The clinical features of 51 patients with adenocarcinoma of the gastric cardia were compared with those of 169 patients with cancer elsewhere in the stomach. The male‐to‐female ratio was cardia 7 to 1, other 2.3 to 1; birth in a country where gastric cancer is common: cardia 3 (6%), other 44 (26%); hiatus hernia: cardia 18 (35%), other 10 (6%); prominent heartburn in the past: cardia 12 (24%), other 10 (6%); past or present duodenal ulcer: cardia 9 (18%), other 9 (5%). The pathologic features of 25 cardia cancers were compared with those of 67 other gastric cancers. The fundal gland mucosa was normal in 21 of the 25 cardia cases compared with only 15 of 67 other cancers. Eight of the 25 cardia cancers had a distinctive microscopic appearance. In 7 cardia cases, there were multiple patches of columnar epithelium proximal to the tumor, and, in 6 others, the lower esophagus was lined with columnar epithelium. Marked atypia or intramucosal cancer was observed in the columnar epithelium in 5 cases. The above differences suggest that cancer of the gastric cardia may be a different disease than cancer elsewhere in the stomach.