- Tumors of the gastroesophageal junction (GEJ) arise at the anatomical boundary between the esophagus and the stomach. This region includes the distal esophagus, the gastric cardia, and the transitional zone known as the Z-line, where squamous epithelium of the esophagus changes into the columnar epithelium of the stomach.
- The GEJ is a unique anatomical and functional region, and tumors here have distinct biological and clinical characteristics.
- The most common tumors of the GEJ are adenocarcinomas, which may develop from intestinal metaplasia, such as Barrett’s esophagus, or from the gastric cardia epithelium.
- Risk factors for GEJ adenocarcinoma include chronic gastroesophageal reflux disease (GERD), obesity, tobacco use, and dietary factors.
- While Helicobacter pylori infection is a known risk factor for non-cardia gastric cancer, its role in GEJ tumors is more complex and may vary by population.
- Squamous cell carcinoma can also occur near the junction but is more typically found in the mid to upper esophagus.
- To aid diagnosis and treatment planning, GEJ tumors are often classified using the Siewert classification, which divides tumors based on their location relative to the GEJ.
- Type I tumors are located 1–5 cm above the GEJ and are usually of esophageal origin, often associated with Barrett’s esophagus.
- Type II tumors arise directly at the GEJ and are termed true junctional or cardia carcinomas.
- Type III tumors originate 2–5 cm below the GEJ in the proximal stomach and may invade the GEJ secondarily.
- This classification is important for determining the most appropriate surgical and therapeutic approach.
- Clinically, GEJ tumors often present with progressive dysphagia, weight loss, epigastric pain, or gastrointestinal bleeding.
- They are frequently diagnosed at an advanced stage, making management challenging. Treatment typically includes a combination of surgery, chemotherapy, and radiotherapy, with newer approaches incorporating targeted therapies (e.g., HER2 inhibitors) and immune checkpoint inhibitors.
- Prognosis depends on tumor type, stage at diagnosis, molecular characteristics, and response to treatment.
