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Early gastric cancer has not grown beyond the submucosa, whatever the lymph nodes show. In Japan and Korea, where screening endoscopy finds most stomach cancers at this stage, many are removed through the endoscope without an operation, and the rest are cured by gastrectomy.
Early gastric cancer is defined by depth: a tumour limited to the mucosa (T1a) or submucosa (T1b), regardless of nodal spread. Its detection depends on endoscopy in people without symptoms. Korea has offered biennial endoscopic screening to everyone from age 40 in its national programme since 1999, and Japan recommended endoscopy over barium radiography in 2016; as a result more than half of gastric cancers in both countries are early, against about one in five in Europe and North America. Helicobacter pylori causes most of these cancers, and eradication after endoscopic resection roughly halves the risk of a second primary tumour in the remaining stomach.
Endoscopic submucosal dissection removes the lesion in one piece with its margins. The Japanese Gastric Cancer Association criteria cover differentiated intramucosal tumours without ulceration of any size, differentiated ulcerated tumours up to 3 cm, and, after the JCOG1009/1010 trial, undifferentiated intramucosal tumours up to 2 cm without ulceration; when pathology shows deeper invasion, lymphovascular invasion or an involved margin (a high eCura risk), gastrectomy with lymph node dissection follows because the risk of nodal disease rises. Curative dissection preserves the stomach and its function with recurrence rates comparable to surgery in matched series.
For tumours outside those criteria, gastrectomy with D1+ node dissection is standard; laparoscopic distal gastrectomy proved non-inferior to open surgery for stage I disease in the Korean KLASS-01 and Japanese JCOG0912 trials and is now routine, with robotic surgery an alternative. Adjuvant chemotherapy is not given for stage I disease. Surveillance after endoscopic resection is annual endoscopy for metachronous lesions, and the whole model is being tested in Western trials of risk-based screening and in the gastric cancer arm of Lynch syndrome programmes.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Squamous cancers sit in the upper and middle oesophagus, adenocarcinomas at the junction and in the stomach; the stomach wall also gives rise to GIST from its pacemaker cells.
Same organ: Gastric & gastro-oesophageal junction cancer, HER2-positive gastric cancer, Claudin 18.2-positive gastric cancer, PD-L1-high gastric cancer, Microsatellite-unstable (MSI-high) gastric cancer, Oesophageal squamous cell carcinoma, Oesophageal and junctional adenocarcinoma, Oesophageal cancer, Gastrointestinal stromal tumour (GIST), KIT exon 11-mutant GIST, PDGFRA D842V-mutant GIST, Imatinib-resistant GIST
Nothing recorded yet.
Nothing recorded yet.
Background: Screening. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Endoscopic submucosal dissection with en bloc resection and pathological assessment of depth, margins and lymphovascular invasion.
Gastrectomy with D1+ lymph node dissection, laparoscopic or robotic (KLASS-01, JCOG0912).
Helicobacter pylori eradication and annual endoscopic surveillance for metachronous cancer; no adjuvant chemotherapy for stage I.
Biennial endoscopy from age 40 in Korea and from 50 in Japan; risk-based screening for people of East Asian origin and with atrophic gastritis elsewhere.
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The early gastric cancer page's endoscopic criteria and surgical recommendations follow this guideline.
Together with KLASS-01, this trial makes laparoscopic distal gastrectomy the standard for early gastric cancer needing surgery.
Laparoscopic distal gastrectomy is the standard operation for stage I gastric cancer outside endoscopic criteria in East Asia and increasingly elsewhere.
The expanded criteria for endoscopic submucosal dissection in Japanese and international guidelines derive from this analysis.
Query for this cancer: (TITLE:"Early gastric cancer" OR ABSTRACT:"Early gastric cancer" OR TITLE:"T1 gastric cancer" OR ABSTRACT:"T1 gastric cancer" OR TITLE:"Intramucosal gastric cancer" OR ABSTRACT:"Intramucosal gastric cancer" OR TITLE:"Submucosal gastric cancer" OR ABSTRACT:"Submucosal gastric cancer" OR TITLE:"Screen-detected gastric cancer" OR ABSTRACT:"Screen-detected gastric cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Early gastric cancer, not a curated reading list.
No targets or pathways are linked to this cancer yet. Browse the gene hub →
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
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