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Treatment for gastro oesophageal junction cancer

GOJ cancer develops at the point where your food pipe (oesophagus) joins your stomach (the gastro oesophageal junction). The most common treatments for GOJ cancer are:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy and radiotherapy together (chemoradiotherapy)
  • targeted cancer drug treatment

You have one or more of these treatments depending on the stage of your cancer.

Treatment decisions

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 - type 1, 2 or 3

The earlier your cancer is diagnosed, the easier it is to control and possibly cure it.

Your doctor will talk to you about your treatment, its benefits and the possible side effects.

The main treatments

If your cancer hasn’t spread

Your doctor will probably offer you surgery. Your doctor might suggest you have treatment before surgery. You might have:

  • chemotherapy before surgery
  • chemotherapy before and after surgery (this is called perioperative chemotherapy)
  • combined chemotherapy and radiotherapy (chemoradiotherapy) before surgery

If you have a very early stage cancer or you aren’t well enough for preoperative treatment, you might just have surgery.

To remove a very early GOJ cancer, you might have an endoscopic resection. Your doctor passes a long flexible tube (endoscope) into your oesophagus. It has a tiny camera and light on the end. The surgeon then passes special instruments through the tube and removes the cancer.

Surgery for most GOJ cancers is a major operation, so your doctor will make sure you are fit enough to make a good recovery.

You might have chemoradiotherapy instead if you aren’t well enough to have surgery.

If your cancer has spread

Treatment options include:

  • chemotherapy
  • chemoradiotherapy
  • targeted cancer drug treatments
  • treatment to relieve symptoms, such as radiotherapy or a stent

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 GOJ cancer - types 1, 2 and 3. The type of surgery you have depends on your type of cancer.

Type 1

You usually have surgery to remove two thirds of your oesophagus, the nearest lymph nodes, and possibly the top of the stomach.

Type 2 and 3

You might have surgery to remove:

  • part of your oesophagus, the top of your stomach and the surrounding lymph nodes (oesophago-gastrectomy)
  • your stomach and the lower end of your oesophagus, with the surrounding lymph nodes (extended total gastrectomy)

After removing the cancer and surrounding tissue, the surgeon joins the two remaining ends together. 

How your surgeon does your operation

You often have open surgery. This means you have the operation through a cut in your tummy (abdomen) or chest. 

Another method is keyhole surgery. This means having an operation without needing a major cut in your tummy (abdomen). It's also called laproscopic surgery, or you may hear the term minimally invasive surgery. In a few specialist hospitals, the surgeon may use a special machine (robot) to help with laparoscopic surgery. This is called assisted robotic surgery.

Laproscopic surgery and robotic surgery are still quite new ways of removing GOJ cancer. Researchers are monitoring how well they work.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

You might have chemotherapy:

  • before surgery
  • before and after surgery (perioperative chemotherapy)
  • with radiotherapy before surgery (chemoradiotherapy)
  • to reduce or control symptoms of advanced cancer

Chemotherapy before surgery reduces the chance of the cancer coming back. It also shrinks the cancer, making it easier for the surgeon to remove.

There are different combinations of chemotherapy drugs. These include:

  • cisplatin and fluorouracil (5FU)
  • epirubicin, cisplatin and fluorouracil (ECF)
  • epirubicin, cisptlatin and capecitabine (ECX)
  • fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT)

You have epirubicin, fluorouracil, cisplatin, oxaliplatin, and docetaxel into a vein. You take capecitabine as a tablet. 

Radiotherapy uses high energy rays to destroy cancer cells. You might have:

  • radiotherapy combined with chemotherapy (chemoradiotherapy) before surgery 
  • radiotherapy, usually combined with chemotherapy, after surgery if the surgeon couldn't remove a clear border of tissue around your cancer
  • chemoradiotherapy instead of surgery, if you are unable to have surgery
  • radiotherapy to control the symptoms of advanced cancer

Chemoradiotherapy is quite an intensive treatment and the side effects are generally more severe than having chemotherapy or radiotherapy on their own.

 

 

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer. 

Trastuzumab (Herceptin) is a targeted cancer drug. You sometimes have it in combination with chemotherapy for GOJ cancer that has spread (advanced cancer).

It only works if your cancer cells have receptors for trastuzumab (HER2 positive cancer). Your doctor will test your cancer cells to see if there are HER2 receptors.

You have trastuzumab with chemotherapy drugs such as cisplatin and fluorouracil, or capecitabine.

You might have treatment to relieve a blockage, if your cancer blocks your food pipe.

Your doctor can put in a stent. This is a small metal or plastic tube. The surgeon puts it into the food pipe (oesophagus). It keeps the food pipe open.

Or you might have laser therapy, where hot beams of light are used to burn away the cancer cells. Another option is light activating photodynamic therapy to kill cancer cells in the food pipe.

Dietitians can help you cope with swallowing problems and suggest ways of dealing with diet difficulties. Ask your doctor or nurse to refer you.

Research into treatment

Researchers are looking at different ways of diagnosing and treating GOJ cancers. They are interested in:

  • looking at how GOJ cancers develop and how to stage them
  • comparing chemotherapy with chemoradiation before surgery
  • using monoclonal antibody drugs such as trastuzumab, pertuzumab, durvalumab and ipilimumab
  • using immunotherapy drugs such as nivolumab and pembrolizumab
  • using parp inhibitor drugs such as rucaparib

Coping

Coping with a diagnosis of a more aggressive cancer can be especially difficult, both practically and emotionally. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

Talking to other people who have the same thing can also help.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.

The Rare Cancer Alliance offer support and information to people affected by rare cancers.

A clinical nurse specialist is a qualified nurse who has knowledge of GOJ cancers. They help to organise the care between doctors and other health professionals. They support you during and after treatment and make sure you have the information you need to understand the treatment. 

Last reviewed: 
09 Aug 2018
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