What Is Gastroesophageal Junction Adenocarcinoma?

Gastroesophageal junction adenocarcinoma is a rare type of cancer of the esophagus, the tube that connects your mouth and stomach. It starts in the gastroesophageal (GE) junction, the area where the esophagus and stomach join together. The cancer grows from cells that make mucus.

GE junction cancer is similar to other cancers of the esophagus. Your doctor will diagnose and treat it much like those.

It's natural to be nervous or afraid when you're diagnosed with a serious disease like GE junction cancer. Yet treatments for this condition have improved a lot over the years. Try to learn all you can about the disease and its treatments.

Causes

No one knows exactly what causes GE junction adenocarcinoma. It might be that irritation in your esophagus causes healthy cells to turn into cancer.

You may be more likely to get it if you:

  • Have gastroesophageal reflux disease (GERD)
  • Have Barrett's esophagus, a problem with the tissue that lines the inside of your esophagus
  • Are obese
  • Smoke
  • Don't eat enough fruit and vegetables

This type of cancer is most common in white men, although women get it, too.

Symptoms

This cancer can cause:

  • Pressure or burning in your chest (from acid reflux)
  • Weight loss without trying
  • Trouble swallowing or eating, especially solid, dry foods – This gets worse over time.
  • Pale skin, tiredness, trouble catching your breath, and other symptoms of anemia
  • A hoarse voice

Other conditions can also cause these symptoms. So if you have them, it doesn't mean that you definitely have cancer. See your doctor to find out what’s causing your trouble.

Getting a Diagnosis

Your doctor will first ask about your symptoms and medical history. Then he’ll give you a physical exam to look for symptoms of GE junction cancer.

Endoscopy is the main test used to diagnose it. After you get medicine to make you sleepy, the doctor places a flexible tube with a camera on the end through your mouth and into your esophagus and stomach. A monitor connected to the camera lets your doctor find any areas that look unusual.

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You may also get a test called an endoscopic ultrasound at the same time. A probe at the end of the endoscope gives off sound waves that create pictures of your esophagus. This test can show how big the cancer tumor is and if it has spread to other places.

During endoscopy, your doctor can use special tools to remove a small piece of tissue from your esophagus. This is called a biopsy. The sample goes to a lab where technicians can check it for cancer cells.

Other tests also diagnose esophageal cancer and see if it has spread, such as:

  • Upper GI series, also called a barium X-ray. You drink a special liquid that coats your throat, stomach, and part of your small intestine to make them stand out on an X-ray image.
  • Computed tomography (CT) scan. It's a powerful X-ray that makes detailed pictures of your esophagus and stomach.
  • Positron emission tomography (PET) scan. Your doctor injects a radioactive sugar into your bloodstream to make cancer cells show up more clearly on the picture.

GE junction adenocarcinoma is divided into three types based on its location:

  • Type I is 1 to 5 centimeters above the GE junction
  • Type II is between 1 centimeter above and 2 centimeters below the GE junction
  • Type III is 2 to 5 centimeters  below the GE junction

Once your doctor knows the type of cancer you have, he’ll be able to find the right treatment for you.

Questions for Your Doctor

Bring this list of questions to ask your doctor during your exam:

  • What type of GE junction cancer do I have? What does that mean for me?
  • What are my treatment options?
  • What is the goal of each one?
  • Which treatment do you recommend? How might it affect my cancer?
  • What side effects can it cause?
  • What should I do to manage side effects if I have them?
  • Who will be on my medical team?
  • What is the outlook for my condition?

Treatment

You have a few options to treat GE junction cancer. Which treatment you get depends on:

  • The type of GE junction cancer you have
  • Whether your cancer has spread
  • Your overall health

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Esophagectomy surgery is the main treatment for cancer that hasn't spread. Your surgeon will remove:

  • The part of your esophagus that has the tumor
  • Possibly part of your stomach
  • A small piece of your healthy esophagus
  • Lymph nodes close to the tumor

Your surgeon will then reconnect the remaining part of your esophagus to your stomach.

Esophageal dilation is another type of surgery. If the tumor has blocked your esophagus, this procedure can open it so the food you eat can get to your stomach. The surgeon will place a small metal or plastic tube in your esophagus to hold it open.

