Gastric cancer: Where are we heading?

BACKGROUND: Despite its decreasing incidence, gastric cancer remains one of the leading cancers in the world and an important global healthcare problem due to its overall high prevalence and high mortality rate. SUMMARY: Gastric cancer is a consequence of Helicobacter pylori infection in 90% of cases, while in 10% Epstein Barr Virus may be responsible. Moreover, some recent epidemiological data suggest an increasing incidence in some young patients groups possibly due to autoimmunity, and if this tendency is confirmed, it may change the epidemiology of gastric cancer in the future. The pathogenesis of gastric cancer is mainly related to Helicobacter pylori infection, but recent data indicate the possible role of other bacteria and their metabolites, like N-nitrosocompounds or acetaldehyde, interfering during the last steps of carcinogenesis. The new molecular classifications of gastric cancers show a great heterogeneity of this neoplasia, which may in the future help to define personalized treatment strategies for the patients. Early detection and proper surveillance of high risk patients shoud be our major objectives. Key messages: Gastric cancer is still an important healthcare problem, with its several aspects which remain the major challenges for the future.