Gastroesophageal Junction Cancer

Cancers of the gastroesophageal junction (GEJ) remain challenging malignancies to treat effectively. The GEJ represents the transition between esophagus and stomach, and approaching GEJ cancers as “esophageal” or as “gastric” cancers, a priori will run risk for excluding some more appropriate therapeutic options based on actual location. Gastroesophageal junction cancers are increasing in incidence, in particular at the distal esophageal and gastric cardia locations. They may be discovered in an early stage on upper GI endoscopy, but when presenting with dysphagia symptoms they are often of more advanced stage. Endoscopic resection options are limited to non-ulcerated T1 lesions, and surgical resection as only therapy is accepted for nodal-negative T1 or T2 disease. All other mid-stage GEJ cancers should be considered for multimodality therapy and should undergo a formal and complete multidisciplinary evaluation process before any therapy is started. While the proper approach remains debated, most often trimodality therapy with preoperative chemoradiation followed by resection is being offered, as it offers the greatest likelihood for complete pathologic response and survival benef