Gastroesophageal Junction (GEJ) Cancer or Food Tube Cancer
The gastro-esophageal junction (GEJ), as the term suggests, is the part where the esophagus (food-pipe) meets the stomach.
Cancer of this area is one of the growing cancers in the West as well as in Asia.
Symptoms include heart burn, acid reflux (gastroesophageal reflux disease GERD) along with unintended weight loss, and difficulty in swallowing or eating with anemia.
The swallowing difficulty progresses from difficulty in taking solids to problem in swallowing liquids over time.
Risk factors include: obesity, heavy smoking and drinking, male gender, and low Helicobacter pylori infection rates.
Constant irritation at the junction of stomach and food pipe results in change of the surface cellular structure leading to Barrett’s esophagus. Such changes with Barrett’s esophagus can form frank cancer in 3-13% of cases, which can be either esophageal (foodpipe) adenocarcinoma or GEJ adenocarcinoma.
GEJ adenocarcinomas, are located within 5 cm above or below the junction. There are three types of adenocarcinoma classified as per the location. Type I is situated 1–5 cm above the GEJ is an adenocarcinoma of the lower esophagus.
Type II is the true GEJ carcinoma when the cancer arises between 1 cm above and 2 cm below the GEJ. Type III is located 2–5 cm below the GEJ. The treatment of the three types and outcomes are different depending upon the location & stage of the cancer.
The correct location of the cancer is found through fibre-optic endoscopy. The endoscope is a flexible tube inserted through the mouth of a person under light sedation. It carries a camera in one channel, to visualize the food -pipe and stomach and a biopsy guide in the other channel. The diagnosis of a cancer is established after a biopsy.
Sometimes the gastroenterologist applies special stains to the surface of food-pipe to see the abnormal surface that can guide him/her for accurate biopsy location. Endoscopic ultrasonography and CT scans of the chest and abdomen and ultrasound of the liver can provide evidence of organ and helpful in staging the disease. Nowadays PET scan (Positron Emission Tomography) is preferred as it can identify metabolically active cancers in distant sites from the primary cancer.
After proper work up/investigations that may include blood tests, ECG, lung function tests, surgery is the best curative option, if the case is operable. Otherwise the cancer is down staged with either chemotherapy on concurrent chemo & radiation to make surgery possible.
Tri-modality therapy with surgery followed by chemotherapy &/or radiation or pre surgery chemoradiation have shown to provide a 45-50% survival for advanced cancers of GEJ.