How is gastro oesophageal junction cancer treated?
This page has information about treatment for cancers that grow at the junction between the food pipe or gullet (the oesophagus) and the stomach. These are called gastro oesophageal junction (GOJ) cancers and there is information below on
We have a separate question and answer about what gastro oesophageal junction cancers are. The most common treatments for cancer at the join of the food pipe and stomach are surgery, radiotherapy and chemotherapy. You may have surgery on its own, or along with chemotherapy, radiotherapy, or both.
If your cancer blocks your food pipe, you may have treatment to relieve the blockage. For example, you may have a stent put in, photodynamic therapy or laser therapy.
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
- Your age and level of fitness
- The type of gastro oesophageal cancer - there are 3 types, type 1, 2 and 3
The earlier your cancer is diagnosed, the easier it is to control it and possibly cure it. If your cancer hasn't spread, you will probably be offered 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. If you are not, you may be able to have combined chemotherapy and radiotherapy treatment instead.
Before you have treatment, your doctors will arrange for you to have tests to find the stage of your cancer. This helps them decide on the best treatment for you. The tests include
- Endoscopy - you may also have an ultrasound scan during your endoscopy
- CT scan
- MRI scan
- Laparoscopy
- PET-CT scan
You will probably have surgery if your cancer hasn’t spread and you are fit enough. You have the cancer removed along with a clear border of tissue around it. The nearest lymph nodes are also removed.
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 (proximal), 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 pancreas removed, but this is very rare.
You can find detailed information about surgery in the sections about stomach cancer surgery and surgery for oesophageal cancer in CancerHelp UK.
Chemotherapy uses anti-cancer or cytotoxic drugs to kill cancer cells. You may have it
- Before or after surgery
- To control an advanced cancer
- To reduce or control symptoms of advanced cancer
You are likely to have chemotherapy before surgery if the cancer has spread into nearby tissues or lymph nodes (locally advanced cancer). The chemotherapy can shrink the tumour, making it possible for your surgeon to remove it.
Types 1 and 2 gastro oesophageal cancer are usually treated with the standard treatment of cisplatin and fluorouracil. The OEO5 trial is comparing cisplatin and fluorouracil with the combination ECX, which is cisplatin, epirubicin, and capecitabine (Xeloda).
Type 3 gastro oesophageal cancer is usually treated with ECF or ECX combination chemotherapy. ECF contains the drugs epirubicin, cisplatin and fluorouracil. There is a page on the specific side effects of ECF in our section on cancer drugs.
ECX contains the drugs epirubicin, cisplatin and capecitabine (Xeloda). There is a page about the side effects of ECX in our section on cancer drugs. You have the epirubicin and cisplatin into a vein but the capecitabine is taken as a tablet.
The PEP0206 study is looking at irinotecan, docetaxel and a new chemotherapy called PEP02 for advanced gastro oesophageal cancer that has continued to grow after previous chemotherapy.
We need more research to find out which is the best type of chemotherapy for people with this type of cancer.
Radiotherapy uses radiation to treat cancer. You may have radiotherapy combined with chemotherapy if you cannot have surgery. Or if your tumour is large and you have cancer cells in the lymph nodes close to the gastro oesophageal junction, but there is no cancer in other parts of your body. Giving radiotherapy at the same time as some types of chemotherapy can make the chemotherapy work better. This treatment can sometimes control the cancer for many months.
You may have radiotherapy before surgery or, more usually, after surgery for early stage cancer, to try to reduce the chance of the cancer coming back.
Trastuzumab (Herceptin) is a biological therapy sometimes used for people with gastro oesophageal cancer of the stomach that has spread. It only works if the cancer cells have receptors for Herceptin (HER2 positive cancer). You have Herceptin in combination with chemotherapy such as capecitabine or fluorouracil and cisplatin. The National Institute for Health and Clinical Excellence (NICE) have said that people can have it within the NHS in England if they have not had any other treatment for secondary cancer.
Doctors are researching new treatments for gastro oesophageal junction cancers. One trial is looking at adding bevacizumab (Avastin) to chemotherapy for stomach cancers and type 3 gastro oesophageal cancers. Bevacizumab is a monoclonal antibody. Researchers think that giving bevacizumab as well as chemotherapy may be better than chemotherapy alone. The chemotherapy in this trial is ECX. This is epirubicin, cisplatin and capecitabine (Xeloda). This trial has only just started and it will be some time before we know the results.
The REAL3 trial is looking at whether a biological therapy called panitumumab (Vectibix) can improve the results of EOX chemotherapy (epirubicin, oxaliplatin and capecitabine) for people with gastro oesophageal cancer who can't have surgery.
A phase 1 trial for advanced gastro oesophageal junction cancers is looking at adding the drug bortezomib (Velcade) to chemotherapy. Bortezomib is a type of biological therapy called a proteasome inhibitor. The trial aims to find out the best dose of bortezomib and learn about the side effects it causes when you have it with chemotherapy
While these trials are open, you can find out about them on our clinical trials database. Search under 'stomach cancer' to find the trial.
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