One hundred and sixty-seven cases of early gastric cancer were analyzed in terms of growth patterns and were then classified into the Small mucosal type, the superficially spreading (Super) type and the penetrating growth (Pen) type, the latter further subdivided into the Pen A type growing expansively and the Pen B type deepening infiltratively. The Small mucosal, Super, and Pen B types are characterized by a tendency toward dominant depressed lesions, a low incidence of vessel invasion and lymph node metastasis, and a good prognosis after surgery (about 90% of the patients survived for ten years). In contrast, the Pen A type is characterized by dominant elevated lesions usually comprised of well differentiated carcinoma, a relatively high incidence of vessel invasion and lymph node metastasis and a poor prognosis after surgery (64.8% five-year survival), due to early recurrence in the form of liver metastasis. Some attention is given to the related surgical approaches.