Gastric cancer remains one of the leading causes of cancer related deaths worldwide. The overall 5-year survival rate in the United States and most of the Western World ranges from 5 to 15%. The only potentially curative treatment for localized gastric cancer is complete surgical resection. Meta-analyses of adjuvant systemic chemotherapy in gastric cancer have shown at best marginal benefits, neoadjuvant chemotherapy and chemoradiotherapy are also feasible and are the subject of several ongoing studies. In metastatic disease, chemotherapy confers benefit when compared with best supportive care alone. This review will focus on the several treatment modalities available for gastric cancer patients: surgery, adjuvant, neoadjuvant and palliative chemotherapy as well as new target agents.