[Gastric cancer--risk factors and medical therapy]

Gastric cancer is the fourth common cancer worldwide and the second leading cause of cancer related deaths. Although the incidence of gastric cancer is declining, gastric cancer will remain a serious medical problem due to its high mortality rates. In contrast, cancer of the gastroesophageal junction is the most increasing neoplasm in the western world. Unfortunately, the vast majority of gastric cancer is diagnosed at an advanced stage, associated with a poor prognosis where the therapeutic options are limited. Over the past 15 years advances have been made in the knowledge of risk factors as well as the pathogenesis of gastric cancer. As the most important exogenous risk factor Helicobacter pylori was categorized as a class I carcinogen by the WHO. Additionally, genetic changes associated with the risk of gastric cancer have been defined. Progress, although slow, has also been made in the non-surgical therapy of gastric cancer due to multimodal therapeutic strategies. All these advances could lead to a better identification of patients being at risk of developing gastric cancer. Furthermore, new neoadjuvant and adjuvant therapy regimes as well as targeted therapeutic approaches in the future could lead to a better prognosis of gastric cancer.