Gastric and Gastroesophageal Junction Cancers in Focus: Understanding Potential Symptoms, Risks, and Treatment Options

Gastric cancer and gastroesophageal junction cancer (GC/GEJC) are two aggressive, closely related diseases that are challenging to treat.1,2

Despite being the fifth most common cancer worldwide, gastric cancer—also known as stomach cancer—is relatively rare in the US. With nearly 30,000 new diagnoses made each year, gastric cancer accounts for a little more than 1% of all US cancer cases diagnosed annually.2,3,4 GEJC, which is commonly called esophageal cancer, also makes up about 1% of all cancer diagnoses in the US, with nearly 22,000 new cases each year.4,5

Being less common does not make gastric cancer or GEJC less serious. Because it is rare, the symptoms of gastric cancer and GEJC may often go undetected until the diseases are in advanced stages and therefore, may be harder to treat.6,7

Factors Contributing to Gastric Cancer and Gastroesophageal Junction Cancer

Gastric cancer forms in the stomach, while GEJC starts in the area where the esophagus meets the stomach. While the cause of these diseases is not well understood, it is believed that genetics, environment, and lifestyle may all be contributing factors, including8,9:

  • Diet, such as high consumption of meat, very hot liquids, or salty/smoked foods
  • Smoking and/or tobacco products
  • Alcohol use
  • Low physical activity
  • Certain demographics, such as men and individuals over 55
  • Other conditions or infections, such as history with gastroesophageal reflux disease (GERD) or Barrett’s esophagus in GEJC, or Helicobacter pylori (H. pylori) in gastric cancer

Early Detection is Critical, but Symptoms are Vague

Symptoms in the early stages of gastric cancer and GEJC are rarely noticed until they’ve grown or have spread outside the stomach when the cancer is more advanced.6,7 Some of these common shared symptoms may include6,7:  

  • Weight loss
  • Vomiting
  • Blood in the stool, which over time can lead to anemia (low red blood cell levels) and fatigue
  • Digestion issues such as chest pain or trouble swallowing for GEJC, and heartburn, vague abdominal discomfort or indigestion for gastric cancer

Unfortunately, both gastric cancer and GEJC are often diagnosed in the advanced stages when they are more challenging to treat. Even when diagnosed earlier when the cancer may be treatable with surgery, approximately one in four patients with gastric cancer/GEJC still experience their disease returning within one year, and one in four patients do not survive beyond two years.10,11,12 Additionally, the five-year survival rate remains poor, with less than half of patients alive at five years.12,13

One of the reasons for the delay in diagnosis is because of the subtle and nonspecific nature of early symptoms. In fact, it is easy for some patients to mistake symptoms early on for less serious conditions, or ignore symptoms altogether.6,7 This was true for Hans, who while competing as a professional chef on a reality TV show, dismissed his symptoms as stress-related before his diagnosis with gastric cancer.

“I was in a very high stress environment (as a professional chef), so the symptoms I initially had seemed to be classic stress symptoms, like acid reflux, difficulty swallowing, and heartburn. All those symptoms were easily pushed aside during my first few doctor visits,” Hans recalled. “It wasn’t until I received an endoscopy, where a mass was located right at the gastrointestinal junction, where the stomach meets the esophagus. A biopsy of the mass confirmed it was gastric cancer.”

While routine screening for gastric cancer is not recommended in the US for people at average risk, for those with certain risk factors, including genetic predispositions or pre-cancerous conditions, targeted screening tools such as upper endoscopy and biomarker testing may be recommended.6 Hans’ story highlights the value of seeking care when symptoms appear early on, and continuing the conversation with a doctor to help receive a diagnosis for serious conditions that may otherwise go undetected. Diagnosis for gastric cancer and GEJC often begins with symptom evaluation, followed by imaging tests like computed tomography (CT) scans or upper gastrointestinal (GI) series, and confirmatory biopsies during endoscopy. These methods also aid in staging the disease and determining treatment approaches.14

