Treatment for gastro oesophageal junction cancer
The gastro oesophageal junction is where your food pipe (oesophagus) joins your 
. Cancer that starts here is called gastro oesophageal junction (GOJ) cancer. It might also be called oesophago gastric junctional cancer.
The most common treatments for GOJ cancer are:
surgery radiotherapy chemotherapy chemoradiotherapy immunotherapy targeted cancer drugs
Deciding about treatment for gastro oesophageal junction cancer
Your doctors consider many factors to help them decide about your treatment. These include:
- 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
Your doctor will talk to you about your treatment, its benefits and the possible side effects.
A clinical nurse specialist (CNS) is a qualified nurse who has knowledge of GOJ cancers. They help to organise the care between doctors and other health professionals. They will support you during and after treatment. And they can make sure you have the information you need to understand the treatment.
What treatment will you have for gastro oesophageal junction cancer?
The treatment you have depends on whether or not the cancer has spread.
If the cancer hasn’t spread
Your doctor will probably offer you surgery. They might suggest you have treatment before surgery. You might have:
- chemotherapy before and after surgery - perioperative chemotherapy
- chemoradiotherapy before surgery
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.
You might have surgery on its own without other treatments if you have a very early stage cancer. Or you aren’t well enough to have other treatments.
Very early stage cancer
To remove a very early GOJ cancer, you might have an operation called an endoscopic resection. Your doctor passes a long flexible tube (endoscope) into your oesophagus. It has a tiny camera and light on the end. They then pass special instruments through the tube and remove the cancer.
If the cancer has spread
Treatment options include:
- chemotherapy
- chemoradiotherapy
- targeted cancer drugs
- immunotherapy
- treatment to relieve symptoms, such as radiotherapy or a
stent
The main treatments
You usually have surgery if the cancer hasn’t spread, and you are fit enough. Your surgeon removes the cancer along with a clear border of around it. They also remove the nearest .
There are different types of GOJ cancer - types 1, 2 and 3. Your type of GOJ cancer depends on where the cancer is in your oesophagus and stomach.
The surgery you have depends on your type of GOJ cancer.
Type 1 GOJ cancer
You usually have surgery to remove two thirds of your oesophagus. Your surgeon also removes the nearest lymph nodes, and possibly the top of the stomach.
An oesophagectomy is the name for surgery to remove part of your oesophagus. If your surgeon also removes part of your stomach it is called an oesophago gastrectomy.
Type 2 and 3 GOJ cancer
You might have surgery to remove:
- part of your oesophagus
- the top of your stomach
- surrounding lymph nodes.
This is called an oesophago gastrectomy.
Or you might have surgery to remove:
- your stomach
- the lower end of your oesophagus
- the surrounding lymph nodes
This is called an extended total gastrectomy.
How your surgeon does your operation
You often have open surgery. This means you have the operation through a cut in your or chest.
Another method is keyhole surgery. This means having an operation without needing a major cut in your stomach. It's also called laparoscopic surgery. Or you may hear the term minimally invasive surgery. Your surgeon may use a special machine (robot) to help with laparoscopic surgery. This is robot assisted surgery. It is only available in a few specialist hospitals.
Sometimes surgeons combine keyhole and open surgery. You might hear this called a hybrid minimally invasive oesophagectomy. Or a laparoscopically assisted oesophagectomy.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout your 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.
Combinations of chemotherapy drugs
You usually have a combination of 2 or 3 chemotherapy drugs to treat GOJ cancer. A common combination is called FLOT. This is made up of fluorouracil (5FU), leucovorin, oxaliplatin and docetaxel. Leucovorin is also called folinic acid. It isn't a chemotherapy drug but it helps fluorouracil to work better.
You have to be fit and well enough to have FLOT chemotherapy. Other possible combinations of chemotherapy include:
-
folinic acid, fluorouracil and oxaliplatin (FOLFOX)
-
cisplatin and capecitabine (CX)
-
cisplatin and fluorouracil (CF)
-
carboplatin and capecitabine (Carbo X)
-
carboplatin and fluorouracil (Carbo F)
-
oxaliplatin and capecitabine (OX)
You can find information about these chemotherapy drugs, including how you have them and their side effects, from our A to Z list of cancer drugs.
Radiotherapy means the use of radiation, usually x-rays, to treat cancer cells. Chemoradiotherapy is when you have radiotherapy together with chemotherapy.
You might have:
- chemoradiotherapy before surgery
- chemoradiotherapy after surgery - you might have this 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. The side effects are generally more severe than having only chemotherapy or radiotherapy.
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. They are called immunotherapies.
Your doctor might test your cancer cells for particular proteins. This can help to show whether certain drug treatments might work for your cancer. They might test your cancer cells for:
- HER2 receptors
- PD-L1 proteins
The main targeted drugs and immunotherapy for GOJ cancers are:
- trastuzumab (Herceptin or Ontruzant)
- nivolumab (Opdivo)
- pembrolizumab (Keytruda)
Trastuzumab (Herceptin or Ontruzant)
Trastuzumab is a targeted cancer drug. You might have it if you have advanced GOJ cancer which is HER2 positive. HER2 stands for human epidermal growth factor receptor 2.
You might have the original drug called Herceptin, or a biosimilar such as Ontruzant. You usually have it with chemotherapy. You might continue with it alone after the chemotherapy has finished.
Nivolumab (Opdivo)
Nivolumab is a type of immunotherapy. You might have it after chemoradiotherapy and surgery. You have nivolumab after surgery to lower the risk of the cancer coming back. This is called adjuvant treatment.
Nivolumab is also used to treat some advanced HER2 negative GOJ cancers. You have it with chemotherapy.
Pembrolizumab (Keytruda)
You might have pembrolizumab if you can’t have surgery for locally advanced GOJ cancer or if the cancer has spread to other parts of the body. And if your cancer cells:
- have high levels of a protein called PD-L1
- are HER2 negative
You have pembrolizumab with chemotherapy. Pembrolizumab is a type of immunotherapy.
You might have treatment to relieve a blockage, if the cancer blocks your oesophagus.
Your doctor can put in a stent. This is a small metal or plastic tube. The surgeon puts it into the oesophagus to keep it open.
Or you might have laser therapy, where hot beams of light burn away the cancer cells.
Dietitians can help you cope with swallowing problems. And they can suggest ways of dealing with diet difficulties. Ask your doctor or nurse to refer you.
You may also see a speech and language therapist (SLT) if you have any difficulties swallowing. They can assess your swallowing and give you exercises to help.
You may find it helpful to read our information about eating problems. This is in the oesophageal cancer section.
Research into treatment
All cancer treatments must be fully researched before they can be used for everyone. This is so we can be sure that:
- they work
- they work better than the treatments already available
- they are safe
Researchers are looking at different ways of staging and treating GOJ cancers. They are interested in:
- seeing if endoscopic ultrasound is useful (as well as a CT or PET-CT scan) and changes treatment plans
- using
monoclonal antibody drugs with chemotherapy - using immunotherapy drugs with chemotherapy
- treating GOJ cancers with
proton beam radiotherapy - using new drugs for treatment such as MK-2870 which is a type of drug called an antibody drug conjugate
Coping
Coping with a diagnosis of a rare cancer can be especially difficult. Being well informed about your cancer and its treatment can help. It 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.
You can call our nurse freephone helpline on 0808 800 4040. They are available from Monday to Friday, 9am to 5pm. Or you can send them a question online.
The Rare Cancer Alliance offer support and information to people with rare cancers. It has a forum where you might be able to meet others with the same cancer as you.
