Gastro oesophageal junction cancers
This page has information about cancers that grow where the food pipe (oesophagus) meets the stomach and their treatment. These cancers are called gastro oesophageal junction cancers (GOJ) or oesophago gastric junction cancers (OGJ). There is information below on
- What gastro oesophageal cancer is
- Types of gastro oesophageal junction cancer
- How your doctors decide your treatment
- Surgery for gastro oesophageal junction cancer
Gastro oesophageal junction (GOJ) cancer develops at the point where your food pipe (oesophagus) joins your stomach. It may also be called oesophago gastric junctional cancer. The number of people who develop this type of cancer is going up.
Doctors stage gastro oesophageal junction (GOJ) cancers as oesophageal cancers. The stage of a cancer tells the doctor how far it has spread. You can read about the different stages of oesophageal cancer in the treating oesophageal cancer section.
It can sometimes be difficult to tell the difference between stomach, oesophageal and GOJ cancers. But we know from research that GOJ cancers are a separate type of cancer. They can behave differently to cancers of the oesophagus and stomach.
The term gastro oesophageal junction (GOJ) cancer is used to describe cancers where the centre of the tumour is less than 5cm above or below where the oesophagus meets the stomach. Doctors divide GOJ cancers into 3 types, depending on where they are.
- Type 1 is when the cancer spreads down into the gastro oesophageal junction from above - commonly starting from areas where the normal lining of the lower end of the oesophagus is replaced with abnormal cells (Barrett’s oesophagus)
- Type 2 is when the cancer develops at the actual gastro oesophageal junction
- Type 3 is when the cancer spreads up into the gastro oesophageal junction from below (so from the top of the stomach upwards).
Your doctors consider many factors when deciding which treatments are most suitable for you, including
- How far your cancer has grown or spread (the stage)
- Your general health and level of fitness
- The type of gastro oesophageal junction cancer - there are 3 types, type 1, 2 and 3
The earlier your cancer is diagnosed, the easier it is to control and possibly cure it. If your cancer hasn't spread, your doctor will probably offer you surgery. Unless you have a very early cancer, you are likely to have chemotherapy before surgery. In some cases, you may have combined chemotherapy and radiotherapy (chemoradiation) before surgery. Surgery for this type of cancer is a major operation, so your doctor will make sure you are fit enough to make a good recovery.
Before you have treatment, your doctors will arrange for you to have tests to find out the stage of your cancer. This helps them decide on the best treatment for you. The tests include
You will probably have surgery if your cancer hasn’t spread and you are fit enough. Your surgeon removes the cancer along with a clear border of tissue around it. They also remove the nearest lymph nodes.
There are different types of gastro oesophageal junction cancer called types 1, 2 and 3. For type 1 tumours, surgery usually involves removing the oesophagus, the nearest lymph nodes, and possibly the top of the stomach.
For type 2 and 3 tumours, you may have
- Your oesophagus, stomach and lymph nodes removed
- Part of your oesophagus, the top of your stomach and the surrounding lymph nodes removed
- Your stomach and the lower end of your oesophagus removed, with the surrounding lymph nodes
After removing the tumour and surrounding tissue, the surgeon joins the two remaining ends together. Occasionally people also need to have their spleen and part of their pancreas removed, but this is very rare.
Chemotherapy uses anti cancer or cytotoxic drugs to kill cancer cells. You may have it
- Before surgery (possibly with radiotherapy)
- Before and after surgery (for types 2 and 3 gastro oesophageal junction cancer)
- To control an advanced cancer
- To reduce or control symptoms of advanced cancer
Giving chemotherapy before surgery reduces the chances of the cancer coming back. It also shrinks the tumour, making it easier for the surgeon to remove.
There are a number of different combinations of chemotherapy drugs doctors can use. Most of which you have through a drip into a vein. Cisplatin and fluorouracil (5FU) or epirubicin, cisplatin and fluorouracil (ECF) are common combinations.
If you have type 2 or 3 gastro oesophageal junction cancer, you are likely to have chemotherapy before and after surgery (peri operative chemotherapy). You usually have ECF or ECX chemotherapy. ECX contains the drugs epirubicin, cisplatin and capecitabine (Xeloda). We have information about the side effects of ECF and ECX chemotherapy. You have the epirubicin and cisplatin into a vein but you take capecitabine as a tablet.
Radiotherapy uses radiation to treat cancer. You may have radiotherapy combined with chemotherapy (chemoradiation) before surgery. If you are unable to have surgery, you may have chemoradiation on its own instead. Giving some types of chemotherapy at the same time as radiotherapy can make the radiotherapy work better.
Chemoradiation is quite an intensive treatment and the side effects are generally more severe than having chemotherapy or radiotherapy on their own. We have information about the side effects of chemoradiation in the page about chemoradiation for oesophageal cancer.
Trastuzumab (Herceptin) is a biological therapy doctors sometimes use as a first treatment for people with gastro oesophageal junction cancer that has spread (advanced cancer). It only works if the cancer cells have receptors for trastuzumab (HER2 positive cancer). You have trastuzumab in combination with chemotherapy, such as cisplatin and fluorouracil or capecitabine. We have more information about trastuzumab in the page about biological therapy for oesophageal cancer.
Doctors are constantly researching different combinations of chemotherapy drugs, biological therapies and new treatments for gastro oesophageal junction cancers.
The OE05 trial is comparing the chemotherapy drugs cisplatin and fluorouracil with the combination ECX, which is epirubicin, cisplatin and capecitabine (Xeloda), before surgery. This trial has closed and we are waiting for the results.
The COUGAR-02 trial looked at how well docetaxel chemotherapy worked for people with advanced gastro oesophageal cancers who had already had one course of chemotherapy. The researchers found that on average people who had docetaxel lived longer than people who just had treatment to control symptoms.
The ST03 trial is looking at adding bevacizumab (Avastin) to chemotherapy (before and after surgery) for gastro oesophageal cancers. Bevacizumab is a monoclonal antibody. Researchers think that giving bevacizumab as well as chemotherapy may be better than chemotherapy alone.
The REAL3 trial looked at whether a biological therapy called panitumumab (Vectibix) could improve the results of EOX chemotherapy (epirubicin, oxaliplatin and capecitabine) for people with gastro oesophageal cancers. The results showed that having panitumumab with chemotherapy did not help people live longer and may increase the side effects from treatment.
Ramucirumab is another monoclonal antibody researchers are looking at in clinical trials. Two international trials have recently shown promising results with ramucirumab for people with advanced gastro oesophageal junction cancers and stomach cancers who have had chemotherapy before.
There is more information about research for gastro oesophageal junction cancers in the pages about oesophageal cancer research and stomach cancer research. You can also search for trials for oesophageal (food pipe) cancer on our clinical trials database.
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