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Multimodality approaches to potentially resectable esophagogastric junction and gastric cardia adenocarcinomas

Ajlan Atasoy, MD
Michael K Gibson, MD, PhD, FACP
Mark F Berry, MD
Noah C Choi, MD
Section Editors
Joseph S Friedberg, MD
Kenneth K Tanabe, MD
Richard M Goldberg, MD
Deputy Editors
Diane MF Savarese, MD
Wenliang Chen, MD, PhD


Esophageal and gastric cancers are significant worldwide health problems. They are often lethal diseases, with a case-fatality ratio of 84 percent (esophageal) and 75 percent (gastric), respectively [1].

The esophagogastric junction (EGJ; also called the gastroesophageal junction or GEJ) and gastric cardia (figure 1), represent anatomical sites with a remarkably high and rapidly rising incidence of adenocarcinoma. (See "Epidemiology of gastric cancer", section on 'Change in histology pattern' and "Epidemiology, pathobiology, and clinical manifestations of esophageal cancer", section on 'Epidemiology'.)

Although surgery is the primary curative modality for EGJ cancers, long-term outcomes are not satisfactory with resection alone, even if microscopically complete (R0). This poor long-term outcome has prompted an evaluation of neoadjuvant (preoperative) and adjuvant (postoperative) combined modality therapy. The best form of multimodality therapy is not established.

This topic will cover the definition and classification of EGJ tumors and provide an overview of the clinical trials that support the multimodality management of locally advanced but potentially resectable EGJ adenocarcinomas, focusing on considerations that influence the choice of the specific multimodality approach. Principles of surgical management for gastric tumors and thoracic esophageal tumors, treatment of locally advanced, unresectable esophageal cancers, adjuvant and neoadjuvant approaches to gastric cancers, and neoadjuvant and adjuvant approaches to tumors of the thoracic esophagus are covered elsewhere, as is management of dysplasia and early superficial cancer (including adenocarcinoma) arising in Barrett's esophagus.

(See "Surgical management of invasive gastric cancer".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.
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