Search
gastroesophageal junction cancer/adenocarcinoma
Pathology:
- 30-40% of cancers potentially resectable upon presentation
- recurrence rates high
- cure rates low
Laboratory:
- HER2 copy number
- HER2 amplification in 25% of meatastatic cancers [1]
- favorable response trastuzumab
Special laboratory:
- upper GI endoscopy & biopsy establishes diagnosis [1]
- mass in the gastric cardia
- endoscopic ultrasound to assess tumor depth & involvement of lymph nodes
Radiology:
- CT of chest, abdomen & pelvis (1st test with biopsy pending) [5]
- PET scan is option after CT [5]
- PET/CT widely used for preoperative staging [1]
Differential diagnosis:
- gastric cancer
- esophageal cancer
Management:
- neoadjuvant chemotherapy + radiation therapy prior to surgery
- adjuvant nivolumab improves disease-free survival [3]
- adding trastuzumab for tumors with HER2 overexpression may provide a modest survival benefit [1]
- elderly: no survival benefit from full-dose vs reduced-dose chemotherapy [4]
Related
esophageal cancer
gastric cancer
General
gastrointestinal (GI) cancer
References
- Medical Knowledge Self Assessment Program (MKSAP) 18, 19.
American College of Physicians, Philadelphia 2018, 2019.
- van Hagen P, Hulshof MC, van Lanschot JJ et al for the CROSS Group.
Preoperative chemoradiotherapy for esophageal or junctional cancer.
N Engl J Med. 2012 May 31;366(22):2074-84.
PMID: 22646630 Free Article
- Kelly RJ, Ajani JA, Kuzdzal J et al
Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.
N Engl J Med 2021; 384:1191-1203. April 1.
PMID: 33789008
https://www.nejm.org/doi/full/10.1056/NEJMoa2032125
- Hall PS, Swinson D, Cairns DA et al.
Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine
on quality of life and cancer control among older and frail patients with
advanced gastroesophageal cancer: The GO2 phase 3 randomized clinical trial.
JAMA Oncol 2021 Jun 1; 7:869.
PMID: 33983395 PMCID: PMC8120440 Free PMC article
- NEJM Knowledge+ Gastroenterology