Treatment for gastro oesophageal junction cancer
The gastro oesophageal junction is where your 
joins your . Gastro oesophageal junction cancer (GOJ) cancer starts here. The most common treatments for GOJ cancer are:
surgery radiotherapy chemotherapy chemoradiotherapy immunotherapy targeted cancer drug treatment
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 - 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. 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 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 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.
An oesophagectomy is surgery to remove part of your oesophagus. 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 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. The 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 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
You may have one drug or a combination of drugs to treat GOJ cancer. Your doctor or chemotherapy nurse will give you information about your treatment before you start.
The most common types of chemotherapy drugs to treat GOJ cancer are:
- fluorouracil (5FU) or capecitabine (Xeloda)
- cisplatin or oxaliplatin
- epirubicin
Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.
Radiotherapy uses high energy rays to destroy 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)
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
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 treating GOJ cancers. They are interested in:
- seeing if endoscopic ultrasound is useful 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
- learning about how cancer develops and test a new staging systems for GOJ cancer
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.
