Early gastric carcinoma (EGC) refers to cancer infiltration limited to the mucosal layer and submucosal layer, regardless of the presence or absence of lymph node metastasis and the extent of the disease. Gastric cancer is one of the major malignant tumors in China, and its mortality rate accounts for about 24% of all malignant tumors, ranking first among all types of cancer mortality. Symptoms 80% of early gastric cancer patients have no obvious symptoms, so it is called “invisible killer”. Therefore, it is crucial to catch the “fox tail” of stomach cancer, early detection and early treatment. In fact, as long as you pay attention to it, there are signs and symptoms of stomach cancer. Many symptoms of early gastric cancer patients can be mixed with other gastric diseases, which makes the detection of early gastric cancer more difficult. Early gastric cancer patients usually only have mild indigestion and other symptoms, such as hidden pain and discomfort in the upper abdomen, slight fullness, pain, nausea, belching, etc. These symptoms are not unique to gastric cancer, but can be seen in chronic gastritis, ulcer disease, functional dyspepsia, and even in normal people occasionally. However, more than 70% of early gastric cancer can be asymptomatic, and some patients can show discomfort or pain in the upper abdomen, and the symptoms often worsen after eating. As the disease progresses, the pain intensifies and attacks are frequent, accompanied by decreased appetite, fatigue and weakness, nausea and vomiting, warm gas and acidity, and burning in the stomach. Diao Dechang, Department of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine 1. Stomach pain: Most patients with gastric cancer have symptoms of stomach pain at the early stage of the disease. At first, they just feel discomfort or a feeling of swelling and heaviness in the upper abdomen and sometimes a vague pain in the heart fossa, therefore, they are often mistaken as gastritis or ulcer disease by patients, and the symptoms can be temporarily relieved after treatment. If the lesion occurs in the patient’s gastric sinus, it may induce functional changes in the duodenum and cause rhythmic pain similar to ulcer disease, which is often ignored by patients until the symptoms such as persistent pain or even black stool or vomiting blood appear, and then the patient’s condition has often developed to the advanced stage of gastric cancer and the best time for treatment is lost. Therefore, it is necessary to be alert to this non-specific early sign of gastric cancer, especially for those who are over 40 years old. 2. Loss of appetite, emaciation and weakness: The appearance of loss of appetite, emaciation and weakness is also a common but non-specific early sign of gastric cancer. Loss of appetite without stomach pain may be the early manifestation of gastric cancer, especially if it occurs together with stomach pain symptoms and hepatitis is excluded. Some patients automatically restrict their daily diet after eating because of symptoms such as bloating and belching, resulting in weight loss, emaciation and weakness. Since the location of abdominal distension is mostly under the saber process or to the right, it can be easily misdiagnosed as gallbladder disease. 3. Nausea, vomiting, vomiting blood, blood in stool: Early stage patients with gastric cancer may also experience a feeling of fullness after eating and mild nausea. The tumor in the cardia may start to show symptoms such as unpleasant eating, and then gradually show symptoms such as difficulty in swallowing and food reflux. Patients with early stage of gastric cancer also often have blood in stool, which is caused by the lesion destroying small blood vessels in the stomach. Patients with a small amount of intra-stomach bleeding may show positive fecal occult blood, and when the bleeding is large, it may show as vomiting blood and black stool. Elderly people who usually have no stomach problems should be especially alert to the occurrence of gastric cancer once black stools appear. In addition, symptoms such as diarrhea, constipation, discomfort in the lower part of stomach, deep pressure pain and mild muscle tension when pressing on the upper abdomen can also be regarded as early signs of gastric cancer and should be examined as early as possible. To sum up, the hidden nature of gastric cancer is mainly reflected in the following two aspects: firstly, 80% of early gastric cancer patients have no symptoms, and even if a few patients have symptoms, they are some atypical symptoms, such as loss of appetite and abdominal discomfort. These symptoms are easily confused with gastric diseases such as gastritis and gastric ulcer. Therefore, patients should not simply judge their condition based on some symptoms, and should not buy drugs from pharmacies to treat themselves. Secondly, gastric cancer that mainly manifests outside the stomach is easy to be ignored. The extragastric manifestations of gastric cancer mainly include: ovarian metastasis as the first manifestation, and the symptoms of gastrointestinal tract are not obvious; liver metastasis as the first manifestation, and the rate of liver metastasis of gastric cancer is 45.9%-46.5%; enlarged lymph nodes on the body as the first manifestation, and gastric cancer is detected only afterwards. Therefore, people should be reminded to pay attention to the prevention of gastric cancer in their daily life, such as developing good eating habits, eating regularly and quantitatively, eating less or no pickles and fried food, and eating more fresh vegetables and fruits. High-risk groups must develop the habit of regular health checkups for early detection and treatment. Some patients think that they will not get stomach cancer after gastric resection. In fact, after