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About gastro oesophageal junction cancer

Gastro oesophageal junction (GOJ) cancer develops at the point where your food pipe (oesophagus) joins your stomach. It might also be called oesophago gastric junctional cancer.

Diagram of the gastro oesophageal junction

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 number of people who develop this type of cancer is going up.

Types

Cancer is described as GOJ cancer if the centre of the cancer is less than 5cm:

  • above the GO junction
  • below the GO junction

 There are 3 types of GOJ cancers, depending on where they are:

Type 1

Type 1 GOJ cancer spreads down into the gastro oesophageal junction from above. So, there are cancer cells in the lower part of the oesophagus and the gastro oesophageal junction. The cancer’s centre is between 1 and 5 cm above the junction.

Type 2

Type 2 GOJ cancers develop at the actual gastro oeosphageal junction. The cancer's centre is between 1 cm above and 2 cm below the junction.

Type 3

Type 3 GOJ cancer spreads up into the gastro oesophageal junction from below. So there are cancer cells in the top of the stomach and the gastro oesophageal junction. The cancer’s centre is between 2 and 5 cm below the junction.

Diagram showing types of gastro oesophageal junction cancer

Causes

We don’t know what causes all GOJ cancers. But there are some factors that may increase your risk of developing it.

Being very overweight (obese) and having chronic gastro-oesophageal reflux are both risk factors for GOJ cancer. 

Type 1 GOJ cancers are similar to oesophageal cancers, and type 3 GOJ cancers are similar to stomach cancers. But the characteristics of type 2 GOJ cancer cells are somewhere in between stomach and oesophageal cancer cells. So we have a better understanding of what causes types 1 and 3 compared to type 2.

Barrett's oesophagus increases your risk of type 1 GOJ cancer. This is a condition where the cells lining your oesophagus have become abnormal. This can happen due to long term acid indigestion (acid reflux).

Type 3 GOJ cancers are linked to infection with Helicobacter pylori (H.pylori). H. pylori is a bacteria that lives in the mucous of the lining of the stomach.

Tests

Before you have treatment, your doctors will arrange for you to have tests to find out the stage of your cancer. The stage of a cancer tells you how big it is and whether it has spread.

This helps them decide on the best treatment for you. The tests include:

  • endoscopy and biopsy - you might also have an ultrasound scan during your endoscopy
  • CT scan
  • laparoscopy
  • PET-CT scan

Stages

The stage of a cancer tells you how big it is and how far it’s spread. It helps your doctor decide which treatment you need.

The tests and scans you have to diagnose your cancer give some information about the stage. Sometimes it’s not possible to be certain about the stage of a cancer until after surgery.

Doctors use different staging systems, depending on the type of cancer. Some GOJ cancers are staged in the same way as oesophageal cancers. And some are staged as stomach cancers. 

The doctor stages your cancer in the same way as oesophageal cancer if the centre of your cancer is no more than 2cm into the stomach.

The doctor stages your cancer in the same way as stomach cancer if the centre of your cancer is more than 2cm into the stomach.

Treatment

The most common treatments for gastro oesophageal junction cancer are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy and radiotherapy together (chemoradiotherapy)
  • targeted cancer drug treatment
Last reviewed: 
08 Aug 2018
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

  • Western strategy for EGJ carcinoma
    Giacopuzzi S and others
    Gastric Cancer (2017) 20 (Suppl 1) S60 – S68

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Oesophago-gastric cancer: assessment and management in adults [NG83]
    National Institute for Health and Care excellence, 2018

  • Aetiology and classification of adenocarcinoma of the gastro-oesophageal junction/cardia
    K McColl  and J Going
    Gut 59 (3), 2010

  • Upper Gastrointestinal Surgery. A Companion to Specialist Surgical Practice (6th edition)
    Eds SM Griffin, PJ Lamb.
    WB Saunders Ltd 2018 

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