[Diagnosis, staging and therapy of gastric cancer].

In spite of a continuously decreasing incidence in Western countries, gastric cancer remains a major health problem world-wide and a leading cause of cancer-related deaths. The molecular pathogenesis of the vast majority of sporadic tumours has not yet been clarified in detail, while for some familial cancer types causal germline mutations have been identified. Only radical resection offers a chance of cure and the prognosis is determined by the stage of disease at diagnosis. Unfortunately, about two-thirds of patients are still diagnosed in a late stage. The results of surgery have reached a plateau of effectiveness, in stages III and IV (UICC) an R0 resection will be possible in only about 40 % of cases and even, after successful curative resection, the prognosis is limited due to a high recurrence rate. The benefit of neoadjuvant chemotherapy in locally advanced cancers has been verified in phase II studies. Less clear is the adjuvant situation - the benefit of adjuvant radiochemotherapy after systematic lymphadenectomy awaits to be proven. In the palliative situation platinum-based high-dose 5-FU infusion protocols are currently the standard therapy.