GASTROESOPHAGEAL

JUNCTION
ADENOCARCINOMA
Sarah Mae Marcos
Edel Shariff Martinez
Rodel Maglelong Manabat
What is Gastroesophageal Junction
Adenocarcinoma?

 It is a cancer that begins in cells located near

the GE junction, the area where the
esophagus connects to the stomach.
 GE junction adenocarcinomas are staged
and treated like cancers of the esophagus.
 Increasing age. Over 85% of cases occur in
people over 55.
Gastroesophageal Junction

The esophagus is the tube

that allows the food to
travel from the mouth to the
stomach. The lower part of
the esophagus that connects
to the stomach is called the
gastroesophageal junction.
The GE junction lies just
below the diaphragm
beneath the lungs.
Etiology & Risk Factors:

 Unknown, but certain factors can increase the risk of

developing them.
 Acute irritation
 Achalasia, a disorder of movement of the esophagus.
▪ GERD and Barrett’s esophagus, a change in the lining
of the esophagus that occurs after a long-term reflux
of stomach acid into the lower esophagus.
▪ Smoking tobacco and alcohol use also increase at risk.
Signs and Symptoms:

 Dysphagia
 Odynophagia or heartburn-like chest pain or burning.
 Unintentional weight loss
 Cough or hiccups
 Nausea & vomiting
 Increased production of saliva: The body compensates for difficulty swallowing by
producing more saliva. This can lead to coughing up mucus or excessive saliva.
 Black stool from bleeding in the area of cancer.
 Bone pain if the cancer has spread to the bones.
Diagnostics:

Upper endoscopy
Is a procedure that uses a
flexible light tube to
examine the inside of the
esophagus and GE
junction. With this
instrument , samples of
any suspicious and
abnormal areas can be
taken for analysis.
Endoscopic ultrasound

Endoscopic ultrasound
Often performed with an
endoscopy. This uses an
ultrasound probe that
allows the doctor to
determine the size and
the extent to which it has
spread.
Barium swallow

Barium X-ray
The client drink a
special liquid that
coats the throat,
stomach, and part of
the small intestine to
make them stand out
on an X-ray image.
CT scan, PET scan, and MRI

CT scan – makes detailed

pictures of your esophagus
and stomach.
PET scan – they inject a
radioactive sugar into the
bloodstream to make
cancer cells show up more
clearly on the picture.
MRI – helps to distinguish
normal or cancerous tissue
masses in the image.
Treatment:

 GE junction is divided into three types based on its location:

1. Type I – 1 to 5 cm above the GE junction.
2. Type II – between 1 cm above and 2 cm below the GE junction.
3. Type III – 2 to 5 cm below the GE junction.
 Treatment for gastroesophageal junction adenocarcinoma is
dependent upon the tumor stage and can involve a combination of
different methods.
 Treatment is the trimodality approach: chemotherapy, radiation,
and surgical resection.
Treatment:

1. Surgery (esophagectomy) – is the main treatment for cancer that

hasn’t spread. The surgeon will remove:
 The part of your esophagus that has the tumor.
 Possibly part of your stomach.
 A small piece of your healthy esophagus.
 Lymph nodes close to the tumor.

 Your surgeon will then reconnect the remaining part of your

esophagus to your stomach.
Treatment:

2. Chemotherapy – uses medicine to kill cancer cells. You take them

by mouth or as an injection into the vein. Sometimes, doctors will
suggest that you get radiation along with chemotherapy to shrink the
tumor before surgery. You can also get chemo after surgery to kill any
cancer cells that are left behind.
3. Radiation therapy – uses high-energy X-rays to kill cancer cells or
stop their growth.
4. Immunotherapy – is a type of cancer treatment that boosts the
body’s natural defences to fight cancer. It uses substance made by the
body or in laboratory to improve or restore immune system function.
Nursing responsibilities:

Preoperative Period – begins with the decision to perform surgery and ends
with client’s transfer to the OR table.
 Identify any obvious risk factors for surgery-related complications
 Assess respiratory status
 Assess cardiovascular status
 Assess for and report evidence of fluid and electrolyte imbalance
 Assess hepatic and renal function
 Assess immunologic and hematologic function
 Evaluate medical history
Nursing responsibilities:

 Assess the client and the family’s knowledge base.

 Consider psychosocial factors that could affect the clients response to
surgery.
 Promote measures that help decrease anxiety for the client and his family.
 Discuss the surgical experience with the client and his family to minimize
anxiety and increase knowledge.
 Provide client and family teaching.
 Perform preoperative skin preparation as appropriate.
 Provide GI preparation as prescribed.
Nursing responsibilities:

Intraoperative Period - begins when the client is received in the OR

and ends with his admission to the PACU.
 Assess the client’s record for appropriate documentation.
 Ask client for any known allergies.
 Assess for special surgical considerations and precautions.
 Assess the client’s risk for hypothermia or malignant hyperthermia
during anesthesia administration and surgery.
 Promote measures that maintain adequate fluid and electrolyte
balance.
Nursing responsibilities:

 Promote measures that decrease the risk of infection.

 Ensure the client’s safety in the operating room.
Immediate Postoperative Period – begins when the client is admitted
to the PACU and extends through follow-up home or clinic evaluation.
 Position the client before assessment to ensure an adequate airway.
 Prioritize the assessment accordingly.
 Assess the client and document the client’s condition on the recovery
room scoring guide.
 Promote measures that address potential complications.
Nursing responsibilities:

 Maintain airway patency and optimal respiratory function.

 Provide pain relief.
 Promote measures that prevent immobility.
 Offer emotional support and allow the client to verbalize feelings of
anxiety.