise of various medical fields to combat cancer from all angles. Here are some of the top most common cancers in Malaysia, and where to seek professional help for the specific cancer types.
Top 5 Most Prevalent Cancers in Malaysia 1 Breast Cancer
Breast cancer, one of the most common cancers worldwide, begins when cells in the breast grow uncontrollably, forming a tumour that can often be felt as a lump. This disease predominantly affects women, though men can also be diagnosed. This cancer can be categorised in several ways and most often it is classified by the place it originates and whether it moves from that particular spot. When determining treatment for breast cancer, the process is divided into three key stages: clinical examination, imaging (mammogram and ultrasound), and pathology. After identifying the issue through clinical examination or imaging, a tissue sample is taken for pathology via a minimally invasive biopsy. This involves using a small hollow needle to extract tissue from the lump. Collaborating with a radiologist, this procedure ensures enough tissue is collected for an accurate diagnosis. Once all three diagnostic aspects are reviewed, a personalised treatment plan is developed to guide your care.
Who to look for? It is important to be aware of what lies ahead when it comes to cancer. At Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to the tailored medical specialty and procedure by our Breast surgeons: https://gleneagles.com.my/kuala-lumpur/medical-specialties/breast-surgery
2 Colorectal Cancer
Being one of the second most common cancers in Malaysia, this cancer is a formidable foe within the digestive system, begins in the colon or rectum, often starting as a benign polyp that can slowly transform into a malignant tumour. This cancer is notorious for its silent progression, frequently showing no symptoms in its early stages. However, as it advances, it can cause changes in bowel habits, abdominal pain, and even blood in the stool. Early detection through regular screenings like colonoscopies is vital, as it dramatically improves the chances of successful treatment and survival.
Being a very serious illness responsible for countless deaths in Malaysia, at Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to t Who to look for? It is important to be aware of what lies ahead when it comes to cancer. If you notice unusual changes in the area of colon, at Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to the tailored medical specialty and procedure by our Colorectal surgeons: https://gleneagles.com.my/kuala-lumpur/medical-specialties/colorectal-surgery
3 Lung Cancer
Lung cancer, often a silent adversary, begins in the lungs and is notorious for being the leading cause of cancer deaths in Malaysia. This aggressive disease typically starts in the cells lining the bronchi and parts of the lung, often going unnoticed until it reaches an advanced stage. It is a major cause of concern for Malaysians. One in 55 males and one in 135 females have this cancer. Early symptoms can be easily mistaken for common respiratory issues, including a persistent cough, shortness of breath, and chest pain.
Who to look for? Being a very serious illness responsible for countless deaths in Malaysia, at Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to the tailored medical specialty and procedure by our Pulmonologist: https://gleneagles.com.my/kuala-lumpur/medical-specialties/respiratory-medicine
4 Nasopharyngeal Cancer
Nasopharyngeal cancer, a rare yet intriguing form of cancer, originates in the nasopharynx, the upper part of the throat behind the nose. This type of cancer is particularly prevalent in certain regions, such as Southeast Asia and North Africa, pointing to a fascinating interplay of genetic, environmental, and viral factors. One of the most compelling aspects of nasopharyngeal cancer is its strong association with the Epstein-Barr virus (EBV), which is also known for causing infectious mononucleosis. While most people infected with EBV do not develop cancer, those with a genetic predisposition or exposure to certain dietary and environmental factors, like salted fish and inhaling wood dust, may be at higher risk. Nasopharyngeal cancer often presents with subtle symptoms that can be easily overlooked, such as a persistent stuffy nose, nosebleeds, hearing loss, or a lump in the neck.
