We found 28 cases (13%) of early gastric cancer from among 213 cases of gastric cancer resected over a 10-yr period. The incidence was higher in the second 5 yr than the first. The lesions were classified into type I (polypoid, 29%), type II (superficial, 21%). Type III (ulcerated, 32%), and mixed (18%) according to the Japanese classification. Twenty-nine percent had lymph node metastases. In only 50% of the early cases had endoscopy or radiology suggested that the lesions were malignant. Biopsy diagnosis of carcinoma was made in 20 cases preoperatively and was negative for carcinoma in 4 others. Adequate numbers of endoscopic biopsy specimens must be taken to ensure a diagnosis in early gastric cancer. Follow-ups were obtained in all early, and 70% of the advanced cancer patients. Life table survival curves revealed 5-yr survival rates for 68% for the early gastric cancer and 27% for the advanced cancer cases (p less than 0.01). None of the patients in the first group died of gastric cancer. The early gastric cancer patients had a 32% incidence of other, nongastric malignancies compared to 7.7% in the advanced cancer group. Gastric cancer is being diagnosed at an early stage and the survival rates for these patients are significantly greater than those with advanced gastric cancer.