Gastric Cancer Today: Epidemiology and Treatment-An Updated Review

Abstract

Gastric cancer remains a serious public health challenge, ranking as the fifth most incident malignancy and the fourth leading cause of cancer related death worldwide. Current epidemiology shows marked regional variation, with high rates in East Asia, Eastern Europe, and South America, while incidence has been declining in most highincome countries an effect attributed to Helicobacter pylori control, improvements in food refrigeration, and reduced smoking rates. In Brazil, the estimated incidence for 2023 to 2025 is 13.44 cases per 100,000 men and 7.31 per 100,000 women. Curative treatment is based on radical gastrectomy with D2 lymphadenectomy, complemented by perioperative chemotherapy with the FLOT regimen, which has demonstrated a survival benefit. In metastatic disease, the advent of immunotherapy has reshaped the landscape: nivolumab combined with chemotherapy has shown superior overall survival compared to chemotherapy alone, and the addition of pembrolizumab to trastuzumab has become the new standard for HER2 positive tumors. Moreover, the molecular classification proposed by ESMO now guides targeted therapies, including FGFR2b and Claudin 18.2 inhibitors. Despite these advances, five year survival remains below 40 % globally, underscoring the need for high risk screening programs, primary prevention policies, and equitable access to high complexity centers.