Introduction: Despite limited population-based data, gastric adenocarcinoma represents a major health concern in Guatemala. Strengthening population-based cancer registries is needed to identify the true disease burden to the Guatemalan people and to improve cancer control and prevention endeavors in the country. We aimed to determine the relative frequency of gastric cancer in the pathology laboratories in Guatemala City and assess the quality and adequate content of pathology reports in public and private laboratories. Methods: All pathologists from the largest public hospital and a convenience sample from the Guatemalan National Pathology Association (ANPG) were included. A retrospective review of all the gastric biopsy reports was performed from 1/2013 to 6/2015. We recorded demographic variables, anatomic location, findings, diagnosis, and staging. Student's t test and Pearson's Chi-squared were used to compare variables within and between groups. Results: We reviewed 95,294 pathology reports, of which 19.9% were gastric biopsies. 83.8% described a normal mucosa or gastritis, 13.7% intestinal metaplasia, 0.1% dysplasia and 2.5% gastric cancer. Gastric adenocarcinoma represented 2.2% of all gastric samples and 88.9% of all neoplasias, followed by lymphoma (6.9%) and neuroendocrine tumors (2.2%). 97.4% of samples were obtained through upper endoscopy and the remainder surgically. Age of diagnosis and gender distribution were similar in public and private pathology laboratories (57.2±15.4 vs. 57.7±15.3 years, respectively, p=0.51) (41.4% male vs. 39.2% male, respectively, p=0.32). Tissue sample processing and reporting was on average twice more expensive in private laboratories (US$32 vs US$17). After excluding cases with normal mucosa or gastritis, the public hospital had lower intestinal metaplasia rates (86.2% of all abnormal samples vs. 76.4%, p < 0.001), but higher adenocarcinoma rates (11.9% vs. 19.4%, p < 0.001) compared to the private centers. Incomplete data were more common in the public laboratory: missing demographic information (18.2% vs. 26.3%, p < 0.001), anatomic location (14.1% vs. 86.6%, p < 0.001), but not degree of differentiation of cancer cases (3.6% vs. 5.2%, p=0.06). Conclusion: 2.2% of gastric samples in Guatemala City were adenocarcinoma, suggesting that this disease is a leading cause of disability and death. Inadequate pathology report content was frequently noted, particularly in the public hospital system.