The incidence of adenocarcinoma of the esophagogastric junction (EGJ) has increased in Europe and North America in the 1970s and 1980s; however, the increasing trend has leveled off in the Third Millennium. In Eastern Asia, the rise in cardia cancer has been much smaller and somewhat delayed, occurring in the last two decades. Nowadays, cardia adenocarcinoma represents one third of all gastric cancer in Europe, and in some areas of China. Prognosis is still poor in Europe and in the United States, 5-year survival being less than 20 %; a better 5-year survival, approaching 40 %, is observed in patients undergoing surgery with curative intent.
Most cases of EGJ adenocarcinoma occur in men aged 60 years and over. Caucasians are more affected than the other ethnic groups. The rise in EGJ cancer during the last 50 years mainly reflected an increase in the subtype related to gastroesophageal reflux, while the Helicobacter pylori-related subtype declined over the same period.
In addition to gastroesophageal reflux, adenocarcinoma of the EGJ shares several risk factors with esophageal adenocarcinoma: obesity, meat and fat consumption, smoking, body posture, and occupational activities. At variance, abdominal obesity, alcohol, and antioxidant intake have been associated with esophageal adenocarcinoma but not with EGJ adenocarcinoma.