The first 60 days: 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. Below, week by week, is what OnCo's record of Early gastric cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Within endoscopic criteria.
- SurgeonNamed in the standard of care for: Within endoscopic criteria, Non-curative resection or outside criteria.
- Medical oncologistNamed in the standard of care for: After resection.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?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?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?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?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?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?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?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?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Early gastric cancer: the full pageEarly 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Screening: Testing people who have no symptoms to catch cancer, or its precursors, early enough to cure.
- Gastrectomy: Removing part (subtotal) or all (total) of the stomach for stomach cancer, with the bowel joined to what remains.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
- Endoscopy (EGD, EUS, ERCP): Looking inside a hollow organ with a camera on a flexible tube, taking biopsies and sometimes treating on the spot.
Every term links to the glossary.