[Stomach cancer. Spontaneous course, therapy and prognosis]

The incidence of gastric cancer in Switzerland has decreased remarkable in the last fifty years and now constitutes 4% of all newly diagnosed neoplasms. Nutrition plays an important role in the pathogenesis of this tumor. The pathology, natural history and the staging of stomach cancer are reviewed, with special emphasis on early gastric cancer. Radiological and gastroscopic diagnosis is correct in almost all cases. Surgery remains as it was 100 years ago when Billroth performed the first gastrectomy, the only curative treatment. In the last few years combination chemotherapy for gastric cancer has been markedly improved, and with modern cytostatic regimens objective tumor responses are achieved in one third to half of patients. The value of adjuvant chemotherapy in radically resected patients remains to be proven. The poor prognosis of gastric cancer can be improved by early diagnosis, better understanding of the pathogenesis of this tumor, elimination of carcinogens from our food and incorporation of effective systemic treatment in the primary treatment plan for stomach cancer.