Between 1977 and 1989, 958 patients were admitted for gastric carcinoma to the Second Department of Surgery, University of Siena, Italy. Of these, 142 (15%) had early gastric cancer. The diagnosis of this form of cancer has increased from 7% in 1977 to 22% in 1989. Following a detailed analysis of the clinical data and diagnostic techniques, it can be concluded that endoscopy is a far better method for diagnosis than x-ray. The data presented in the present paper strongly support this conclusion. Tumors were classified according to the Japanese Research Society Committee on Histological Classification of Gastric Cancer. The five-year survival rate which we have obtained is 89%, slightly lower than that of Japanese authors, but higher than that reported by other western authors. Lesions confined to the mucosa were observed in 75 patients (52.8%) while those involving the submucosa were observed in 67 patients (47.2%), with survival rates of 94 and 85%, respectively. Lymph node involvement was present in 14 cases (9.8%), with primary lymph nodes (N1) in 11 cases (7.7%) and secondary lymph nodes (N2) in three (2.1%). The five-year survival rates, with respect to lymph node involvement, was 57% in the presence of lymph node metastases and 93% in their absence (P < 0.001). The lesions were frequently found to be localized in the lower third of the stomach (106 cases, 74.6%). Patients with such lesions had a survival rate of 93%, a significant difference from those cases with lesions localized in the middle or upper third of the stomach (P < 0.05). The surgical treatment preferred in our Institute, has been subtotal gastrectomy associated with lymphadenectomy R1 and R2, leaving total gastrectomy for lesions localized in the upper third of the stomach.