Gastric cancer remains one of the most common causes of cancer mortality worldwide, despite a decline in incidence in Western countries. An important recent finding has been the recognition of an association between Helicobacter pylori and gastric cancer. The mechanisms, however, by which H. pylori infection and other environmental factors influence gastric tumorigenesis remain to be elucidated. The recent identification of growth factors and their receptors has provided insights into the regulation of cell growth, proliferation, and differentiation. Furthermore, studies of the effects and interactions of growth factors, oncogenes, and tumor suppressor genes on biological behavior of human gastric cancers are in progress and may aid in therapeutic decision-making. Fortuitously, molecular analysis requires small amounts of tumor tissue, which can be obtained from endoscopic biopsies. Regarding the treatment of gastric cancer, promising data on the use of neoadjuvant chemotherapy to increase surgical resectability have been obtained. However, locoregional failure continues to be the major obstacle and the addition of adjuvant intraperitoneal chemotherapy is specifically aimed at this problem. Novel therapeutic approaches are clearly needed in the management of advanced disease in view of the relatively poor results thus far with available compounds.
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