Narrow Results

This review describes the following issues: H. pylori infection rate and features of background gastric mucosa of early gastric cancer patients; the relationship between H. pylori infection and the development of gastric cancer in Japan; inhibition of the development and growth of gastric cancer by eradication of H. pylori in human and animal model; and finally, the morphologic and functional change of gastric mucosa by eradication. There is a higher incidence of gastric cancer in Japan than in the West, and this is suspected to be associated with the rapid rate of corpus gastritis development, which is associated with chronic corpus atrophic gastritis and the increased risk of gastric cancer. There have been several evidences that eradication of H. pylori pushes towards the direction in which the development and growth of cancer in gastric mucosa is inhibited. It is now expected that gastric cancer prevention by eradication of H. pylori will be established in the near future in Japan.

Chemotherapy for metastatic gastric cancer surely has a survival benefit compared to best supportive care. In the recent decades, some phase III trials have been conducted for metastatic gastric cancer all over the world. However, no chemotherapy regimen has shown a survival benefit with 5-FU alone, and there is no standard treatment. Recently, not a few anti-tumor agents have been developed, including irinotecan, oral pyrimidines, Taxane, and molecular target agents. Many phase I and II trials conducted in Asia have shown their activity both as single agents and in combination. Moreover, phase III trials including these new agents are underway, and some of them are expected to prolong survival and establish a standard treatment for metastatic gastric cancer.

Gastric cancer is the second most common cancer in the world. It is also the second most common cause of death from cancer. It has an uneven geographical distribution with incidence and mortality rates that vary greatly from high risk to low risk areas. Even within the same country, there may be variations associated with regional differences or ethnic composition. Time trends over the last few decades reveal a decreasing incidence and mortality. All these, together with incidence and mortality patterns in migrant populations, point to a predominantly environmental etiology in gastric cancer. Gastric cancer carries a poor prognosis with global 5-year survival of less than 20%. Gastric cancer will remain a sizeable healthcare problem for many more years.