Skip to main contentLast updated: 18-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Stomach Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
An early stomach cancer has not grown past the layer under the lining. Its depth, size, cell type and ulcer decide between the endoscope and an operation.
Removal through the endoscope suits only small cancers confined to the inner lining. A cancer that reaches deeper usually needs an operation that also takes lymph nodes.
When an operation is needed, the tumour’s position in the stomach decides how much is removed. Some early cancers allow operations that keep part of the stomach.
Doctors call a stomach cancer early when it has not grown beyond the layer just under the lining. This is the T1 stage. It is split into two parts, and the split matters more than anything else on this page.
T1a means the cancer sits only in the inner lining, called the mucosa. T1b means it has reached the next layer down, called the submucosa. An endoscopic ultrasound, or EUS, helps tell the two apart before treatment.
Early stomach cancer is the only stage where removal through the endoscope, without any cut on the belly, can be the whole treatment for a few patients.
Five features of the tumour point the plan one way or the other. The biopsy, the endoscopy photos and the EUS give most of them.
| Feature | Points toward removal through the endoscope | Points toward an operation |
|---|---|---|
| Depth | Inner lining only (T1a). | Into the layer under the lining (T1b), in almost all cases. |
| Size | Small. The standard limit is 2 cm. | Larger than the limit for its type. |
| Cell type | Well formed cells, called differentiated. | Poorly formed cells, unless the tumour is small and has no ulcer. |
| Ulcer | No ulcer on the tumour. | An ulcer, unless the tumour is small and well formed. |
| Tiny vessels | No cancer inside small blood or lymph vessels. | Cancer seen inside small vessels. |
Why does depth matter so much? Once cancer reaches the layer under the lining, it is much more likely to have reached the lymph nodes. The endoscope cannot remove lymph nodes. Only an operation can.
The endoscopic method is called endoscopic submucosal dissection, or ESD. The tumour is lifted off the deeper layers and taken out in one piece through the mouth. The stomach stays.
The standard rule, from Japan, allows ESD for a cancer that is well formed, inside the inner lining, 2 cm or smaller, with no ulcer and no cancer in small vessels.
Wider rules now allow ESD for a few more tumours:
ESD needs a skilled endoscopy team. In India it is mostly done in large specialist endoscopy units.
ESD is judged complete only when the tumour came out in one piece, every edge is clear, small vessels are free and the size fits the rules.
If any one condition fails, the next step is an operation that removes part or all of the stomach with its lymph nodes. Common reasons are a deep edge with cancer, cancer in small vessels, or a tumour deeper than the wider rules allow. An operation at this point is the planned next step, not a failure of care.
When ESD is not suitable, the operation depends mostly on where the tumour sits in the stomach.
| Where the tumour is | Usual operation |
|---|---|
| Lower stomach (antrum) | Removal of the lower part of the stomach, called a distal or subtotal gastrectomy. The remaining stomach is joined to the bowel. |
| Middle (body) | Subtotal or total removal. It depends on the safe edge and on how much healthy stomach can be left. |
| Upper stomach (cardia) | Removal of the upper part with a double-tract join, or removal of the whole stomach for larger tumours. |
| Several spots, or a spreading pattern in the wall | Removal of the whole stomach. This is rare in early cancer. |
Each of these is explained in more depth on the pages for lower stomach cancer, cancer in the middle of the stomach and upper stomach cancer.
For early cancer with no suspicious nodes, a smaller node removal called D1 or D1+ is usually enough. The wider D2 removal is kept for suspicious nodes.
Two operations keep more of the stomach in carefully chosen early cancers with no node spread:
A small wedge removal is not a standard operation for this cancer. It is used for other tumours, such as GIST. Limited surgery guided by a single sentinel node is still being studied.
For early cancer, keyhole (laparoscopic) surgery is the standard approach. A robotic operation is used in selected patients.
The final report on the removed stomach settles this. If the cancer stayed in the first layers, the edges are clear and no node holds cancer, complete removal is usually the whole treatment. No chemotherapy is needed.
If the report finds cancer in the nodes, or the stage turns out higher, chemotherapy after surgery is considered. The order of chemotherapy and surgery for later stages is on the chemotherapy before surgery page.
Follow-up visits include endoscopy, scans and blood tests. Blood counts, vitamin B12 and iron are checked, because absorption can change after stomach surgery. Visits are closer together in the first years, then yearly.
A new early cancer can appear in another part of the stomach years later. So after ESD, endoscopy continues for life. After a subtotal gastrectomy, the remaining stomach is still checked.
Sometimes. It needs to sit in the inner lining only, be small, and meet the other rules. EUS and the biopsy help decide.
The tissue report missed one of the four conditions. Usually an edge was not clear, or cancer was seen in small vessels. Surgery then removes the lymph nodes too.
Not always. A lower or middle tumour often needs only part removed. Some upper or middle tumours allow operations that keep the outlet valve or the lower stomach.
Usually not, if the final report shows the cancer stayed in the first layers and no node held cancer. It is considered if the stage turns out higher.
Visits are closer in the first years, then yearly. After ESD, endoscopy continues for life, because a new early cancer can appear elsewhere in the stomach.
The full range of stomach cancer care is on the stomach cancer treatment page. For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy, staging laparoscopy, surgery and inpatient care.
Has your biopsy or EUS shown an early stomach cancer, and you are weighing the endoscope against an operation? The endoscopy, biopsy, EUS and CT reports can be sent ahead on WhatsApp, so the consultation starts with them already read. Your treatment is decided at the consultation, after examination. Call +91-63555-64601 Send reports before your visit
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