They're cancers that form in the cells lining your stomach or your esophagus, the tube that carries food from your mouth to your stomach. They can behave differently depending on where they start. But they’re often grouped together in medical research because they have similar risk factors, diagnosis techniques, symptoms, and treatment approaches.
Adenocarcinoma is the most common type of esophageal cancer in the U.S., making up over half of all esophageal cancers. Almost all stomach cancers are adenocarcinomas.
Types of Gastric and Esophageal Adenocarcinomas
Doctors classify gastric and esophageal adenocarcinomas based on where they start:
- Esophageal adenocarcinoma starts in mucus-producing cells (glandular cells) of your lower esophagus.
- Gastric and esophageal junction (GEJ) adenocarcinomas start in glandular cells where your esophagus meets your stomach.
- Gastric adenocarcinoma starts in the glandular cells of the innermost lining of your stomach.
Your adenocarcinoma type determines which treatment is best. Depending on location, your doctor may treat it more like esophageal cancer or stomach cancer.
Your doctor may also describe your tumor by how it looks under a microscope:
- Intestinal-type tumors tend to grow in a more organized pattern.
- Diffuse-type tumors spread more irregularly and can be harder to treat.
If you have gastric adenocarcinoma, your doctor may describe it by its location in your stomach:
- Proximal (cardia) cancers start in the cardia, just below the GEJ, which is the exact spot where your esophagus meets your stomach.
- Distal (non-cardia) cancers start in other parts of your stomach.
Causes and Risk Factors
Gastric and esophageal adenocarcinomas usually happen after years of damage or irritation to the lining of your esophagus or stomach. One of the biggest risks is gastroesophageal reflux disease (GERD), a chronic condition where stomach acid frequently flows back into your esophagus, causing persistent heartburn, discomfort, and potential tissue damage.
“Longstanding heartburn can cause damage to the lining of the esophagus and lead to a condition called Barrett’s esophagus,” says Veena Shankaran, MD, co-director of the Hutchinson Institute for Cancer Outcomes Research (HICOR) at Fred Hutch Cancer Center.
Over time, Barrett’s esophagus can increase your risk of getting cancer. The lining of the esophagus doesn’t typically have glandular cells, but with Barrett’s esophagus, glandular cells grow there. If you have Barrett’s esophagus, you’ll need regular endoscopies to look for changes.
Other risk factors include:
- Smoking
- Eating a high-fat diet
- Being male
- Older age
- Obesity
- Helicobacter pylori (H. pylori) infection
These factors don’t guarantee you’ll get gastric or esophageal adenocarcinomas, but they increase your risk.
Symptoms
It’s common for gastric and esophageal adenocarcinomas to have no symptoms early on. This makes early diagnosis and treatment difficult.
As tumors grow, symptoms appear and worsen. Your specific symptoms depend partly on where your cancer started. The most common symptom for esophageal adenocarcinoma is difficulty swallowing. You may notice it first with liquids and later with solid foods.
“(These cancers) are often asymptomatic until they start to reach deeper into the muscle layers and start blocking the opening of the esophagus,” says Shankaran.
You may also have:
- A sensation that food is getting stuck in your throat or chest
- Weight loss you can’t explain
- Persistent heartburn or worsening reflux
- Chest discomfort
- Feeling full quickly when eating
- Loss of appetite
- Nausea or vomiting
- Fatigue
- Indigestion that doesn’t improve
Some symptoms specific to gastric adenocarcinoma are:
- Abdominal pain
- Bloating after meals
- Black stools caused by bleeding in the stomach
These signs can overlap with symptoms of common digestive issues. It’s important to talk to your doctor if you have any of these that don’t go away.
Diagnosing Gastric and Esophageal Adenocarcinomas
The diagnosis process usually starts when you notice symptoms and report them to your doctor. If you see a primary care doctor, they’ll likely refer you to a gastroenterologist, who’ll take a closer look at your esophagus with special instruments.
“A gastroenterologist is the appropriate specialist to diagnose the cancer through endoscopy for direct visualization and biopsy,” says Shankaran.
