Often, patients are found to have advanced cancer after undergoing checkups, and they suffer a lot of pain during treatment, which is very regrettable, and their families suffer from great mental and financial burdens. If it can be detected early, the result should not be like this. For many years, experts and scholars have been emphasizing the importance of early detection and early treatment, no matter what kind of tumor. Fortunate among unfortunate in early stage of gastric cancer Let’s take a look at 2 cases. The first case is a 65-year-old Ms. Liu who had splenectomy half a year ago and was hospitalized after finding portal vein embolus formation during outpatient review without obvious complaints of discomfort and no family history of gastrointestinal tumor. After hospitalization, gastroscopy revealed a 2.0 cm × 2.0 cm lesion on the lateral side of the greater curvature of her gastric sinus, with a rough and uneven central erosion and surrounding elevation. A preliminary diagnosis of early gastric cancer was made, endoscopic mucosal dissection (ESD) was performed and sent for biopsy, and the patient met the criteria for curative resection based on the pathological findings. The second case is a 52-year-old Mr. Zhao, who had a depressed lesion visible in the lesser curvature of the gastric horn 2 years ago by gastroscopy, which was highly suspicious of early cancer, but for various reasons, no biopsy was taken and no treatment was given. 2 years later, the gastroscopy was repeated and progressive cancer in the lesser curvature of the gastric horn was found, and the biopsy pathology showed hypofractionated adenocarcinoma, which is a very regrettable case. In China, the prevalence and mortality rate of gastric cancer are more than twice the world average, and about 170,000 people die from gastric cancer every year. At present, 90% of gastric cancers found in China belong to the progressive stage, and the 5-year survival rate is less than 30%, while the 5-year survival rate after treatment of early gastric cancer can exceed 90%, or even reach the effect of cure. It can be seen how important early detection, early diagnosis and early treatment are to the health of gastric cancer patients. What is early gastric cancer? Early gastric cancer means the tumor is only limited to the mucosal layer or submucosal layer. And no matter how big the tumor is and whether there is lymph node metastasis or not, it is considered early stage gastric cancer. Since most patients with early stage gastric cancer do not have obvious clinical symptoms, doctors cannot diagnose early stage gastric cancer based on patients’ clinical manifestations, but mainly rely on gastroscopy and biopsy under gastroscopy to determine whether it is early stage gastric cancer. Early gastric cancer is classified according to the size of the tumor: small gastric cancer: the diameter of the cancer lesion is 6-10 mm. Microscopic gastric cancer: the diameter of the cancer lesion is ≤5 mm. Punctate carcinoma: the gastric mucosa biopsy is cancerous, but no cancerous tissue can be found in the surgical resection specimen series sampling. Endoscopically, early gastric cancer is further divided into: Type I (polyp-like type): those with cancer mass protruding about 5 mm or more. Type II (superficial type): cancerous masses with elevation or depression of 5 mm or less. Type III (ulcerative type): those whose cancer mass is depressed more than 5 mm in depth, but does not exceed the submucosa layer. In recent years, with the improvement of endoscopic technology, the detection rate of early gastric cancer is getting higher and higher, so how should we choose the treatment method if early gastric cancer is detected? Endoscopic resection is preferred for early gastric cancer Once early gastric cancer is diagnosed, endoscopic resection is preferred. Compared with traditional surgery, endoscopic resection has the advantages of less trauma, fewer complications, faster recovery and lower cost, and the efficacy of both is basically equivalent. Therefore, endoscopic resection is recommended as the first choice of treatment for early gastric cancer both at home and abroad. Gastroscopic detection of early gastric cancer includes two steps: discovery of lesions and diagnosis of lesions. To discover a lesion means to “find” a suspicious lesion under endoscopy; to diagnose a lesion means to roughly determine whether the lesion is benign or suspicious of malignancy through endoscopic morphological analysis of the suspicious lesion, including ordinary white light endoscopy, staining endoscopy, magnifying endoscopy, confocal endoscopy, etc., and then to perform biopsy on the suspicious malignant lesion, and finally to confirm the diagnosis