Objective: To summarize the causes of difficulty in gastric cancer diagnosis in young people and explore potential methods of improving diagnostic accuracy. Methods: We retrospectively analyzed 78 cases of gastric cancer in young people (14–35 years). Results: The clinical manifestations of gastric carcinoma in young people show no specificity, and the initial symptoms were diverse, with discomfort in the upper abdomen as the main symptom. There are four causes of difficulty in early detection: (1) The previous physician relied on antacids and did not use or analyze the results of gastroscopic examination and barium meal examination of the upper digestive tract; (2) The physician performing the endoscopic examination did not strictly follow the standards in the biopsy of fine pathological changes in suspected early cancer; (3) The physician lacked a good understanding of the clinical progress of ulcerating-healing-ulcerating in the ulcerating type of early gastric cancer; (4) Lacked a good understanding of precancerous lesions in the gastric mucosa. Conclusion: Early gastroscopy and pathological examina- tion must be conducted for people who above 20 years of age with one or more of the following symptoms: dull pain in the upper abdomen, anorexia, fatigue, tarry stool and vomiting of unknown origin. The results of gastroscopic examination should be taken into consideration for patients with recurrent ulcer, and biopsy should be standardized. Biopsy specimens should be taken from several loci in the suspected lesions, and should be repeated if necessary. Precancerous lesions of gastric mucosa should be closely followed up using gastroscopy. Objective: To summarize the causes of difficulty in gastric cancer diagnosis in young people and explore potential methods of improving diagnostic accuracy. Methods: We retrospectively analyzed 78 cases of gastric cancer in young people (14-35 years). Results: The clinical manifestations of gastric carcinoma in young people show no specificity, and the initial symptoms were diverse, with discomfort in the upper abdomen as the main symptom. There are four causes of difficulty in early detection: (1) The previous physician relied on antacids and did not use or analyze the results of gastroscopic examination and barium meal examination of the upper digestive tract; (2) The Physician performing the endoscopic examination did not strictly follow the standards in the biopsy of fine pathological changes in suspected early cancer; (3) The Physician lacked a good understanding of the clinical progress of ulcerating-healing-ulcerating in the ulcerating type of early gastric cancer; (4) Lacked a good understanding of precancerous lesions in the gastric mucosa. Conclusion: Early gastroscopy and pathological examina- tion must be conducted for people for above 20 years of age with one or more of the following symptoms: dull pain in the upper abdomen, anorexia, fatigue , the results of gastroscopic examination should be taken into consideration for patients with recurrent ulcer, and biopsy should be standardized. Biopsy specimens should be taken from several loci in the suspected lesions, and should be repeated if necessary Precancerous lesions of gastric mucosa should be closely followed up using gastroscopy.