Progress In The Diagnosis And Therapy Of Esophagogastric Junction Adenocarcinoma

The past few years have witnessed two facts in gastric cancer research: the morbidity of distal gastric cancer has shown a significant downward trend worldwide;and the incidence of the adenocarcinoma of esophagogastric junction(AEG) has gradually increased. AEG is a unique clinical pathology, which is different from the true sense of the esophageal carcinoma and stomach carcinoma. AEG caused widespread concern in the medical profession. At present, the classification of AEG are mainly Siewert, WHO, Liverpool. So far,the Siewert classification which is based on anatomy is gradually being accepted by clinicians.The primary pathogenesis of AEG is Barrett’s esophagus pathway and gastric pathway.The early clinical symptoms of AEG are not significant, and the detection rate is very low. The research for diagnostic technology of AEG mainly focused on tumor type and stage of symptomatic patients. The accurate staging have a great impact for patient on choosing the best method of treatment. With the rapid development of medical imageology and endoscopic techniques, the diagnostic methods of AEG get an important progress. The endoscopy is first choice to exclude upper gastrointestinal tumors, which can directly observe the location and extent of the lesion and get biopsy of it. EUS, the most valuable way of preoperative staging on clinical, has dual function, including endoscopy and ultrasound. CT is still the first choice of exclude near and distant organ metastasis, which can provide anatomical evidence on tumors staging. PET has a higher detecting rate of tumor metabolism than CT and EUS.Currently, there is no standard criterion of AEG treatment worldwide. Surgery is the main treatment for AEG. Complete excision of foci and thoroughly clean the corresponding draining lymph nodes is currently the most effective treatment methods and the best prognostic criteria. Minimally invasive surgery can be used for early cancer or limited surgery. Surgery alone is not optimistic with poor prognosis.Showing the necessity of Comprehensive treatment. Perioperative chemotherapy can improve the prognosis of patients to some extent. In comparison with surgery alone and chemotherapy before surgery, neoadjuvant chemotherapy prolongs the overall survival of patient significantly by inhibiting and destructing tumor, and improves the prognosis of patients. Neoadjuvant chemoradiation therapy benefits the patients on survival, which is the future trend of the standard treatment regimen. Currently, the findings of the AEG is still controversial, and further study remain to focus on treatment. This paper summarize the progress of research on the diagnosis and treatment of AEG.