Recently, during the general outpatient clinic, we have encountered many patients who found a lesion during a general gastroscopy and underwent a routine biopsy, but unexpectedly found a malignant tumor (mainly adenocarcinoma). After that, of course, they were in a panic and had no idea, so they rushed to consult with us and were afraid. Therefore, we hope to introduce what we should do in this situation, and hope that it will be helpful to patients and family members, so that we can be a little guide in the panic. Can gastric cancer be detected by gastroscopy? Gastroscopy can detect gastric cancer, and it is recommended to go to a higher level hospital in time to review and confirm the specific situation if the patient’s condition is found to be early, so it is recommended to carry out treatment as soon as possible according to the actual situation of the examination. Generally, cancer can be treated by considering surgery, chemotherapy and radiotherapy. First of all, after the discovery of gastric cancer, it is necessary to further improve the imaging examination. We should know that stomach is a hollow organ, just like a bib, divided into inner and outer layers. Gastroscopy is equivalent to probing the bib from the inside, and the problem is found. What about the outer layer, does the lesion involve the outer layer? Unfortunately, we don’t know at this point. Therefore, at this point, we need to do abdominal and pelvic CT to further understand, for example, whether the tumor is growing out or not? What is the condition of the surrounding lymph nodes? Is there any metastasis in liver, lung or abdominal cavity? Only after looking at the imaging results from the outside, 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 of surgical resection. A large body of evidence shows that for specific conditions, preoperative or postoperative radiotherapy and biologic therapies can significantly improve patient prognosis. It is like war, before there are fewer methods, only infantry can go up and fight with bayonet, but now there are more methods and stronger technology, we should consider whether to carpet bomb before infantry go up? Do you want to carry out a precise “decapitation operation” first? In short, no matter what tactics are chosen, the purpose is just to better destroy the enemy. Therefore, patients and family members who are first diagnosed with gastric cancer should not necessarily be anxious about when to operate, but should seriously consult the relevant experts for the most suitable treatment plan. Finally, the most important question for patients is: Is this disease serious now? How long can I live with this condition? Do I need any other treatment after the surgery? Will it recur and metastasize in the future? Sometimes I feel helpless to answer this series of questions when I am faced with anxious first-time patients who only have a gastroscopy result. Because medicine is evidence-based and requires evidence, it is difficult for a clever woman to cook a meal without rice, which requires at least imaging results (of course, eventually the gold standard for post-surgical pathology results), in order to roughly clarify the diagnosis, staging, and then speculate on the patient’s prognosis, but of course this is only a general answer. In recent years, a tool called line chart has been used clinically to estimate the prognosis of patients according to their specific conditions, which has been applied in Europe and the United States, and we are further studying it, hoping that it can be used clinically to serve patients as soon as possible. As mentioned above, the discovery of gastric cancer by gastroscopy biopsy is only a starting point for diagnosis and treatment, and the anxiety and urgency of patients and their families is 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 and calm, which is especially important for the family members next to the patient.