Reconsidering the terminology of "early" and "advanced" gastric cancer: toward a harmonized global lexicon

The term early gastric cancer (EGC), defined as carcinoma confined to the mucosa or submucosa irrespective of lymph node status, has been widely accepted worldwide. In contrast, the terminology surrounding advanced gastric cancer remains inconsistent across regions. In Western oncology, "advanced cancer" often denotes unresectable or metastatic disease, whereas "early-stage cancer" may include resectable stage II-III tumors. This semantic discrepancy has led to confusion in international communication, clinical trials, and guideline interpretation. We propose a three-tier terminology-early gastric cancer, locally advanced gastric cancer, and advanced gastric cancer-to align the Japanese pathological concept with global clinical staging practice and therapeutic intent.