Treatment for gastro oesophageal junction cancer
The gastro oesophageal junction is where your food pipe (oesophagus) joins your stomach. Gastro oesophageal junction cancer (GOJ cancer) starts here. The most common treatments for GOJ cancer are:
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surgery
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radiotherapy
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chemotherapy
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chemotherapy and radiotherapy together (chemoradiotherapy)
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immunotherapy and targeted cancer drug treatment
You have one or more of these treatments depending on the stage of your cancer.
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
The earlier your cancer is diagnosed, the easier it is to control and possibly cure it.
Your doctor will talk to you about your treatment, its benefits and the possible side effects.
What treatment will I have?
The treatment you have depends on whether or not your cancer has spread.
If your cancer hasn’t spread
Your doctor will probably offer you surgery. Your doctor might suggest you have treatment before surgery. You might have:
- chemotherapy before and after surgery (this is called perioperative chemotherapy)
- combined chemotherapy and radiotherapy (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
- 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. The surgeon then passes special instruments through the tube and removes the cancer.
If your cancer has spread
Treatment options include:
- chemotherapy
- chemoradiotherapy
- targeted cancer drug treatments
- treatment to relieve symptoms, such as radiotherapy or a stent
The main treatments
You usually have surgery if your cancer hasn’t spread and you are fit enough. Your surgeon removes the cancer along with a clear border of tissue around it. They also remove the nearest lymph nodes.
There are different types of GOJ cancer - types 1, 2 and 3. Your type of GOJ cancer depends on whereabouts 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. The surgeon also removes the nearest lymph nodes, and possibly the top of the stomach.
Surgery to remove part of your oesophagus is called an oesophagectomy. The surgeon might also remove part of your stomach. This 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 tummy (abdomen) or chest.
Another method is keyhole surgery. This means having an operation without needing a major cut in your tummy (abdomen). It's also called laparoscopic surgery. Or you may hear the term minimally invasive surgery. The surgeon may use a special machine (robot) to help with laparoscopic surgery. This is called 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 the 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.
Usually you have a combination of 2 or 3 drugs. The most common drugs are:
- fluorouracil (5FU) or capecitabine (Xeloda)
- cisplatin, oxaliplatin or carboplatin
- paclitaxel or docetaxel
- epirubicin
Common combinations include:
- epirubicin, cisplatin and capecitabine (ECX)
- fluorouracil, leucovorin, oxaliplatin, docetaxel (FLOT)
You have epirubicin, fluorouracil, cisplatin, oxaliplatin, and docetaxel into a vein. You take capecitabine as a tablet.
Radiotherapy uses high energy rays to destroy cancer cells. When you have radiotherapy together with chemotherapy it is called chemoradiotherapy.
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 of Ontruzant)
You might have trastuzumab 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)
You might have nivolumab after chemoradiotherapy and surgery. You have nivolumab after surgery to lower the risk of the cancer coming back. This is called adjuvant treatment.
Pembrolizumab (Keytruda)
You might have pembrolizumab if you can’t have surgery for advanced GOJ cancer. And if your cancer cells:
- have high levels of a protein called PD-L1
- are HER 2 negative.
You have pembrolizumab with chemotherapy as your first line treatment.
You might have treatment to relieve a blockage, if your cancer blocks your food pipe.
Your doctor can put in a stent. This is a small metal or plastic tube. The surgeon puts it into the food pipe (oesophagus). It keeps the food pipe open.
Or you might have laser therapy, where hot beams of light burn away the cancer cells. Another option is light activating photodynamic therapy (PDT).
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.
Research into treatment
Researchers are looking at different ways of treating GOJ cancers. They are interested in:
- comparing chemotherapy with chemoradiation before surgery
- using monoclonal antibody drugs such as trastuzumab, pertuzumab, durvalumab and ramucirumab
- using immunotherapy drugs such as ipilimumab and pembrolizumab
- using parp inhibitor drugs such as rucaparib
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.
A clinical nurse specialist is a qualified nurse who has knowledge of GOJ cancers. They help to organise the care between doctors and other health professionals. They support you during and after treatment. And they can make sure you have the information you need to understand the treatment.