An upper endoscopy is an important test used to diagnose gastric and esophageal adenocarcinomas. During this procedure, your doctor guides a thin, flexible tube with a camera (an endoscope) through your mouth and into your esophagus and stomach. This allows them to look for abnormal areas and collect tissue samples.
A biopsy is the only way to know for sure if there’s cancer. The tissue sample is examined under a microscope to determine the type of cancer and other characteristics that may help guide treatment.
If your doctor thinks there’s cancer, you may have more tests such as:
- Upper GI series, also called a barium X-ray. During this test, you drink liquid that helps your throat, stomach, and part of your small intestine stand out on an X-ray image.
- Computed tomography (CT) scan. This test uses a strong X-ray to make detailed pictures of your esophagus and stomach.
- Positron emission tomography (PET) scan. This test involves the injection of a safe radioactive tracer that goes into your body to help detect diseased cells.
These tests help to detect and stage your cancer so your doctor can recommend the best treatment.
The stages include:
Stage 0. Cancer is on the innermost lining of your esophagus or stomach wall only.
Stage I. Cancer cells have spread into other parts of your esophagus or stomach wall as far as the thick muscle, but not into your lymph nodes.
Stage II. Cancer cells have spread as far as your connective tissue and may also be abnormal looking, grow fast, or be in one or two lymph nodes near your tumor.
Stage III. Cancer cells have spread as far as your diaphragm, azygos vein, pleura, sac around the heart, or peritoneum with cancer cells also in lymph nodes near your tumor.
Stage IV. Cancer cells have spread into nearby structures, such as your aorta, airway, spine, liver, or lungs and are in your lymph nodes near the tumor.
Each stage has a letter grade of A, B, or C, depending on how close it is to the next stage.
Your doctor may order biomarker testing, which looks for features such as:
- HER2 overexpression
- PD-L1 expression
- Microsatellite instability (MSI-H)
- Other molecular changes that may help identify targeted therapies or immunotherapies
Treatment Options
Your treatment plan depends on several factors, including where your cancer started, how advanced it is, whether it has spread, and your overall health.
“If the cancer is caught early enough, the goal of therapy is still to try and cure or eradicate the cancer,” says Shankaran. “Once the cancer has spread, treatment is no longer curative.”
For advanced cancers, treatment often aims to control tumor growth, reduce symptoms, and help you maintain the best possible quality of life.
For early stages, your doctor may recommend:
Surgery. This is the most common treatment for gastric and esophageal adenocarcinomas. If you have a very early stage, your doctor may be able to do a procedure called endoscopic resection. They make a small incision and use an endoscope with a small tool attached to remove tissue.
If you have a more advanced tumor, you may need a larger surgery. Most often for esophageal cancers, a surgeon will remove a part of your esophagus and then connect what’s left to your stomach in an operation called an esophagectomy. You may also need a metal tube called a stent inside your esophagus if your tumor is making it too narrow.
For stomach cancers, a surgeon may remove part of your stomach (partial gastrectomy) or your entire stomach (total gastrectomy), depending on your tumor's location and size.
Radiation therapy. This uses high-energy rays to kill cancer cells or stop them from growing. You may get it through a beam outside your body pointed at the area where the tumor is, or you may have a seed, needle, or wire that gives off radiation put inside your body near the tumor.
Chemotherapy. This treatment uses drugs to kill cancer cells or stop them from growing and spreading. These drugs travel through your bloodstream to treat cancer throughout your body, or your doctor can give them to you in a more targeted way for a specific area depending on your cancer and how advanced it is.
Immunotherapy. This type of treatment helps your immune system find and fight cancer cells. Some cancers can “hide” from your immune system, but these drugs block that hiding process so your immune cells can attack the cancer. Examples include the PD-L1 inhibitor durvalumab (Imfinzi) or the CTLA-4 inhibitor ipilimumab (Yervoy).
You might need this kind of treatment if you can’t have surgery or if your cancer cells have specific features. Your doctor may combine it with chemotherapy.
Targeted therapy. Special drugs are used to attack specific features of cancer cells. Some adenocarcinomas have a protein called HER2 that helps them grow, and certain targeted drugs can block it to slow the cancer.
