Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.