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It develops along an inflammation-metaplasia-dysplasia-carcinoma sequence and remains clinically challenging because early lesions are often occult and advanced disease is shaped by a treatment-resistant tumor microenvironment. A clinically useful review therefore needs to distinguish gastric cardia cancer from non-cardia gastric cancer and from esophageal adenocarcinoma, while also clarifying where current evidence is direct and where it is only extrapolated. Banxia Xiexin Tang (BXT) is a seven-botanical formula containing Pinellia ternata (Thunb.) Makino. [Araceae] (Pinelliae Rhizoma), Coptis chinensis Franch. [Ranunculaceae] (Coptidis Rhizoma), Scutellaria baicalensis Georgi [Lamiaceae] (Scutellariae Radix), Zingiber officinale Roscoe [Zingiberaceae] (Zingiberis Rhizoma Recens), Panax ginseng C.A.Mey. [Araliaceae] (Ginseng Radix et Rhizoma), Glycyrrhiza uralensis Fisch. ex DC. [Fabaceae] (Glycyrrhizae Radix et Rhizoma), and Ziziphus jujuba Mill. [Rhamnaceae] (Jujubae Fructus). Available preclinical and supportive-care studies suggest that Banxia Xiexin Tang or selected metabolites within the formula may modulate inflammatory signaling, oxidative stress, epithelial barrier injury, and treatment-related gastrointestinal toxicity. However, the current evidence base is uneven: much of it comes from gastritis, reflux injury, or non-cardia gastric disease models rather than directly from human gastric cardia cancer. This review critically synthesizes the available literature on integrative management of gastric cardia cancer and related precancerous lesions, with emphasis on what the current data do support, what they do not support, and what research gaps remain. The revision adds a transparent search strategy, clearer terminology, a more cautious interpretation of pharmacological claims, and an explicit discussion of limitations. Because the included studies were heterogeneous in design, population, intervention, and outcome reporting, the evidence is synthesized narratively rather than through quantitative meta-analysis.<\/jats:p>","DOI":"10.3389\/fphar.2026.1763396","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:29:01Z","timestamp":1781843341000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrative management of gastric cardia cancer and precancerous lesions: prospects and mechanistic rationale for Banxia Xiexin Tang"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiao","family":"Liang","sequence":"first","affiliation":[{"name":"Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology","place":["Anyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yang","sequence":"additional","affiliation":[{"name":"Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology","place":["Anyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueshan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology","place":["Anyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaiqi","family":"Yuan","sequence":"additional","affiliation":[{"name":"Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology","place":["Anyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonggui","family":"Hong","sequence":"additional","affiliation":[{"name":"Anyang Tumor Hospital, The Affiliated Anyang Tumor Hospital of Henan University of Science and Technology","place":["Anyang, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/jso.27276","article-title":"Does non\u2010metastatic gastric cancer of the cardia warrant a different treatment strategy?","volume":"128","author":"Ajay","year":"2023","journal-title":"J. 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