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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.