The Siewert classification of adenocarcinoma at the gastroesophageal junction divides tumours based on their relationship to the anatomical GEJ. Type II (true cardia carcinoma) is defined as having its centre located:

• A More than 5 cm above the GEJ in the distal oesophagus
• B 1-5 cm above the GEJ in the lower oesophagus
• C Within 1 cm above to 2 cm below the anatomical GEJ ✓
• D 2-5 cm below the GEJ in the proximal stomach

Explanation

Siewert classification: Type I = adenocarcinoma of the distal oesophagus, centre 1-5 cm above GEJ (usually arising in Barrett's oesophagus); Type II = true carcinoma of the gastric cardia, centre within 1 cm above to 2 cm below GEJ; Type III = subcardial carcinoma, centre 2-5 cm below GEJ. Surgical approach differs: Type I is treated as oesophageal cancer (Ivor-Lewis or transhiatal oesophagectomy); Type II can undergo either oesophagectomy or extended total gastrectomy; Type III is treated as gastric cancer with total gastrectomy and D2 lymphadenectomy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.