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Living with cancer·Standard of care

Early gastric cancer: the decisions you may face

Cancer page →Second-opinion finder →

4 treatment settings, 0 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Within endoscopic criteria

One path named

Endoscopic submucosal dissection with en bloc resection and pathological assessment of depth, margins and lymphovascular invasion.

The path, in plain words
Endoscopic resection (EMR / ESD)Standard of care

Endoscopic resection lifts an early cancer of the oesophagus or stomach with an injection and cuts it out from inside with a snare or electrosurgical knife, keeping the organ intact. It cures cancers confined to the mucosa (T1a) and gives a definitive depth reading; deeper invasion or lymph node spread still needs surgery.

  • Organ preservation, low morbidity
  • Curative for T1a disease
  • Provides definitive staging
Also referenced:Endoscopy (EGD, EUS, ERCP)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Endoscopic resection (EMR / ESD)
  • Operator-dependent, long learning curve for ESD
  • Not curative for deeper invasion or nodal disease
  • Requires endoscopic surveillance afterwards
Questions to ask about this decision
  1. Is Endoscopic resection (EMR / ESD) the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. 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.

Add these to your appointment list, or take the full question set for this cancer.

Other settings

Non-curative resection or outside criteria

One path named

Gastrectomy with D1+ lymph node dissection, laparoscopic or robotic (KLASS-01, JCOG0912).

The path, in plain words
Robotic & minimally invasive surgeryStandard of care

Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.

  • Precision, shorter stay
  • Enables complex minimally invasive resections
Also referenced:GastrectomyLymphadenectomy (lymph node dissection)Japan Clinical Oncology Group (JCOG)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Robotic & minimally invasive surgery
  • Cost
  • Loss of haptic feedback
  • Not superior for every indication
Questions to ask about this decision
  1. Is Robotic & minimally invasive surgery the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. 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).

Add these to your appointment list, or take the full question set for this cancer.

Other settings

After resection

One path named

Helicobacter pylori eradication and annual endoscopic surveillance for metachronous cancer; no adjuvant chemotherapy for stage I.

The path, in plain words
Chemoprevention & risk-reducing surgeryStandard of care

Drugs or surgery for people at high inherited risk, before any cancer appears.

  • Large absolute risk reduction in carriers
Also referenced:Endoscopy (EGD, EUS, ERCP)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record
Chemoprevention & risk-reducing surgery
  • Side effects deter uptake; surgery is irreversible
Questions to ask about this decision
  1. Is Chemoprevention & risk-reducing surgery the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
    Why: A single standard does not mean a single choice; timing and trials are decisions too.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. 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.

Add these to your appointment list, or take the full question set for this cancer.

Described in words

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.

The path, in plain words

This setting names no product or technology record yet; the approach above is the standard as written. Ask your team which specific treatments they mean.

Also referenced:ScreeningEndoscopy (EGD, EUS, ERCP)
The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision
  1. Which specific treatments are you proposing for this setting, and what are the alternatives?
    Why: The standard of care here is described in words rather than named products; ask for the names.
  2. What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
    Why: The aim shapes how much side effect and disruption is worth accepting.
  3. What happens if I delay, or decline this step for now? Is the decision reversible?
    Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
  4. 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.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.