Gastroesophageal junction cancer - current topic and treatment dilemmas

Abstract

Treatment of gastroesophageal junction carcinomas have been debated for many years. This type of carcinomas has been classified as either gastric or esophageal carcinomas until Siewert?s classification was established and they were defined as a distinct entity. Risk factors for the development of these cancers are gastroesophageal reflux and Barrett?s esophagus, obesity, Helycobacter pylori infection, smoking, and alcohol. Symptoms of this disease include retrosternal pain, dysphagia to aphagia, and weight loss. Esophagogastroduodenoscopy with biopsy and pathohistological verification as well as CT of the chest and abdomen are crucial in establishing the diagnosis. Adenocarcinoma is predominant histological type of these tumors. The stage of the disease is defined by the TNM classification. Treatment of gastroesophageal junction cancer is complex, multidisciplinary, and multimodal, and involves the use of surgery, chemotherapy, and radiotherapy, alone or in different combinations. Surgery is the major treatment modality for these tumors, especially in local stages. Radiotherapy is used in the treatment of these tumors in all stages of the disease, and especially in the multimodal treatment of locally advanced gastroesophageal junction cancer, both preoperatively and postoperatively, usually in combination with chemotherapy. Chemotherapy is used in the treatment of these cancers as preoperative, postoperative and systemic. Immunotherapy and target therapy, as new promising therapy, is usually applied in a systemic and postoperative approach. Future directions in the treatment of these cancers are directed towards new surgical procedures, new types of immunotherapy, as well as new radiotherapy techniques.