# Oesophageal and junctional adenocarcinoma

Source: https://onco.cc/cancers/oesophageal-adenocarcinoma/  
OnCo record `oesophageal-adenocarcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adenocarcinoma of the lower oesophagus and junction grows out of Barrett's oesophagus, the change in the lining caused by long-standing acid reflux. Chemotherapy or chemoradiation before surgery is standard, and HER2, PD-L1 and claudin 18.2 now guide drugs for advanced disease as they do in stomach cancer.

## Summary

Oesophageal adenocarcinoma arises in the lower oesophagus and gastro-oesophageal junction from Barrett's oesophagus, driven by reflux, obesity and smoking; TP53 mutation, chromosomal instability and amplification of HER2, EGFR, MET or KRAS are typical. Barrett's surveillance and endoscopic ablation or resection of dysplasia prevent progression. Locally advanced disease is treated with perioperative FLOT chemotherapy, which the ESOPEC trial showed gives better survival than CROSS chemoradiation, followed by oesophagectomy. Advanced disease is managed with stomach cancer regimens: nivolumab or pembrolizumab with chemotherapy for PD-L1-positive tumours, trastuzumab with chemotherapy for HER2-positive tumours, zolbetuximab for claudin 18.2-positive tumours, and trastuzumab deruxtecan after HER2-directed therapy.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Esophageal adenocarcinoma; EAC; Gastro-oesophageal junction adenocarcinoma; Barrett's cancer
- Tags: subtype-page
- Group: gastrointestinal
- Burden: The dominant oesophageal cancer in Western countries, where its incidence has risen several-fold since the 1970s with reflux and obesity; it affects men six times more than women, and five-year survival is about 20 percent overall.
- Subtypes: Barrett's-associated adenocarcinoma of the lower oesophagus; Gastro-oesophageal junction adenocarcinoma (Siewert types I to III); HER2-positive (about 15 to 20 percent); Claudin 18.2-positive; Mismatch repair-deficient (a minority)
- Biomarkers: HER2 amplification; PD-L1 combined positive score; Claudin 18.2 expression; Mismatch repair and microsatellite instability; Barrett's dysplasia grade on surveillance

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/oesophageal-adenocarcinoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/oesophageal-adenocarcinoma/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/oesophageal-adenocarcinoma/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/oesophageal-adenocarcinoma/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/oesophageal-adenocarcinoma/#treating-it [4 settings, 3 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/oesophageal-adenocarcinoma/#evidence [16 trials, 4 key papers, 6 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/oesophageal-adenocarcinoma/#science [24 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/oesophageal-adenocarcinoma/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/oesophageal-adenocarcinoma/#living-with-it [17 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/oesophageal-adenocarcinoma/coming/ [11 medicines, 16 trials, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/oesophageal-adenocarcinoma/data/ [82 connected records]

## Standard of care

- Barrett's oesophagus: Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer. ([Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/))
- 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)](https://onco.cc/drugs/flot/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [CROSS](https://onco.cc/trials/cross/))
- 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](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Zolbetuximab](https://onco.cc/drugs/zolbetuximab/), [HER2](https://onco.cc/targets/her2/), [PD-L1](https://onco.cc/targets/pdl1/), [Claudin 18.2](https://onco.cc/targets/cldn18-2/))
- Later lines: Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil. ([Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/))

## State of the art

- ESOPEC settled a decade-long argument in favour of perioperative chemotherapy over chemoradiation for adenocarcinoma.
- Three biomarkers, HER2, PD-L1 and claudin 18.2, now decide first-line treatment of advanced disease.
- Endoscopic therapy of Barrett's dysplasia prevents cancer and has replaced surgery for early disease.

## Open problems

- Barrett's surveillance finds few of the cancers that occur.
- Rising incidence with obesity.
- Oesophagectomy remains a major operation with lasting effects on eating.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer

