Despite the increasingly wider application of the highly efficient endoscopic diagnostic and therapeutic techniques, the detection of gastric cancer at the early stages of its development and the subsequent adequate treatment of this pathology remains a major challenge for modern oncology and endoscopy. The management of the patients presenting with multicentric early gastric cancer encounters especially serious difficulties because it requires efficient comprehensive diagnostics and the correct choice of the treatment strategy. The article reports a case of multicentric early gastric cancer in a 69-year-old patient with a severe concomitant pathology. A specific feature of this case was the difficulty of endoscopic identification of the sites affected by early cancer and the elucidation of indications for the optimal treatment of the elderly patient presenting with a polymorbid condition.