Oesophageal and junctional adenocarcinoma
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.
Overview
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.
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.
Anatomy and lymph node drainage
Squamous cancers sit in the upper and middle oesophagus, adenocarcinomas at the junction and in the stomach; the stomach wall also gives rise to GIST from its pacemaker cells.
- Upper and middle oesophagus (squamous)
- Lower oesophagus and junction (adenocarcinoma)Barrett's-associated adenocarcinoma of the lower oesophagus · Gastro-oesophageal junction adenocarcinoma (Siewert types I to III)
- Cardia and fundus
- Body (diffuse or intestinal type)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
- Antrum and pylorus
- Muscle wall (GIST)
- perigastric (greater and lesser curve)
- coeliac and hepatic
- mediastinal
- cervical (upper oesophagus)
Same organ: Gastric & gastro-oesophageal junction cancer, Oesophageal squamous cell carcinoma, Oesophageal cancer, Gastrointestinal stromal tumour (GIST)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer.
Perioperative FLOT (docetaxel, oxaliplatin, fluorouracil, leucovorin) and oesophagectomy, preferred over CROSS after ESOPEC; chemoradiation where chemotherapy is not tolerated.
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.
Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil.
Subtypes & biomarkers
top- 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)
How often this target appears
- 1950Norman Barrett describes the columnar-lined oesophagus
- 2010ToGA: trastuzumab for HER2-positive gastro-oesophageal cancer
- 2012CROSS chemoradiation before surgery
- 2019FLOT4: perioperative FLOT beats ECF
- 2024ESOPEC: FLOT better than CROSS in adenocarcinoma
- 2024Zolbetuximab approved for claudin 18.2-positive disease
What is in development for Oesophageal and junctional adenocarcinoma, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Barrett's surveillance finds few of the cancers that occur.
Rising incidence with obesity.
Oesophagectomy remains a major operation with lasting effects on eating.
Trials
topTrials recruiting now
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Landmark trials
Expert centres
topExpert centres
- via Trastuzumab deruxtecan
- Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer CenterBaltimore, USNewsweek oncology #10NCI comprehensivevia Pembrolizumab
- via Trastuzumab deruxtecan
- National Cancer Center Hospital EastKashiwa, Chiba, JPvia Nivolumab, HER2, Claudin 18.2, Trastuzumab deruxtecan
- via Docetaxel, Trastuzumab, HER2
- via Trastuzumab, HER2
- Institut Jules BordetBrussels, BEvia Pembrolizumab, Trastuzumab
- Instituto Alexander FlemingBuenos Aires, ARvia Trastuzumab, HER2
- IRCCS Ospedale San RaffaeleMilan, ITvia Trastuzumab, HER2
- Istituto di Candiolo IRCCS (FPO)Candiolo, ITvia Trastuzumab, HER2
- Kyoto University HospitalKyoto, JPvia Nivolumab, PD-L1
- Peking University Cancer HospitalBeijing, CNvia HER2, Claudin 18.2
- via Trastuzumab, HER2
- via Nivolumab
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Pembrolizumab
- Breast Cancer TrialsNewcastle, NSW, AUvia Trastuzumab
- Breast International Group (BIG)Brussels, BEvia Trastuzumab
- Central Drugs Standard Control OrganizationNew Delhi, INvia Trastuzumab
- via Nivolumab
- German Hodgkin Study GroupCologne, DEvia Nivolumab
- GOG FoundationPhiladelphia, PA, USvia Pembrolizumab
- via Nivolumab
- Istituto Oncologico Veneto IRCCSPadua, ITvia Trastuzumab
- via Nivolumab
- via Pembrolizumab
- via HER2
- National Taiwan University HospitalTaipei, TWvia PD-L1
- NSABP FoundationPittsburgh, PA, USvia Trastuzumab
- via Trastuzumab deruxtecan
- Rosalind and Morris Goodman Cancer Institute, McGill UniversityMontréal, QC, CAvia HER2
- SOLTI Cancer Research GroupBarcelona, ESvia Trastuzumab
- SWOG Cancer Research NetworkPortland, OR, USvia Nivolumab
- Weizmann Institute of ScienceRehovot, ILvia HER2
- via Nivolumab
- via PD-L1
Questions to ask
topQuestions to ask your oncologist about Oesophageal and junctional adenocarcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example HER2 amplification, PD-L1 combined positive score, Claudin 18.2 expression, Mismatch repair and microsatellite instability, Barrett's dysplasia grade on surveillance), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Barrett's-associated adenocarcinoma of the lower oesophagus, Gastro-oesophageal junction adenocarcinoma, HER2-positive.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Barrett's oesophagus
- For my situation (barrett's oesophagus), which of the standard options do you recommend and why?Why: Guideline options include: Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer.
Locally advanced
- For my situation (locally advanced), which of the standard options do you recommend and why?Why: Guideline options include: Perioperative FLOT (docetaxel, oxaliplatin, fluorouracil, leucovorin) and oesophagectomy, preferred over CROSS after ESOPEC; chemoradiation where chemotherapy is not tolerated.
- Am I a candidate for FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Docetaxel, Oxaliplatin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CROSS apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Advanced, first line
- For my situation (advanced, first line), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Nivolumab, Pembrolizumab, Trastuzumab or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Later lines
- For my situation (later lines), which of the standard options do you recommend and why?Why: Guideline options include: Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil.
- Am I a candidate for Trastuzumab deruxtecan, Ramucirumab, Paclitaxel / nab-paclitaxel, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Barrett's surveillance finds few of the cancers that occur”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Rising incidence with obesity”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
9targets
5drugs
11companies
9trials
1Latest papers
topQuery for this cancer: (TITLE:"Oesophageal and junctional adenocarcinoma" OR ABSTRACT:"Oesophageal and junctional adenocarcinoma" OR TITLE:"Esophageal adenocarcinoma" OR ABSTRACT:"Esophageal adenocarcinoma" OR TITLE:"EAC" OR ABSTRACT:"EAC" OR TITLE:"Gastro-oesophageal junction adenocarcinoma" OR ABSTRACT:"Gastro-oesophageal junction adenocarcinoma" OR TITLE:"Barrett's cancer" OR ABSTRACT:"Barrett's cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oesophageal and junctional adenocarcinoma, not a curated reading list.
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