Reactions to diagnosis, coping strategies, and anxiety and depression were prospectively studied in 139 consecutive, newly diagnosed gastrointestinal cancer patients. The reactions varied between diagnoses (colon, rectum, gastric, pancreatic and biliary) and states of illness (cured non-cured). Colon and rectal cancer patients, most of whom were potentially cured, had a more confrontational attitude towards their diagnosis, reported more 'Fighting Spirit' and less 'Anxious Preoccupation' and 'Hopeless/Helplessness'. Non-cured patients reported higher levels of intrusive thoughts and avoidance of aversive thoughts than cured patients. The overall levels of anxiety and depression were low, although higher levels were seen for non-cured patients. On the Hospital Anxiety and Depression scale (HAD), a total of 17% were scored as 'doubtful cases' or 'cases' on the anxiety scale and 21% on the depression scale. Thus, pancreatic/biliary cancer patients, most of which are non-cured, and to some extent those with gastric cancer are more vulnerable to psychological distress in connection with the diagnosis than are colorectal cancer patients.