During preoperative work-up for laparoscopic gastric bypass in a morbidly obese female, gastroscopy visualized two small ulcers in the antrum. Biopsies diagnosed adenocarcinoma of the diffuse type. Staging was performed, and endoscopic ultrasonography showed early gastric cancer. A laparoscopic neartotal gastrectomy with D1 resection and perigastric lymph node dissection and full omentectomy in combination with a gastric bypass, was peformed. This approach respects the oncologic and bariatric principles and gives a combined solution for the patient.