Gastro-oesophageal junctionthe area where the oesophagus and the stomach meet (GOJ) cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs, also known as oesopho gastric junctional cancer, is a rare type of malignancy developing from the gastro-oesophageal junction, the area where the stomach and the oesophagus (food pipe) meet. This type of cancer is often difficult to diagnose, and may be misdiagnosed as stomach or oesophageal cancer.
GOJ cancers are generally more common in men, and tend to be diagnosed over the age of 55. However, anyone can develop this disease.
Types of Gastro-oesophageal Junction Cancers
There are three types of GOJ cancers which can be categorised by their location. As these tumours are rare, research is still being conducted to determine the prevalence of each subtype.
Type 1 GOJ Cancers
Type 1 GOJ cancers are defined as malignancies in the gastro-oesophageal junction that have spread from above (i.e. the lower portion of the oesophagus). The centre of the tumoura tissue mass that forms from groups of unhealthy cells is generally located approximately 1-5cm above the gastro-oesophageal junction.
Type 2 GOJ Cancers
Type 2 GOJ cancers are defined as malignancies that originate in the gastro-oesophageal junction. The centre of the tumour is generally located approximately 1cm above and 2cm below the gastro-oesophageal junction.
Type 3 GOJ Cancers
Type 3 GOJ cancers are defined as malignancies in the gastro-oesophageal junction that have spread from below (i.e. the upper portion of the stomach). The centre of the tumour is generally located approximately 2-5cm below the gastro-oesophageal junction.
Treatment
If GOJ cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cellsthe basic structural and functional unit of all living things look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for GOJ cancers may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Gastrectomycomplete or partial removal of the stomach.
- Oesophagectomycomplete or partial removal of the oesophagus.
- Lymphadenectomysurgical removal of lymph node(s).
- Surgery to insert a feeding tube, such as a gastronomy tube (G-tube)a feeding tube surgically inserted through an incision in the abdominal wall directly into the stomach to get fluids/food/liquids to and from the stomach or nasogastric tube (NG tube)a thin, soft tube that goes in through the nose, down the throat, and into the stomach to get fluids/food/liquids to and from the stomach, also known as a NG tube.
- Oesophagogastrectomyremoval of part or all of the oesophagus, as well as the upper portion of the stomach.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of GOJ cancer remains unknown, some of the following factors may increase the riskthe possibility that something bad will happen of you developing the disease:
- Being obese.
- Having pre-existing conditions of the gastrointestinal tract (e.g., Barrett’s oesophagus or gastro-oesophageal reflux disease (GORD)).
- Previous infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body with helicobacter pylori (H. pylori).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The symptoms of GOJ cancers may include a combination of stomach cancer symptoms and oesophageal cancer.
Symptoms of Stomach Cancer
Symptoms of a stomach cancer may include:
- Unexplained weight loss and/or loss of appetite.
- Difficulties swallowing.
- Indigestion, which may carry its own set of symptoms:
- Abdominal pain/burning.
- Heartburn.
- Frequent burping.
- Reflux.
- Nauseato feel sick or likely to vomit and/or vomiting.
- Abdominal pain.
- Feeling full after eating small quantities of food.
- Abdominal swelling and/or bloating.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Anaemiaa condition where there aren't enough red blood cells in the blood, causing fatigue, weakness and pale skin and affecting how the body responds to infection.
- Vomit with bloodthe red bodily fluid that transports oxygen and other nutrients around the body in it.
- Discoloured stools.
Symptoms of Oesophageal Cancer
Symptoms of oesophageal cancers may include:
- Difficulty swallowing.
- New heartburn or reflux.
- Worsening indigestion.
- Food or liquids ‘catching’ in the throat or choking episodes when swallowing.
- Pain when swallowing.
- Unexplained weight loss.
- Unexplained loss of appetite.
- Discomfort in abdomenstomach, stomach area, belly.
- Fatigue.
- Vomit or stoolwaste product from the bowel sent to the anus for removal; also known as faeces or poo with blood.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a GOJ cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Endoscopic ultrasoundan ultrasound taken during an endoscopy.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs.
- Biopsyremoval of a section of tissue to analyse for cancer cells.