The best treatment for gastric cancer remains early detection and prompt surgical removal. Currently, the majority of gastric carcinomas diagnosed in western centers are late-stage tumors with poor prognoses. Endoscopic ultrasound and diagnostic laparoscopy aid our ability to accurately stage patients with gastric cancers, and may prevent unnecessary laparotomies in asymptomatic patients. While extended lymphadenectomy is the standard approach in Japanese centers, the utility of this procedure in improving long-term survival has yet to be proved in prospective, randomized trials. Accurate staging of patients preoperatively and selected multidisciplinary approaches to individual patients may eventually lead to improvements in survival for patients with gastric cancer.