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. The cells can grow into surrounding tissues 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 very overweight (obese) 
• having chronic gastro-oesophageal reflux 

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 mucous of the lining of the stomach.

Tests to diagnose gastro oesophageal junction cancer

Your doctors will arrange for you to have tests to diagnose your cancer find out the stage. The stage of a cancer tells you how big it is and whether it has spread.

This helps them decide on the best treatment for you. The tests include:

• test a test to look inside your body (endoscopy) - your doctor might take samples of any abnormal areas (biopsies)
• An ultrasound from inside the body (endoscopic ultrasound or EUS)
• CT scan
• a small operation to look inside your tummy (laparoscopy)
• PET-CT scan

Stages of gastro oesophageal junction cancer

The stage of a cancer tells you how big it is and how far it’s spread. It helps your doctor decide which treatment you need.

The tests and scans you have to diagnose your 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. Some GOJ cancers are staged in the same way as oesophageal cancers. And some are staged as stomach cancers. 

The doctor stages your cancer in the same way as oesophageal cancer if:

• the centre of your cancer is no more than 2cm into the stomach 

This includes types 1 and 2 GOJ cancer.

The doctor stages your cancer in the same way as stomach cancer if:

• the centre of your 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
• chemotherapy and radiotherapy together (chemoradiotherapy)
• immunotherapy and targeted cancer drug treatment