Gastric Cancer; Epidemiology and Diagnosis

Most gastric cancers develop on the background of chronic inflammation of the gastric mucosa with glandular atrophy and intestinal metaplasia representing preneoplastic conditions. Infection with Helicobacter pylori is the most relevant risk factor, with dietary factors and host genetic factors further modifying the risk, supporting a central role of the modulation of the local and systemic immune-response in gastric cancer onset. Recent multiomics profiling studies helped to better understand the pathobiological features of the disease, but translation of the new knowledge into clinical practice is slow. Due to a lack of noninvasive biomarkers, gold-standard for diagnosis of gastric cancer is assessment by gastroscopy and respective biopsy sampling. Modern advances in virtual chromoendoscopy facilitate the detection of early neoplastic lesions. Patients with advanced neoplastic conditions should be enrolled in endoscopic surveillance programs with structured gastric cancer screening strategies being currently available only in high incidence countries in Asia.