Gastroesophageal junction carcinoma multimodal treatment: standards, debate and new therapeutic options

Abstract

Author for correspondence: Department of Surgery, Ioannina University School of Medicine, Ioannina, TK 451 10, Greece and Personalized Cancer Networks Medicine, Biobank, Ioannina University, Ioannina, TK 451 10, Greece Tel.: +30 265 100 7423 Fax: +30 265 100 7094 droukos@uoi.gr has occurred in the USA and North-West Europe than in Japan and other Asian countries [1,2]. However, an increase in the incidence rate of cancer that anatomically straddles the distal esophagus and proximal stomach, called cardia or GEJ cancer, has been observed [3]. The reasons for this diverse prevalence of cardia and noncardia cancer are unclear. One of the reasons may be the decreasing incidence of noncardia cancer risk factors, such as Helicobacter pylori infection, that may not have a protective effect on GEJ tumors. Another explanation might be an increase in the frequency of gastroesophageal reflux and Barrett’s esophagus, which is thought to increase the risk of adenocarcinoma in the GEJ. Multiple environmental and genetic factors are involved in esophagogastric tumorigenesis, and the molecular mechanisms underlying disease initiation are still poorly understood.