[Frontiers in Bioscience S2, 403-412, January 1, 2010] 403 Clinical and biological markers in gastric cancer: update and perspectives Alessandro Cappellani 1 , Antonio Zanghi 1 , Maria Di Vita 1 , Ernesto Zanet 2 , Pierfrancesco Veroux 3 , Bruno Cacopardo 4 , Andrea Cavallaro5, Gaetano Piccolo 1 , Emanuele Lo Menzo 6, Paolo Murabito 7 and Massimiliano Berretta 2 1 University of Catania, Department of Surgery, General and Breast Surgery Unit , University Hospital of Catania, Italy, 2 Department of Medical Oncology, National Cancer Institute – IRCCS, Aviano (PN), Italy, 3 University of Catania, Department of Surgery, Transplantation and Advanced Technologies; Vascular Surgery and Organ Transplant Unit , University Hospital of Catania, Italy, 4 University of Catania, Department of Internal Medicine, “Garibaldi-Nesima” Hospital, University of Catania, Catania Italy, 5 University of Catania, Research Fellow in Surgical Pathology, 6 University of Maryland, Division of Laparoscopic and Bariatric Surgery, Baltimore, MD, USA, 7 Department of Anaesthesia and Intensive Care, Catania University Hospital, Catania, Italy. TABLE OF CONTENTS 1. Abstract 2. Introduction 3. Markers primarily related to screening and carcinogenesis 3.1. HP 3.1.1. HP virulence factors 3.2. Host factors 3.3. Pepsinogen (PG) 3.4. E-cadherin gene(CDH-1) 3.5. p-16 3.6. Microsatellite instability (MSI) 3.7. hMLH1 gene 3.8. Reprimo 4. Markers related to advanced gastric cancer 4.1. Classic biomarkers: 4.1.1. CEA 4.1.2. Ca 19.9 4.1.3. Ca 72-4 4.1.4. MG7aG 4.1.5. Ki-67 4.2. p53 4.3. p21 4.4. bcl-2 4.5. Matrix metalloproteinases 4.6. Phosphatase and tensin homologue deleted on chromosome ten/mutated in multiple advanced cancers 1 (PTEN/MMAC1 gene) 4.7. Urokinase-type plasminogen activator (u-PA) 4.8. Epidermal growth factor receptor (EGFR) 4.9. Vascular endothelial growth factor (VEGF. 4.10. Insulin-like growth factor type I receptor (IGF-IR) 4.11. K-sam-II gene 4.12. C-Met gene 4.13. Phospholipase A2 group IIA (PLA2G2A) 4.14. Survivin 4.15. Aurora Kinase A (AURKA) 4.16. Cyclooxygenase-2 (COX –II) 4.17. MASPIN 5. Conclusions 6 Acknowledgements 7 References 1. ABSTRACT Gastric cancer is the second cause of death from cancer worldwide and the only chance to reach better outcomes lays on an early diagnosis. The need for non- invasive, low-cost tests is invoked also in countries in which imaging and endoscopic screening have already showed the ability to improve early diagnosis and overall survival. Genomic medicine could allow a better understanding of regulatory pathways driving the development and growth of gastric cancer and the characterization of specific molecular targets actually stimulate new drug developments.