# Oesophageal and junctional adenocarcinoma

Source: https://onco.cc/cancers/oesophageal-adenocarcinoma/  
OnCo record `oesophageal-adenocarcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adenocarcinoma of the lower oesophagus and junction grows out of Barrett's oesophagus, the change in the lining caused by long-standing acid reflux. Chemotherapy or chemoradiation before surgery is standard, and HER2, PD-L1 and claudin 18.2 now guide drugs for advanced disease as they do in stomach cancer.

## Summary

Oesophageal adenocarcinoma arises in the lower oesophagus and gastro-oesophageal junction from Barrett's oesophagus, driven by reflux, obesity and smoking; TP53 mutation, chromosomal instability and amplification of HER2, EGFR, MET or KRAS are typical. Barrett's surveillance and endoscopic ablation or resection of dysplasia prevent progression. Locally advanced disease is treated with perioperative FLOT chemotherapy, which the ESOPEC trial showed gives better survival than CROSS chemoradiation, followed by oesophagectomy. Advanced disease is managed with stomach cancer regimens: nivolumab or pembrolizumab with chemotherapy for PD-L1-positive tumours, trastuzumab with chemotherapy for HER2-positive tumours, zolbetuximab for claudin 18.2-positive tumours, and trastuzumab deruxtecan after HER2-directed therapy.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Esophageal adenocarcinoma; EAC; Gastro-oesophageal junction adenocarcinoma; Barrett's cancer
- Tags: subtype-page
- Group: gastrointestinal
- Burden: The dominant oesophageal cancer in Western countries, where its incidence has risen several-fold since the 1970s with reflux and obesity; it affects men six times more than women, and five-year survival is about 20 percent overall.
- Subtypes: Barrett's-associated adenocarcinoma of the lower oesophagus; Gastro-oesophageal junction adenocarcinoma (Siewert types I to III); HER2-positive (about 15 to 20 percent); Claudin 18.2-positive; Mismatch repair-deficient (a minority)
- Biomarkers: HER2 amplification; PD-L1 combined positive score; Claudin 18.2 expression; Mismatch repair and microsatellite instability; Barrett's dysplasia grade on surveillance

## Standard of care

- Barrett's oesophagus: Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer. ([Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/))
- Locally advanced: Perioperative FLOT (docetaxel, oxaliplatin, fluorouracil, leucovorin) and oesophagectomy, preferred over CROSS after ESOPEC; chemoradiation where chemotherapy is not tolerated. ([FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)](https://onco.cc/drugs/flot/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [CROSS](https://onco.cc/trials/cross-trial/))
- Advanced, first line: Nivolumab or pembrolizumab with platinum-fluoropyrimidine chemotherapy for PD-L1-positive tumours; trastuzumab with chemotherapy (and pembrolizumab) for HER2-positive tumours; zolbetuximab with chemotherapy for claudin 18.2-positive tumours. ([Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Zolbetuximab](https://onco.cc/drugs/zolbetuximab/), [HER2](https://onco.cc/targets/her2/), [PD-L1](https://onco.cc/targets/pdl1/), [Claudin 18.2](https://onco.cc/targets/cldn18-2/))
- Later lines: Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil. ([Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/))

## State of the art

- ESOPEC settled a decade-long argument in favour of perioperative chemotherapy over chemoradiation for adenocarcinoma.
- Three biomarkers, HER2, PD-L1 and claudin 18.2, now decide first-line treatment of advanced disease.
- Endoscopic therapy of Barrett's dysplasia prevents cancer and has replaced surgery for early disease.

## Open problems

- Barrett's surveillance finds few of the cancers that occur.
- Rising incidence with obesity.
- Oesophagectomy remains a major operation with lasting effects on eating.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer

## Connected records

- drugs: [Docetaxel](https://onco.cc/drugs/docetaxel/), [FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)](https://onco.cc/drugs/flot/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Zolbetuximab](https://onco.cc/drugs/zolbetuximab/)
- trials: [CROSS](https://onco.cc/trials/cross-trial/)
- technologies: [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/)
- targets: [Claudin 18.2](https://onco.cc/targets/cldn18-2/), [HER2](https://onco.cc/targets/her2/), [PD-L1](https://onco.cc/targets/pdl1/)
- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/)

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