Abstract
Gastric cancer is the fifth most common cancer and fourth leading cause of cancer death worldwide. In the United States, it is the fourteenth highest cancer incidence and thirteenth highest cause of cancer death. Gastric adenocarcinoma remains the most common histologic subtype. In contrast to its higher incidence rates in Japan and Korea, screening protocols are not implemented in the West. Risk factors include Helicobacter pylori infection, nitrate consumption, salted/smoked foods, and lack of refrigeration. Overall mortality and incidence have been decreasing worldwide due to improvement in H. pylori treatment, changes in diet, and improved refrigeration. Multimodality therapy is associated with the best treatment outcomes. Surgery is the mainstay of treatment for ostensibly resectable disease, which includes sub-total versus total gastrectomy with adequate lymphadenectomy. Level 1 evidence continues to show the important role of integrating surgical therapy with systemic therapy (chemotherapy and/or immunotherapy) to overcome high rates of distant metastasis and local recurrence.