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What’s the Best Way to Treat GE Junction Tumors? Approach Like Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

The debate as to the optimal classification, staging, and treatment of gastroesophageal junction (GEJ) tumors wages on, and one must acknowledge that there is no “one-size-fits-all” approach. However, in this review we are charged with defending the position that all GEJ tumors are best treated like gastric cancer. We submit that, as stated, this is not a defensible position and that a clear definition of terms is warranted. Given the rarity of squamous cell carcinoma and the dramatic rise in incidence of adenocarcinoma of the GEJ in the West, we define GEJ “tumors” to mean adenocarcinomas of the GEJ. Furthermore, on the basis of their location, pathogenesis, and biologic behavior, we submit that few would argue with the contention that Siewert type I GEJ tumors are best treated like distal esophageal cancer and that Siewert type III GEJ tumors are best treated like gastric cancer. The real debate concerns the management of Siewert type II GEJ tumors, which arise immediately at the esophagogastric junction. Thus, for the purposes of this review, we have taken the liberty of redefining the question as what’s the best way to treat adenocarcinomas of the true GEJ (i.e., Siewert type II tumors), and we submit that these tumors are in fact best treated like gastric cancer. This approach ensures that patients receive those therapies needed for the locoregional and systemic control of their disease together with a surgical procedure that optimizes complete tumor and regional lymph node resection while limiting morbidity.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    John T. Mullen MD

  2. Harvard Medical School, Boston, MA, USA

    John T. Mullen MD, Eunice L. Kwak MD, PhD & Theodore S. Hong MD

  3. Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA

    Eunice L. Kwak MD, PhD

  4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Theodore S. Hong MD

Authors
  1. John T. Mullen MD
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  2. Eunice L. Kwak MD, PhD
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  3. Theodore S. Hong MD
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Correspondence to John T. Mullen MD.

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Mullen, J.T., Kwak, E.L. & Hong, T.S. What’s the Best Way to Treat GE Junction Tumors? Approach Like Gastric Cancer. Ann Surg Oncol 23, 3780–3785 (2016). https://doi.org/10.1245/s10434-016-5426-6

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  • DOI: https://doi.org/10.1245/s10434-016-5426-6

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