Early gastric cancer
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.
Overview
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.
State of the art
- Endoscopic submucosal dissection, developed in Japan, cures the majority of early gastric cancers without removing the stomach.
- Helicobacter pylori eradication after resection is proven to prevent second cancers.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Population endoscopic screening has made early-stage diagnosis the norm in Korea and Japan and is the reason their survival figures lead the world.
Anatomy and lymph node drainage
- Upper and middle oesophagus (squamous)
- Lower oesophagus and junction (adenocarcinoma)
- Cardia and fundus
- Body (diffuse or intestinal type)
- Antrum and pylorus
- Muscle wall (GIST)
- Nodes: perigastric (greater and lesser curve)
- Nodes: coeliac and hepatic
- Nodes: mediastinal
- Nodes: cervical (upper oesophagus)
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.
- Upper and middle oesophagus (squamous)
- Lower oesophagus and junction (adenocarcinoma)
- Cardia and fundus
- Body (diffuse or intestinal type)Distal (antral) early gastric cancer, intestinal type
- Antrum and pylorusDistal (antral) early gastric cancer, intestinal type
- Muscle wall (GIST)
- perigastric (greater and lesser curve)
- coeliac and hepatic
- mediastinal
- cervical (upper oesophagus)
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
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- More than half of gastric cancers diagnosed in Japan and Korea, where endoscopic screening finds them, but a small minority in Western countries; five-year survival above 90 percent when the tumour is confined to the mucosa or submucosa.
- Liquid biopsy (ctDNA)Standard of care
Nothing recorded yet.
Nothing recorded yet.
Background: Screening. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
Subtypes & biomarkers
top- Intramucosal (T1a) differentiated early gastric cancer (endoscopic resection)
- Undifferentiated intramucosal cancer up to 2 cm (endoscopic resection after JCOG1009/1010)
- Submucosal (T1b) early gastric cancer (gastrectomy)
- Distal (antral) early gastric cancer, intestinal type
- Screen-detected early gastric cancer (Japan and Korea)
- Metachronous early gastric cancer after resection
- Depth of invasion, ulceration and size (endoscopic resection criteria)
- Differentiated versus undifferentiated histology
- Lymphovascular invasion and margin status on the resected specimen (eCura risk)
- Helicobacter pylori status
- Intestinal metaplasia and atrophy extent (Kimura-Takemoto, OLGA) for surveillance intervals
How often this target appears
- 1962Japanese Society of Gastroenterological Endoscopy defines early gastric cancer
- 1999Korea launches national gastric cancer screening
- 2000Endoscopic submucosal dissection developed in Japan
- 2008Fukase trial: Helicobacter pylori eradication reduces metachronous cancer after endoscopic resection
- 2016Japan recommends endoscopic over radiographic screening; KLASS-01 supports laparoscopic gastrectomy
- 2020JCOG1009/1010: endoscopic dissection extended to small undifferentiated tumours
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 7 changes by month →- 2026-09-17This recordEarly gastric cancerFacts on this page last checked
When this page itself was last checked or edited.
- 2020MilestoneJapan Clinical Oncology Group (JCOG)JCOG1009/1010: endoscopic dissection extended to small undifferentiated tumours
A milestone in how this cancer is treated.
- 2016MilestoneEarly gastric cancerJapan recommends endoscopic over radiographic screening; KLASS-01 supports laparoscopic gastrectomy
A milestone in how this cancer is treated.
- 2008MilestoneEarly gastric cancerFukase trial: Helicobacter pylori eradication reduces metachronous cancer after endoscopic resection
A milestone in how this cancer is treated.
- 2000MilestoneEndoscopic resection (EMR / ESD)Endoscopic submucosal dissection developed in Japan
A milestone in how this cancer is treated.
- 1999MilestoneEarly gastric cancerKorea launches national gastric cancer screening
A milestone in how this cancer is treated.
What is in development for Early gastric cancer, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Western countries have no screening and diagnose most gastric cancers late.
and how the field plans to fix it →What is being done about thisFinding cancer earlierAvailable now- Liquid biopsy (ctDNA)Standard of care
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Background: Screening. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Predicting nodal spread in submucosal tumours to spare more patients surgery.
and how the field plans to fix it →What is being done about thisAdvanced and metastatic diseaseAvailable now- Endoscopic resection (EMR / ESD)Standard of care
- Liquid biopsy (ctDNA)Standard of care
- MRD / molecular residual disease testingEstablished
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Atlas of advanced disease · Invasion and metastasis.
Artificial intelligence detection of subtle lesions is promising but not yet proven to change outcomes.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Expert centres
topExpert centres
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Tokyo · government | Japan | none recorded | 0 | 1,599 | 21,937 | none recorded | #13 |
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
London · hospital | United Kingdom | none recorded | 0 | 2,376 | 28,940 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Miami, FL · cancer center | United States | 0 | 1,607 | 15,145 | - | ||
Guangzhou · hospital Programme: Gastric cancer surgery (CLASS trials) | China | none recorded | 0 | 1,245 | 12,931 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Beijing · hospital | China | none recorded | 0 | 1,154 | 11,808 | - | |
Naples · cancer center | Italy | none recorded | 0 | 961 | 15,028 | - | |
Madrid · hospital | Spain | none recorded | 0 | 764 | 13,767 | - | |
Pamplona · cancer center | Spain | none recorded | 0 | 751 | 10,993 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Early gastric cancer but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Early gastric cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Depth of invasion, ulceration and size, Differentiated versus undifferentiated histology, Lymphovascular invasion and margin status on the resected specimen, Helicobacter pylori status, Intestinal metaplasia and atrophy extentfor surveillance intervals), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Intramucosaldifferentiated early gastric cancer, Undifferentiated intramucosal cancer up to 2 cm, Submucosalearly gastric cancer.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Within endoscopic criteria
- For my situation (within endoscopic criteria), which of the standard options do you recommend and why?Why: Guideline options include: Endoscopic submucosal dissection with en bloc resection and pathological assessment of depth, margins and lymphovascular invasion.
Non-curative resection or outside criteria
- For my situation (non-curative resection or outside criteria), which of the standard options do you recommend and why?Why: Guideline options include: Gastrectomy with D1+ lymph node dissection, laparoscopic or robotic (KLASS-01, JCOG0912).
After resection
- For my situation (after resection), which of the standard options do you recommend and why?Why: Guideline options include: Helicobacter pylori eradication and annual endoscopic surveillance for metachronous cancer; no adjuvant chemotherapy for stage I.
Screening
- For my situation (screening), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Any stage
- Are there clinical trials I could join, for example of Endoscopic resection (EMR / ESD), Robotic & minimally invasive surgery, Liquid biopsy (ctDNA), MRD / molecular residual disease testing?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Western countries have no screening and diagnose most gastric cancers late”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Predicting nodal spread in submucosal tumours to spare more patients surgery”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Early gastric cancer, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
5institutions
1terms
4Latest papers
topQuery 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.
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