## Connected records

- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Oesophageal squamous cell carcinoma](https://onco.cc/cancers/oesophageal-squamous-cell-carcinoma/)
- trials: [A Dose Optimization/Expansion Study of SAR445877 in Adult Chinese Participants With Advanced Gastric or Gastroesophageal Junction Cancer](https://onco.cc/trials/nct07692204/), [A Study of Novel Agents or Combinations as Perioperative Treatment in Participants With Locally Advanced Resectable Gastroesophageal Adenocarcinoma](https://onco.cc/trials/nct07069712/), [A Study to Evaluate Sacituzumab Tirumotecan (MK-2870) in Advanced/Metastatic Gastroesophageal Adenocarcinoma (MK-2870-015)](https://onco.cc/trials/nct06356311/), [ASKB589 in Combination With CAPOX and PD-1 Inhibitors in Patients With Advanced, and Unresectable G/GEJ Cancer.](https://onco.cc/trials/nct05632939/), [CheckMate 577](https://onco.cc/trials/checkmate-577/), [Clinical Study of Time Optimizing of Endoscopic Photodynamic Therapy on Esophageal and/or Gastric Cardiac Cancer](https://onco.cc/trials/nct02628665/), [CROSS](https://onco.cc/trials/cross/), [ESOPEC](https://onco.cc/trials/esopec/), [FLOT4-AIO](https://onco.cc/trials/flot4/), [KEYNOTE-590](https://onco.cc/trials/keynote-590/), [Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy](https://onco.cc/trials/nct03223662/), [Phase 1/2 Study of BHB810 in Advanced Gastric and GEJ Adenocarcinoma](https://onco.cc/trials/nct07529808/), [Sonesitatug Vedotin in Combination With Capecitabine With or Without Rilvegostomig in Participants With Advanced or Metastatic Gastric, Gastroesophageal Junction, or Esophageal Adenocarcinoma Expressing Claudin18.2](https://onco.cc/trials/nct07431281/), [Substudy 06C: A Study of Investigational Agents With Pembrolizumab (MK-3475) and Chemotherapy in Participants With First-Line Locally Advanced Unresectable/Metastatic Gastroesophageal Adenocarcinoma (MK-3475-06C/KEYMAKER-U06)](https://onco.cc/trials/nct06469944/), [Substudy 06D: Combination Therapies in Second Line (2L) Gastroesophageal Adenocarcinoma (MK-3475-06D/Keymaker-U06)](https://onco.cc/trials/nct06445972/), [Symbiotic-GI-16: A Study to Learn About the Study Medicine Called PF-08634404 in Combination With Chemotherapy in Gastroesophageal Cancer](https://onco.cc/trials/symbiotic-gi-16/)
- key papers: [CheckMate 649: nivolumab plus chemotherapy as first treatment for advanced gastric, gastro-oesophageal junction and oesophageal adenocarcinoma](https://onco.cc/key-papers/paper-checkmate-649-lancet-2021/), [CROSS: preoperative chemoradiotherapy for oesophageal or junctional cancer](https://onco.cc/key-papers/paper-cross-nejm-2012/), [FLOT4-AIO: perioperative FLOT versus ECF/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma](https://onco.cc/key-papers/paper-flot4-lancet-2019/), [KEYNOTE-590: pembrolizumab plus chemotherapy for first-line treatment of advanced oesophageal cancer](https://onco.cc/key-papers/paper-keynote-590-lancet-2021/)
- drugs: [Docetaxel](https://onco.cc/drugs/docetaxel/), [FLOT (5-FU, leucovorin, oxaliplatin, docetaxel)](https://onco.cc/drugs/flot/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Ramucirumab](https://onco.cc/drugs/ramucirumab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Zolbetuximab](https://onco.cc/drugs/zolbetuximab/)
- technologies: [CT body composition and sarcopenia measurement](https://onco.cc/technologies/ct-body-composition-sarcopenia/), [DPYD genotyping and DPD phenotyping before fluoropyrimidines](https://onco.cc/technologies/dpyd-genotyping/), [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/)
- targets: [AXIN1](https://onco.cc/targets/axin1/), [CANT1](https://onco.cc/targets/cant1/), [CDH11](https://onco.cc/targets/cdh11/), [CDX2](https://onco.cc/targets/cdx2/), [Claudin 18.2](https://onco.cc/targets/cldn18-2/), [CTNND2](https://onco.cc/targets/ctnnd2/), [DCC](https://onco.cc/targets/dcc/), [EPHA3](https://onco.cc/targets/epha3/), [GRM3](https://onco.cc/targets/grm3/), [H3C2](https://onco.cc/targets/h3c2/), [HER2](https://onco.cc/targets/her2/), [HLA-B](https://onco.cc/targets/hla-b/), [KAT6A](https://onco.cc/targets/kat6a/), [MSN](https://onco.cc/targets/msn/), [NBEA](https://onco.cc/targets/nbea/), [NCOA2](https://onco.cc/targets/ncoa2/), [NUMA1](https://onco.cc/targets/numa1/), [NUTM1](https://onco.cc/targets/nutm1/), [PD-L1](https://onco.cc/targets/pdl1/), [TGFBR1](https://onco.cc/targets/tgfbr1/), [ZNF208](https://onco.cc/targets/znf208/), [ZNF750](https://onco.cc/targets/znf750/)
- people: [Jens Höppner](https://onco.cc/people/jens-hoeppner/), [Jong-Mu Sun](https://onco.cc/people/jong-mu-sun/), [Salah-Eddin Al-Batran](https://onco.cc/people/salah-eddin-al-batran/)
- companies: [AIO (Arbeitsgemeinschaft Internistische Onkologie)](https://onco.cc/companies/aio/)

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JSON: https://onco.cc/api/v1/entities/oesophageal-adenocarcinoma.json