gastroesophageal junction cancer/adenocarcinoma
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Pathology
- 30-40% of cancers potentially resectable upon presentation
- recurrence rates high
- cure rates low
Laboratory
- HER2 copy number
- HER2 amplification in 25% of meatastatic cancers[1]
- favorable response trastuzumab
- HER2 amplification in 25% of meatastatic cancers[1]
Diagnostic procedures
- upper GI endoscopy & biopsy establishes diagnosis[1]
- mass in the gastric cardia
- endoscopic ultrasound to assess tumor depth & involvement of lymph nodes
Radiology
- CT of chest, abdomen & pelvis (1st test with biopsy pending)[5]
- PET scan is option after CT[5]
- PET/CT widely used for preoperative staging[1]
Differential diagnosis
Management
- neoadjuvant chemotherapy + radiation therapy prior to surgery
- adjuvant nivolumab improves disease-free survival[3]
- adding trastuzumab for tumors with HER2 overexpression may provide a modest survival benefit[1]
- elderly: no survival benefit from full-dose vs reduced-dose chemotherapy[4]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2019.
- ↑ van Hagen P, Hulshof MC, van Lanschot JJ et al for the CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22646630 Free Article
- ↑ 3.0 3.1 Kelly RJ, Ajani JA, Kuzdzal J et al Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. N Engl J Med 2021; 384:1191-1203. April 1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33789008 https://www.nejm.org/doi/full/10.1056/NEJMoa2032125
- ↑ 4.0 4.1 Hall PS, Swinson D, Cairns DA et al. Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine on quality of life and cancer control among older and frail patients with advanced gastroesophageal cancer: The GO2 phase 3 randomized clinical trial. JAMA Oncol 2021 Jun 1; 7:869. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33983395 PMCID: PMC8120440 Free PMC article
- ↑ 5.0 5.1 5.2 NEJM Knowledge+ Gastroenterology