Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths. The incidence, diagnostic studies, and therapeutic options have undergone important changes in the last decades, but the prognosis for gastric cancer patients remains poor, especially in more advanced stages. Surgery is the mainstay of treatment of this disease. At least D1 resection combined to removal of a minimum of 15 lymph nodes should be recommended. In recent years, important advances have been achieved in the adjuvant setting, where survival benefits were demonstrated by perioperative chemotherapy and postoperative chemoradiotherapy. In advanced disease, patient prognosis remains very poor with median survival times rarely approaching 1 year. In this setting, palliation of symptoms, rather than cure, is the primary goal of patient management. No standard regimens have yet been established worldwide. Recent clinical trials have demonstrated major improvements, which include the development of orally administered fluoropyrimidines (capecitabine, S-1), and the addition of new drugs such as docetaxel, irinotecan, oxaliplatin. This review summarizes the most important recommendations for the management of patients with gastric cancer.