the stomach is mostly or completely removed, it may still develop into residual gastric cancer. Therefore, patients with gastric cancer should not take this lightly. Staged early gastric cancer and progressive gastric cancer can both present with upper gastrointestinal bleeding, often in black stool. Few early gastric cancers may show mild upper gastrointestinal bleeding symptoms, i.e. black stool or persistent positive occult blood in stool. It is mostly seen in polyp-like and ulcer-like early gastric cancer, which is caused by the surface erosion of the lesion or the invasion of capillaries by the cancer, resulting in a small amount of bleeding for a long time, and also in the subtypes of early gastric cancer with flat lesions. It is characterized by the fact that it is not easy to be controlled by drug therapy. Elderly people without gastric disease should be more alert to the possibility of gastric cancer once black stool appears. If the stool is tarry and the fecal occult blood test is persistently positive, especially when it is not easy to stop even after general diet control or gastric medicine, it is one of the important early gastric cancer symptoms. Therefore, those who have such symptoms should go to a hospital in time for gastroscopic examination to make a clear diagnosis. Unexplained emaciation, weakness and mental depression are also a group of common but unspecific signs of gastric cancer, and they are progressively getting worse. Some of them are secondary to dyspepsia, in which patients automatically restrict their daily diet due to bloating and belching after eating, resulting in weight loss and weakness. In addition, nausea and vomiting can also cause further loss of nutrition, resulting in malnutrition and aggravating the symptoms of emaciation and weakness. Of course, in the late stage of progressive gastric cancer, the wasting and weakness will be more obvious. In addition, it is worth mentioning that most gastric cancers occur on the basis of chronic gastritis (especially atrophic gastritis), Helicobacter pylori (HP) infection, residual gastritis, gastric polyp, gastric ulcer, etc. Therefore, some patients have a long history of chronic gastric disease, with symptoms such as epigastric discomfort and indigestion. On this basis, if the nature of pain, epigastric fullness, etc. has changed or increased recently, or the rhythm of pain related to diet has changed, or cannot be relieved after taking medication, or there is emaciation and weakness, then we should be more alert to the occurrence of gastric cancer. In Japan, the detection rate of early gastric cancer is 70-80%, and the survival rate of 5 years after surgery can be about 90%. At present, the proportion of early gastric cancer patients in China is still relatively low, and the literature reports that it is 4-10%. How to increase the detection rate of early gastric cancer in China to improve the prognosis of gastric cancer is the most urgent task. The concept of early gastric cancer was first proposed by the Japanese Society of Endoscopy in 1962, and is defined as the infiltration of cancer confined to the mucosa or submucosa, regardless of whether it has lymph node metastasis. The prognosis of this type of gastric cancer is good, with a 5-year survival rate of more than 90%, while that of progressive gastric cancer is generally 30%-40%. Improving the early diagnosis rate of gastric cancer and increasing the proportion of early stage cases is the key to improve the prognosis of gastric cancer. Early gastric cancer has no specific symptoms or even no symptoms at all. It is often manifested as discomfort or pain in the middle and upper abdomen, similar to the symptoms of gastritis and gastric ulcer. Most patients have a history of gastric ulcer or chronic atrophic gastritis. The detection rate of early gastric cancer by upper gastrointestinal imaging is low, coupled with the fact that gastroscopic screening of high-risk groups cannot be carried out in China yet, the detection rate of early gastric cancer in China is low at present. Fiberoptic gastroscopy can directly observe morphological changes in the stomach and take biopsy of lesions, so it is the preferred method to diagnose early gastric cancer. Gastroscopy plus lesion biopsy can achieve a diagnosis rate of early gastric cancer of more than 90%. The key to improve the detection rate of early gastric cancer is to improve clinical examination skills and the alertness of both doctors and patients to gastric cancer. For patients over 40 years old with unexplained upper abdominal symptoms, endoscopy can be routinely performed, and patients with chronic gastric disease should be reviewed regularly. Patients with moderate to severe atypical hyperplasia reported by gastroscopic biopsy should repeat gastroscopy and biopsy several times to avoid delaying the diagnosis. The treatment of early gastric cancer is still based on open surgery. Depending on the location of cancer and the size of lesion, endoscopic, laparoscopic, combined or open surgery can be used to perform local resection, distal gastrectomy or total gastrectomy, and the scope of lymph node removal: early gastric cancer confined to the mucosa can be removed at station 1 (D1), while those invading the submucosa should be removed at station 2 (D2). The prognosis is better, with a 5-year survival rate of 93.7% after surgery. The incidence of recurrence and distant metastasis after surgery for early gastric cancer is low, with less than 5% reported in the literature, so chemotherapy is generally not required after surgery. Patients with early gastric cancer with perigastric lymph node metastasis have a higher incidence of postoperative recurrence and distant metastasis, so chemotherapy should be given and followed up regularly.