Objective To explore the changes in symptom perception and psychological distress experienced by patients with gastric cancer during the perioperative period，and to provide references for medical staff to develop targeted interventions. Methods A purposive sampling method was used to recruit 14 hospitalized patients with gastric cancer. Semi-structured interviews were conducted, and data were analyzed using both cross-sectional and longitudinal approaches. Results Four themes and 12 subthemes were identified:perception of symptoms (insufficient attention to gastrointestinal symptoms, influence of past symptom experiences, greatest impact on daily life rather than most severe symptoms), causal reasoning in cognition (multiple attributions of causation, inability to objectively evaluate self-efficacy, attributing symptoms to controllable factors), persistent negative emotions (fear of gastric cancer and surgical treatment, concerns about postoperative recovery, frustration with inability to return to normal social life), and knowledge needs after ineffective coping (avoidance behaviors, need for preoperative care knowledge, need for rehabilitation knowledge). Conclusion The perception of symptoms and psychological distress in patients with gastric cancer during the perioperative period is complex and dynamic. Nurses should pay attention to and analyze these changes to meet the different care needs of patients throughout the perioperative period.