An elderly Thai woman had presented with dyspepsia and reflux symptoms since 6 years. Oesophagogastroduodenoscopy showed a large gastric ulcer with a histopathological diagnosis of signet ring cell carcinoma. The test for Helicobacter pylori was positive and it was successfully eradicated. An abdominal CT scan showed the irregularly thick antral wall along with non-specific subcentimeter lymph nodes which was compatible with at least stage IA. Her serum carcinoembryonic antigen level was within normal range. She refused any surgical treatment and preferred to take her own medications. To date, 6 years after her first diagnosis, the second oesophagogastroduodenoscopy was performed and showed a large gastric ulcer at the incisura extending to the gastric antrum. The histopathological result of the ulcer confirmed the presence of poorly differentiated adenocarcinoma with signet ring cell. She remains healthy and refused to have a follow-up disease staging or additional treatment.