Gastric carcinoma: an evolutionary scenario.

Despite the progressive decline of its incidence and mortality over the past decades, gastric cancer remains the forth most common cause of cancer-related death in Europe. While historically gastric adenocarcinoma has been classified according to the Lauren classification in intestinal and diffuse subtype, the knowledge of the complex molecular mechanisms underlying its carcinogenesis has led to new molecular classifications which can represent the starting point for the development of a personalized approach also in this disease. From a clinical point of view, while the addition of trastuzumab in the therapeutic armamentarium paved the way for the introduction of targeted therapy in the first-line treatment, only recently the confirmation of the role of second-line therapy along with the approval of ramucirumab as a standard of care in this setting led to a new concept of "continuum of care" in gastric cancer. Furthermore, also the pivotal role of nutritional counseling and support both in early- and advanced-stage disease has been recently confirmed in many retrospective and prospective series.