through pathology. The diagnosis is confirmed by pathology. Currently, the main endoscopic resections commonly used are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which is a new technique developed from EMR to avoid the limitations of EMR in terms of tumor infiltration and size. accurate pathological staging to minimize late recurrence. Minimally invasive treatment under gastroscopy, with no external incisions, requires only about a week of hospitalization. There is also no need for chemotherapy or radiotherapy after surgery. This is the most advanced and mature means of treating early-stage GI cancers. It is worth mentioning that in addition to being less painful, the cost of this procedure is not high. It should be noted that endoscopic resection is a minimally invasive surgery, but there is still a high incidence of complications, mainly including bleeding, perforation, stricture, abdominal pain, infection, etc., due to the influence of equipment and instruments, operator experience, technical methods, and patient’s general condition. Therefore, patients must actively cooperate with doctors in postoperative care, recuperation, and review in order to recover as soon as possible. Not all early gastric cancers are feasible to be resected endoscopically Laparoscopy is performed. For patients with early gastric cancer that cannot be resected endoscopically, laparoscopic surgery can be considered. Laparoscopic surgery involves opening tiny channels in the patient’s abdomen, inserting the laparoscope and operating instruments through these channels, transmitting the image data from the abdomen to the monitor through the laparoscope, and completing gastric cancer surgery under the guidance of the laparoscope. Laparoscopic surgery can perform the operations of traditional open surgery, such as major or total gastric resection and removal of suspected lymph nodes, with less bleeding, less injury, smaller postoperative incision scar, less pain, and faster recovery of gastrointestinal function after surgery. Open surgery. Since 5% to 6% of intramucosal gastric cancer and 15% to 20% of submucosal gastric cancer have perigastric lymph node metastasis, especially undifferentiated adenocarcinoma in young women, traditional open surgery (radical resection and lymph node dissection) can be considered. Surgery can certainly remove the cancer, but there may be residual cancer, or regional lymph node metastasis, or the presence of cancer thrombus in blood vessels, etc. The chance of recurrence and metastasis is very high. Recurrence and metastasis can be effectively prevented through post-operative radiotherapy and regular re-examination. After resection of gastric cancer, except for a small number of early stage patients, most patients in the middle and late stage need to undergo postoperative chemotherapy, because cancer cells may remain after surgery, or some gastric cancers are difficult to be completely removed by surgery, or there are metastatic lesions through lymphatic or blood system, etc. Early cancer screening to arouse public awareness of scientific cancer prevention The “Health China 2030” plan outlines that chronic disease screening and early detection should be strengthened, and early diagnosis and treatment should be carried out for key cancers in high-incidence areas, so as to increase the overall cancer survival rate by 15% in 5 years by 2030. Currently, screening for early cancers of the gastrointestinal tract is mainly through gastroscopy. Research shows that regular early cancer screening for elderly high-risk people can detect 70% of early cancers of the digestive tract through standardized operation, and the cure rate reaches 95%. According to the national situation and epidemiology of gastric cancer in China, those who meet any one of the criteria 1 and 2-6 should be classified as high-risk groups for gastric cancer and are recommended to be screened: (1) age 40 years or older, male or female; (2) people in areas with high incidence of gastric cancer; (3) people with H. pylori infection; (4) people with chronic atrophic gastritis, gastric ulcer, gastric polyps, post-surgical residual stomach, hypertrophic gastritis, pernicious anemia, etc. (5) First-degree relatives of gastric cancer patients; (6) Other high-risk factors for gastric cancer (high salt, pickled diet, smoking, heavy alcohol consumption, etc.). Many early gastric cancer patients have no uncomfortable symptoms, so early cancer screening is a very meaningful thing. We hope people can pay attention to the awareness of scientific cancer prevention, cultivate residents’ health science literacy, pay attention to early cancer, recognize early cancer, detect early cancer and treat early cancer.