Who to look for? Often present with very vague signs making early detection challenging, underscoring the importance of vigilance and awareness is essential. At Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to the tailored medical specialty and procedure by our Ear, Nose & Throat (ENT) surgeons: https://gleneagles.com.my/kuala-lumpur/medical-specialties/ear-nose-and-throat-surgery-ent
5 Liver Cancer
The liver, the body's largest internal organ, plays a crucial role in healing wounds and absorbing nutrients. Nestled in the upper right abdominal cavity beneath the ribs, the liver produces bile, a dark yellowish-brown fluid essential for digesting vitamins, fats, and other nutrients. Additionally, the liver acts as a reservoir, storing vital nutrients like glucose to ensure the body remains nourished and operates smoothly. Liver cancer, a formidable challenge within the body's metabolic powerhouse, arises when abnormal cells grow uncontrollably in the liver. This organ, essential for detoxification, nutrient processing, and bile production, can be affected by various factors such as chronic infections (like hepatitis B or C), excessive alcohol consumption, obesity, and certain genetic conditions. What makes liver cancer particularly intriguing is its ability to develop silently, often without obvious symptoms until later stages. Early signs may include unexplained weight loss, abdominal pain, or jaundice, a yellowing of the skin and eyes.
Who to look for? One of the most important organs in our body, if ignored it can lead to death. At Gleneagles Hospital Kuala Lumpur, we aim to provide comprehensive treatment to our patients according to the tailored medical specialty and procedure by Hepatologists: https://gleneagles.com.my/kuala-lumpur/medical-specialties/hepatology
Treatments for Cancer
Radiation Therapy
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Radiation therapy uses high-energy rays or particles to destroy or damage cancer cells. It is focused on specific areas of the body where tumours are located and can be used alone or in combination with surgery or chemotherapy.
Chemotherapy
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Chemotherapy uses drugs to kill cancer cells or stop their growth. These drugs can be administered orally or intravenously and travel throughout the body to target cancer cells wherever they may be.
Immunotherapy
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Immunotherapy works by boosting the body's immune system to recognise and attack cancer cells. It includes various approaches such as checkpoint inhibitors, CAR-T cell therapy, and cancer vaccines.
Treatments for Cancer
Targeted Therapy
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Targeted therapy targets specific molecules or pathways involved in the growth and survival of cancer cells. These therapies are tailored to the genetic makeup of the cancer cells and can often be more precise than traditional chemotherapy.
Gamma Knife Radiosurgery
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Gamma Knife is a non-invasive procedure that uses precise beams of radiation to target and treat tumours or lesions in the brain. It is highly accurate, minimising damage to surrounding healthy tissue, and is typically used for conditions such as brain tumours, trigeminal neuralgia, and arteriovenous malformations (AVMs).
Surgery
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Surgery involves physically removing tumours or cancerous tissue from the body. It is often used to remove localized tumours that haven't spread extensively.
Prevention is Better Than Cure! There are several ways to reduce the risk of developing cancer which include:
Quit smoking If you smoke, quit. If you do not, don’t start. Smoking is linked to various cancers, not just lung cancer. Quitting now reduces your future cancer risk.
Avoid over exposure to the sun UV rays from the sun can raise your risk of skin cancer. Reduce exposure by staying in the shade, wearing protective clothing, or using sunscreen. Exercise regularly each week Exercising reduces the risk of cancer. Start for at least 30 minutes on most days a week if you have not.
Maintain a healthy diet
Consume a diet rich in fruits and vegetables. Select whole grains and lean proteins and limit the intake of processed food.
Maintain a healthy weight Being overweight or obese may increase the risk of cancer. So, achieve a healthy weight through healthy diets and regular exercise. Drink alcohol in moderation, if you choose to If you really have the urge to drink, do so in moderation. Consult a professional about immunisations Some viruses such as hepatitis B and HPV, increase cancer risk. Immunisation can help prevent these. Ask your doctor if these vaccines are right for you.
Schedule cancer screening exams Always consult a professional on what cancer screening works best for you based on the risk factors. Scheduling screening exams is the first step for early detection which can lead to saving lives. Keeping your health in check means staying on top of everything in life, and at Gleneagles Hospital Kuala Lumpur, we prioritize your well-being by offering comprehensive health screening services stated below. This provides valuable insights into potential health risks, allowing early detection of diseases before they progress.
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