Treatment of esophago-gastric junction adenocarcinoma

The incidence of Adenocarcinoma of the esophagogastric junction (EGJ) is increasing and its treatment is still debated, primarily because of the non-uniform definition of EGJ.

The most used classification of EGJ cancer was proposed by Siewert and it divides the EGJ in three regions: from 5 to 1 cm above the Z line (Siewert type I or esophageal Adenocarcinoma), from 1 over to 2 below the Z line (Siewert type II or real Cardia cancer) and from 2 below to 5 below the Z line (Siewert type III or proximal Gastric cancer diffused to Cardia). The neoplasia is defined type I, II or III depending on where is the center of the cancer.

This classification did not show to be related to differences in prognosis and survival, but it has been used to guide the surgical strategy based on the site of the tumor. Criticism about this classification focuses mainly on the non-uniform treatment, in the current literature, of Siewert Type II cancer.

From January 2010, a new definition of EGJ carcinoma has been introduced by TNM. This new definition considers esophageal cancers all the ones whose centers falls inside a line drawn 5 cm below the Z line with invasion of the esophagus. This means that Siewert type I and II are now considered esophageal cancers, while type III can be esophageal or proximal gastric cancer depending if the esophagus is infiltrated or not. Criticism about this new definition rises on the border-line definition of former Siewert type III cancers.