Oesophageal and junctional adenocarcinoma
Prepared with OnCo (onco.cc/prep/oesophageal-adenocarcinoma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
17 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.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?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (barrett's oesophagus), which of the standard options do you recommend and why?
- 6.For my situation (locally advanced), which of the standard options do you recommend and why?
- 7.Am I a candidate for FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Docetaxel, Oxaliplatin or related drugs, and what side effects should I expect?
- 8.How do the results of CROSS apply to someone like me?
- 9.For my situation (advanced, first line), which of the standard options do you recommend and why?
- 10.Am I a candidate for Nivolumab, Pembrolizumab, Trastuzumab or related drugs, and what side effects should I expect?
- 11.For my situation (later lines), which of the standard options do you recommend and why?
- 12.Am I a candidate for Trastuzumab deruxtecan, Ramucirumab, Paclitaxel / nab-paclitaxel, and what side effects should I expect?
- 13.Are there clinical trials I could join, for example of Zolbetuximab, Trastuzumab deruxtecan?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “Barrett's surveillance finds few of the cancers that occur”. How does that affect my plan?
- 17.I read that “Rising incidence with obesity”. How does that affect my plan?
Tests and results to bring
Biomarker results to ask for: HER2 amplification, PD-L1 combined positive score, Claudin 18.2 expression, Mismatch repair and microsatellite instability, Barrett's dysplasia grade on surveillance.
Scans and tests linked to this cancer: Companion diagnostics, DPYD genotyping and DPD phenotyping before fluoropyrimidines, Endoscopic resection (EMR / ESD), CT body composition and sarcopenia measurement.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- 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), Docetaxel, Oxaliplatin, Fluorouracil (5-FU), CROSS)
- Barrett's oesophagus: Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer. (Endoscopic resection (EMR / ESD))
- 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, Pembrolizumab, Trastuzumab, Zolbetuximab, HER2, PD-L1, Claudin 18.2)
- Later lines: Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil. (Trastuzumab deruxtecan, Ramucirumab, Paclitaxel / nab-paclitaxel)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.