Abstract. Gastric cancer (GC) remains one of the most significant global health challenges, ranking among the top causes of cancer mortality worldwide. Despite declining incidence in many high-income regions, gastric cancer continues to show substantial geographical variation, with East Asia, Eastern Europe, and parts of Latin America bearing the highest burden. The disease arises from a multifactorial interaction of environmental exposures, chronic infections—especially Helicobacter pylori—dietary habits, genetic predisposition, and socioeconomic determinants. This review synthesizes high-quality epidemiological evidence, incorporating global population-based registries, cohort studies, meta-analyses, and international cancer surveillance data. The article follows a hybrid systematic–narrative design to provide a comprehensive overview of incidence, mortality, risk factors, protective factors, histological patterns, and temporal trends. Special focus is given to the divergent patterns of non-cardia gastric cancer (NCGC) and cardia gastric cancer (CGC), the impact of H. pylori eradication, demographic transitions, and the influence of Western lifestyle patterns. The review highlights the persistent public health importance of gastric cancer and emphasizes that early detection, infection control, dietary modification, and molecularly targeted screening strategies remain essential for reducing disease burden. These findings underscore the need for region-specific preventive policies and strengthened cancer surveillance systems.