Oesophagogastric junctional adenocarcinoma

A type of cancer located at the junction of the esophagus and stomach

Oesophagogastric junctional adenocarcinoma is a type of cancer that occurs at the junction where the esophagus meets the stomach. This area is known as the oesophagogastric junction (OGJ). Adenocarcinomas are cancers that form in mucus-secreting glands and are the most common type of cancer found in this region.

Classification

Oesophagogastric junctional adenocarcinomas are classified based on their location relative to the OGJ. The classification system most commonly used is the Siewert classification, which divides these tumors into three types:

• Type I: Adenocarcinomas of the distal esophagus, which may infiltrate the OGJ from above.
• Type II: True carcinoma of the cardia, arising from the OGJ.
• Type III: Subcardial gastric carcinoma, which infiltrates the OGJ from below.

Pathophysiology

The development of oesophagogastric junctional adenocarcinoma is often associated with chronic gastroesophageal reflux disease (GERD) and Barrett's esophagus, a condition where the normal squamous epithelium of the esophagus is replaced by columnar epithelium. This metaplastic change increases the risk of developing adenocarcinoma.

Esophageal adenocarcinoma under high magnification

Symptoms

Patients with oesophagogastric junctional adenocarcinoma may present with symptoms such as:

• Dysphagia (difficulty swallowing)
• Weight loss
• Epigastric pain
• Heartburn
• Vomiting

Diagnosis

Diagnosis of oesophagogastric junctional adenocarcinoma typically involves:

• Endoscopy with biopsy to obtain tissue samples for histological examination.
• Imaging studies such as CT scan or PET scan to assess the extent of the disease.
• Endoscopic ultrasound to evaluate the depth of tumor invasion and involvement of lymph nodes.

Treatment

The treatment of oesophagogastric junctional adenocarcinoma depends on the stage of the disease and may include:

• Surgery: Esophagectomy or gastrectomy with lymph node dissection.
• Chemotherapy: Often used in combination with surgery or as a primary treatment in advanced cases.
• Radiation therapy: May be used in conjunction with chemotherapy or surgery.
• Targeted therapy: For tumors expressing specific molecular targets.

Prognosis

The prognosis for patients with oesophagogastric junctional adenocarcinoma varies based on the stage at diagnosis and the response to treatment. Early-stage cancers have a better prognosis, while advanced-stage cancers are associated with a poorer outcome.

Prevention

Preventive measures include managing risk factors such as GERD and Barrett's esophagus, maintaining a healthy weight, and avoiding tobacco and excessive alcohol consumption.

Related pages

• Esophageal cancer
• Gastric cancer
• Barrett's esophagus
• Gastroesophageal reflux disease