Sixteen patients with early gastric cancer (carcinoma which is confined to mucosa and submucosa) are described. Despite a long duration of symptoms and frequently large tumour surface areas, lymph-node metastasis occurred in only one patient. Findings of endoscopic biopsy were more accurate (100%) than endoscopic (75%), radiological (50%), or clinical features in diagnosing malignancy. However, only an average of 58% of biopsy specimens demonstrated cancer, which emphasises the need for multiple biopsies. After resection, no deaths due to cancer occurred during a mean follow-up period of 28 months. Endoscopy, plus carefully directed biopsy when a lesion is found, should be performed in patients with dyspepsia in whom X-ray examination reveals no abnormality, and in those with persistent symptoms in the upper gastrointestinal tract. Such an approach is a prerequisite to the accurate diagnosis of gastric cancer in its early, curable, stage.