What is gastro oesophageal junction cancer?
The gastro oesophageal junction is where your food pipe (oesophagus) joins your stomach. Cancer that starts here is called gastro oesophageal junction (GOJ) cancer. It might also be called oesophago gastric junctional cancer.
Cancer is when abnormal cells start to divide and grow in an uncontrolled way. Over time the cells can grow into surrounding 
or organs, and may spread to other areas of the body.
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 of gastro oesophageal junction cancer
There are 3 types of GOJ cancer, depending on where the cancer is:
Type 1
Type 1 GOJ cancer spreads down into the gastro oesophageal junction from above. So, the cancer cells are 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 oesophageal 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.
Causes of gastro oesophageal junction cancer
We don’t know what causes all GOJ cancers. But there are some factors that may increase your risk of developing it. These include:
- being
obese - having chronic gastro oesophageal reflux - when acid from the stomach repeatedly leaks back into the oesophagus
There are different risks factors for each type of GOJ cancer.
Type 1
Type 1 GOJ cancers are similar to oesophageal cancers. 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 2
We don't have such a good understanding of what causes type 2 cancers compared to type 1 and 3. This is because of the characteristics of type 2 cancer cells. Type 2 characteristics are somewhere between stomach and oesophageal cancer cells.
Type 3
Type 3 GOJ cancers are similar to stomach cancers. They are linked to infection with Helicobacter pylori (H.pylori). H. pylori is a bacteria that lives in the that lines the stomach.
Symptoms of gastro oesophageal junction cancer
The symptoms of GOJ cancers are very similar to oesophageal cancer. There are many other conditions that also cause these symptoms. Most of them are much more common than GOJ cancer.
The most common symptoms include:
- difficulty swallowing (dysphagia)
- unexplained weight loss
- indigestion or heartburn that doesn't go away
See your GP if you have any of these symptoms. It is important to get them checked.
Tests to diagnose gastro oesophageal junction cancer
Your doctor will arrange tests to find out the cause of your symptoms. You usually have a test to look at the inside of your oesophagus, stomach and first part of your small bowel (duodenum). This is called a gastroscopy. You may also hear it called an endoscopy or oesophago gastric duodenoscopy (OGD).
During the test your doctor takes samples of tissue (biopsies) of any abnormal looking areas.
If you are diagnosed with cancer of the gastro oesophageal junction you have further tests to find out more. These tests include:
endoscopic ultrasound CT scan PET-CT scan laparoscopy
Stages of gastro oesophageal junction cancer
The stage of a cancer tells you about its size and whether it has spread. It helps your doctor decide which treatment you need.
The tests and scans you have to diagnose 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. They stage some GOJ cancers in the same way as oesophageal cancer. They do this if the centre of the cancer is no more than 2 cm into the stomach. This includes type 1 and 2 GOJ cancer.
They stage other GOJ cancers as stomach cancer. They do this if the centre of the cancer is more than 2cm into the stomach. This includes type 3 GOJ cancers.
Treatment for gastro oesophageal junction cancer
The most common treatments for gastro oesophageal junction cancer are:
surgery radiotherapy chemotherapy chemoradiotherapy immunotherapy targeted cancer drugs
