Considering the esophagogastric junction as a ‘zone’

Abstract

Siewert's classification of adenocarcinoma of the esophagogastric junction (EGJ) classifies tumors anatomically for determining the appropriate surgical technique. According to this classification, a type II tumor, true carcinoma of the cardia, is defined as a cancer within 1 cm proximal to 2 cm distal of the EGJ. Histological analysis indicates that the cardiac gland is present with a high degree of frequency between 1–2 cm to the gastric side and 1–2 cm to the esophageal side of the EGJ, which means that this zone can be considered as neither the stomach nor the esophagus but rather as a third zone known as the ‘EGJ zone’. It has been suggested that there are multiple causes for development of adenocarcinoma in the EGJ zone. The TNM Classification of Malignant Tumours 7th Edition considers EGJ adenocarcinoma (EGJAC) occurring in the EGJ zone to be a part of esophageal adenocarcinoma (EAC). However, recent studies have indicated that EGJAC behaves differently from EAC and gastric carcinoma. Barrett's esophagus is now considered an important factor in the etiology of EGJAC, but, as yet, no studies have elucidated the differences between cancer arising from short-segment Barrett's esophagus and cancer of the gastric cardia. Thus, there is currently no clinical relevance to subdivision of adenocarcinoma in the EGJ zone into above or below the EGJ line.