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The proximal stomach is now the most common site for gastric cancer in the West. Because the lower oesophagus is also a very common site of adenocarcinoma approximately 60% of all malignancies in the upper gastrointestinal tract occur in proximity to the GOJ (see Chapter 66 ). Adenocarcinoma at this site has doubled in incidence in the UK over the last 30 years. This high prevalence of proximal gastric cancer is not seen in Japan, where distal cancer still predominates, as it does in most of the rest of the world.