Radiation uses high-energy X-rays to kill cancer cells or stop their growth. You may get this treatment before surgery to shrink the tumor and make it easier to remove. This is called neoadjuvant therapy.

Chemotherapy uses medicine to kill cancer cells. You take them by mouth or as an injection into a vein. Sometimes, doctors will suggest that you get radiation along with chemotherapy to shrink the tumor before surgery. This treatment is called chemoradiation. You can also get chemo after surgery to kill any cancer cells that are left behind.

Targeted therapy uses special drugs that work against specific changes in cells that turn them into cancer. Some GE junction cancers have a protein called HER2 on the surfaces of their cells that helps them grow. These are called HER2-positive cancers. Trastuzumab (Herceptin) treats them by targeting the HER2 protein. Another targeted drug, ramucirumab (Cyramza), works against a protein called VEGF, which tumors need to make new blood vessels.

Taking Care of Yourself

Surgery, radiation, and chemotherapy will shrink your tumor. While you go through treatment, it’s important to keep yourself feeling as good as you can. There are a few things you can try to relieve your symptoms. 

Make eating easier. Cancer in any part of the esophagus can make it hard to swallow, which can prevent you from getting the nutrition you need. Some cancer treatments cause nausea, which may make you lose your appetite. Your doctor can prescribe medicine to relieve pain and nausea. A speech and language specialist can teach you how to swallow more easily.

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Keep nutrition in mind. You might lose weight or not get enough nutrients due to your cancer or its treatment. After surgery, your stomach might not be able to hold as much as it once did. Food also can move too quickly from your stomach into your intestine, causing symptoms like diarrhea and sweating after you eat. This is called dumping syndrome. A dietitian can teach you tips to get more calories and nutrition and adjust your diet to prevent problems.

Exercise. It's normal to feel more tired than usual when you have cancer. Exercise is one way to give yourself more energy. Do only as much as you can -- even if you can only walk for a few minutes each day. Rest whenever you need a break.

Let others help. A cancer diagnosis can be very hard on you emotionally. Lean on friends and family for support. See a therapist who specializes in treating people with cancer. Or join a support group. You might get comfort and reassurance from talking with people who have the same condition that you have. Ask your doctor to recommend a support group in your area.

What You Can Expect

Your outlook depends on the type of GE junction adenocarcinoma you have, whether it has spread, and the treatment you need. Cancer that is only in your esophagus is easiest to treat and has the best outcome.

For some people, treatment will get rid of the disease. For others, the cancer may never go away for good. The best thing you can do is to follow your treatment plan and see your doctor for all scheduled checkups.

After treatment, you may have trouble with health problems, like acid reflux, trouble swallowing, and a hard time digesting food. Let your doctor know about any problems you’re having and ask about how to handle them. Also, ask what you should be doing to take good care of yourself as your body continues to heal. 

Getting Support

To learn more about GE junction adenocarcinoma, visit the websites of the Esophageal Cancer Awareness Association and the Esophageal Cancer Action Network.

WebMD Medical Reference Reviewed by Gabriela Pichardo on November 18, 2019

Sources

SOURCES:

American Cancer Society: "Key Statistics for Esophageal Cancer," "Living as an Esophagus Cancer Survivor," "Radiation Therapy for Esophageal Cancer," "Surgery for Esophageal Cancer," "Targeted Therapy for Esophageal Cancer," "Tests for Esophageal Cancer," "What is Cancer of the Esophagus?"

Annals of Thoracic Surgery: "The Society of Thoracic Surgeons guidelines on the diagnosis and staging of patients with esophageal cancer."

Cancer.Net: "Esophageal Cancer: Questions to Ask the Doctor."

Cancer Research UK: "About gastro oesophageal junction cancer," "Survival," "Treatment for gastro oesophageal junction cancer."

Cleveland Clinic: "Esophageal Cancer."

Johns Hopkins Medicine: "The Migration of Gastric Cancer to the GE Junction."

Medscape: "Esophageal Cancer."

NHS: "Living with oesophageal cancer."

Radiation Oncology: "Clinical management of gastroesophageal junction tumors: past and recent evidences for the role of radiotherapy in the multidisciplinary approach."

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