For GEJC, exams, tests, and a biopsy (a sample of esophageal cells) are needed to confirm the diagnosis. If cancer is found, further tests are conducted to help determine the disease stage.14

Treatment Options for Gastric Cancer and GEJC

Treatment for gastric cancer and GEJC varies depending on the disease stage and person’s overall health.6,7

For patients whose cancer is caught early and is localized, the primary treatment is surgery and chemotherapy. Yet, even after surgery and chemotherapy, a majority (84%) of patients with Stage 2 and Stage 3 disease see their cancer return within two years, highlighting the unmet need.15

Patients with advanced gastric/GEJ cancers who are not candidates for surgery have different options that include the standard-of-care fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy regimen, given before and after surgery, and radiation therapy. For instance, patients with certain biomarkers, such as locally advanced or metastatic human epidermal growth factor receptor 2 (HER2)-positive gastric or gastroesophageal (GEJ) cancer, may not be candidates for FLOT and may require targeted therapy and precision chemotherapy such as a HER2-directed antibody drug conjugate (ADC).

Research Aims to Close the Gap

Researchers are looking into how they can improve upon current standards for these aggressive cancers so that people with the disease have a chance to live longer.

Every decision we make—from clinical trial design to treatment dosing—centers on how we can improve outcomes without compromising patients’ overall experience. We have a great responsibility to patients like Hans to make sure that no patient is left behind, by taking on the most aggressive cancers.

Don’t Ignore It, Talk to Your Doctor

If you think you may be experiencing symptoms or are at an increased risk for gastric cancer or GEJC speak with your healthcare provider about your concerns.

References:

  1. Yang WJ, Zhao HP, Yu Y, et al. Updates on global epidemiology, risk and prognostic factors of gastric cancer. World J Gastroenterol. 2023;29(16):2452-2468.
  2. American Cancer Society. About stomach cancer. Accessed February 24, 2025. Available at:  https://www.cancer.org/cancer/types/stomach-cancer/about.html
  3. World Cancer Research Fund. Stomach cancer statistics. Accessed February 24, 2025. Available at: https://www.wcrf.org/preventing-cancer/cancer-statistics/stomach-cancer-statistics/
  4. American Cancer Society. Cancer facts & figures 2025. Accessed February 10, 2025. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2025/2025-cancer-facts-and-figures-acs.pdf
  5. American Cancer Society. About esophagus cancer. Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/about.html
  6. American Cancer Society. Stomach cancer early detection, diagnosis, and staging. Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/stomach-cancer/detection-diagnosis-staging.html
  7. American Cancer Society. Esophagus cancer early detection, diagnosis, and staging. Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/detection-diagnosis-staging/signs-and-symptoms.html
  8. American Cancer Society. Stomach cancer risk factors. Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/stomach-cancer/causes-risks-prevention/risk-factors.html
  9. American Cancer Society. Esophageal cancer risk factors. Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/causes-risks-prevention/risk-factors.html
  10. Li Y, Zhao H. Postoperative recurrence of gastric cancer depends on whether the chemotherapy cycle was more than 9 cycles: Based on a retrospective and observational study of follow-up within 3 years of 843 patients. Medicine (Baltimore). 2022;101(5):e28620.
  11. Ilic M, Ilic I. Epidemiology of stomach cancer. World J Gastroenterol. 2022;28(12):1187-1203.
  12. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948-1957.
  13. Liu D, Lu M, Li J, et al. The patterns and timing of recurrence after curative resection for gastric cancer in China. World J Surg Oncol. 2016;14(1):305.
  14. National Cancer Institute. What is cancer of the esophagus? Accessed February 24, 2025. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/about/what-is-cancer-of-the-esophagus.html
  15. Nakauchi M, Vos E, Tang LH, et al. Outcomes of neoadjuvant chemotherapy for clinical stages 2 and 3 gastric cancer patients: analysis of timing and site of recurrence. Ann Surg Oncol. 2021;28(9):4829-4838.