Oesophageal junctional adenocarcinoma is a challeng-ing and increasingly common disease. Optimisation ofpre-operative staging and consolidation of surgery inlarge volume centres have improved outcomes, howev-er the preferred adjunctive treatment approach remainsa matter of debate. This review examines the benefitsof neoadjuvant, peri-operative, and post-operative che-motherapy and chemoradiotherapy in this setting in anattempt to reach an evidence based conclusion. Recentfindings relating to the molecular characterisation ofoesophagogastric cancer and their impact on therapeu-tics are explored, in addition to the potential benefitsof fluoro-deoxyglucose positron emission tomography(FDG-PET) directed therapy. Finally, efforts to decreasethe incidence of junctional adenocarcinoma using earlyintervention in Barrett’s oesophagus are discussed,including the roles of screening, endoscopic mucosalresection, ablative therapies and chemoprevention. Oesophageal junctional adenocarcinoma is a challeng-ing and increasingly common disease. Optimization of pre-operative staging and consolidation of surgery in large volume centers have improved outcomes, howev-er the preferred adjunctive treatment approach remains a matter of debate. This review examines the benefits of neoadjuvant, peri -operative, and post-operative che-motherapy and chemoradiotherapy in this molecular characterization ofoesophagogastric cancer and their impact on therapeu-tics are explored, in addition to the potential benefitsof fluoro- Finally, efforts to decrease the incidence of junctional adenocarcinoma using early intervention in Barrett’s oesophagus are discussed, including the roles of screening, endoscopic mucosal rection, ablative therapies and chemoprevention.