Recently, during the general outpatient clinic, I have encountered many patients who found a lesion during a general gastroscopy and underwent a routine biopsy, only to find a malignant tumor (mainly adenocarcinoma) unexpectedly. Afterwards, of course, they are on pins and needles, panic and have no idea, and rush to consult with us in fear. Therefore, I would like to give a rough introduction on what to do in this situation, and hope that it will be helpful to patients and their families. First of all, after the discovery of gastric cancer, we must further improve the imaging examination. We should know that the stomach is a hollow organ, just like a hood, divided into an inner layer and an outer layer. Gastroscopy is equivalent to probing the hood from the inside, and the problem is found. So, what about the outer layer? Does the lesion involve the outer layer? Unfortunately, at this point we don’t know. Therefore, it is necessary to do abdominal as well as pelvic CT and other tests to further understand the situation. For example, is the tumor growing out? What is the condition of the surrounding lymph nodes? Are there any metastases in the liver, lung or abdominal cavity? Only after looking at the imaging results of the outer layer, it is possible to answer these questions. Secondly, not all patients with gastric cancer are suitable for surgical treatment. With the increased understanding of solid tumors, the treatment of tumors is now not a single modality such as surgical resection. There is abundant evidence that for specific conditions, preoperative or postoperative radiotherapy can significantly improve the prognosis of patients. It is just like warfare, before there are fewer methods, only infantry can go up to fight for their lives with bayonets, while now there are more methods and stronger technology, we should consider how to optimize the strategy. For example, before the infantry go up, should we carpet bomb? Do you want to carry out a precise “decapitation” first? In short, no matter what tactics are chosen, the purpose is to better destroy the enemy. Therefore, for patients and family members who are first diagnosed with stomach cancer, it is not necessary to be anxious about when to have surgery. It is the most important thing to consult relevant experts and ask for the most suitable treatment plan at this time. Finally, don’t rush and don’t panic in the process of seeing the doctor, and actively cooperate with the doctor for examination and treatment. There is no question that patients are more concerned about than when they see a doctor: Is this disease serious? How long can I live with this condition? Do you need any other treatment after the surgery? Will it recur and metastasize in the future? …… Sometimes I feel helpless to answer these series of questions when I am faced with anxious first-time patients who just have a gastroscopy result. The reason is that medicine is evidence-based and requires evidence, and it is difficult for a clever woman to cook without rice. At the very least, imaging results are needed (eventually, of course, post-surgical pathology is needed as the gold standard) in order to roughly clarify the diagnosis, the disease stage, and thus the patient’s prognosis, which of course is only a general answer. In recent years, a tool called columnar chart has been applied in the clinic, using which doctors can estimate the prognosis of patients according to their specific conditions. It has been applied in Europe and the United States, and we are further studying it, hoping to use it in the clinic to serve patients soon. To sum up, often the discovery of gastric cancer by gastroscopic biopsy is only a starting point for diagnosis and treatment. The anxiety and urgency of patients and their families are understandable, but it is most meaningful to be prepared to complete the next examination and treatment. Of course, this is also the time when you need to be rational, calm and composed, which is especially important for the family members next to the patient.