Gastric cancer continues to be a major global health problem. In the American College of Surgeons Patient Care study on gastric cancer, 5-year disease-specific survival was 26%, with an overall survival of 14%. Improvements in survival will require both earlier diagnosis and new therapeutic strategies. The ability of surgical oncologists to understand the natural history of the disease, accurately define its extent, and provide the most effective treatment places them in a key position to see that improvements in outcome are brought about expeditiously.