These include trastuzumab (Herceptin), fam-trastuzumab deruxtecan (Enhertu), and zanidatamab-hrii (Ziihera).
Other drugs like ramucirumab (Cyramza) target proteins like VEGF, which tumors use to make new blood vessels, helping stop your cancer from growing.
Complications
Gastric and esophageal adenocarcinomas can lead to complications, especially as they enter later stages. As your tumor grows, it may narrow or block your esophagus, making it harder to eat and get the nutrition you need.
“These cancers can cause trouble swallowing and weight loss,” says Shankaran.
Other possible complications include:
- Bleeding from the tumor
- Malnutrition
- Pain or discomfort
Your care team will monitor you for any issues and help you manage them as part of your overall care.
How Your Condition Might Change Over Time
If you get an early diagnosis, it may be possible to cure your cancer. But if it spreads, it becomes chronic, and you and your doctor will manage it over time.
“The mainstay of treatment [for later stages] is chemotherapy and/or immunotherapy and the goal is to delay the growth of cancer and help extend life,” says Shankaran.
Even in advanced cases, the right treatment can help control your symptoms and improve your quality of life. Your treatment may change over time, too. You may respond well to therapy for extended periods or need frequent changes in your treatment plan.
Finding Expert Care
It’s common to start your journey with these cancers with your primary care doctor and gastroenterologist. But you’ll also see:
- Oncologists
- Surgeons
- Oncology nurses
- Social workers
- Pharmacists
When you’re looking for care, it helps to choose a center with experience treating gastrointestinal cancers, if possible. These centers coordinate your care through a team approach and likely have access to clinical trials and newer treatments.
As you look at options for centers, find out if they have:
- Many different types of specialists
- Experience with esophageal and stomach cancers
- Access to clinical trials
- Support services such as nutrition counseling
Caring for Your Emotional Health
A diagnosis of gastric or esophageal adenocarcinoma can feel overwhelming. It’s common to feel fear, anxiety, or uncertainty about what comes next.
“It's a scary diagnosis, but treatments are improving every year,” says Shankaran.
Taking care of your emotional health is as important as managing the physical aspects of your disease. You may find it helpful to talk with a therapist, join a support group, or connect with others who understand what you’re going through.
You might also benefit from:
- Stress-reduction practices like mindfulness or breathing exercises
- Support from friends and family
- Palliative care services focused on comfort and quality of life
Information for Caregivers
If you’re caring for someone with gastric or esophageal adenocarcinoma, you may be involved in many parts of their journey. You may:
- Manage appointments and medications
- Help with meals and nutrition
- Provide emotional support
- Monitor for new or worsening symptoms
It’s important to take care of yourself. Caregiving can be extremely physically and emotionally exhausting, it can and increase your own risks for a range of health problems, especially over time.
To support your own well-being, try to:
- Ask for help when you need it
- Take breaks and rest
- Connect with caregiver support groups
- Ask a social worker about available resources
You can find support and information online through several different national organizations such as the American Cancer Society and National Cancer Institute, which provide resources for patients and families.
For caregiver-specific support, try:
- Family Caregiver Alliance
- Caregiver Action Network
- American Cancer Society Cancer Caregiver Resource Guide
- National Cancer Institute’s Caring for the Caregiver
Takeaways
Gastric and esophageal adenocarcinomas are cancers that happen in your esophagus and stomach. They can be aggressive, but treatments are improving. Many people are able to live meaningful, fulfilling lives during and after treatment.
As you navigate your diagnosis, it helps to stay informed, work with an experienced care team, and take care of both your physical and emotional needs.
FAQs
What is the survival rate for gastric and esophageal adenocarcinomas?
They vary depending on the stage of your cancer at diagnosis. When you combine all stages and average them, the five-year survival rate for esophageal adenocarcinoma is 22% and for gastric adenocarcinoma is 38%. Early detection improves these rates.
Can you live without an esophagus?
Yes. After surgery to remove it, doctors create a new pathway using your stomach or intestine. You can still eat, but you’ll typically need smaller, more frequent meals.
Can you live without a stomach?
Yes. If you need a total gastrectomy, your surgeon will connect your esophagus directly to your intestines. You may need to learn different eating patterns and routines as a result.
