Type 1 gastric neuroendocrine tumors (gNETs) are usually small lesions,restricted to mncosal and sub-mucosal layers of corpus and fundus,with low aggressive behavior,for the majority of cases.Nevertheless,some cases present aggressive behavior.The increasing incidence of gNETs brings together a new relevant problem:how to identify potentially aggressive type 1 gNETs.The challenging problem seems to be finding out signs or features able to predict potentially aggressive cases,allowing a tailored approach,since the involved societies dedicated to provide guidelines for management of these neoplasms apparendy failed in producing staging systems able to accurately predict prognosis of these tumors.Additionally,it is also important to try to find out explanations for increasing incidence,as well as to identify potential targets aiming to reach better control of this neoplasia.Here,we discuss potential pathways implicated in aggressive behavior,as well as new strategies to improve clinical management of these tumors.