In the Siewert classification of gastroesophageal junction (GEJ) adenocarcinoma, a type II tumor has its epicenter located within which anatomical boundary?

• A 1 cm above to 5 cm below the anatomical GEJ
• B Entirely in the lower esophagus, more than 1 cm above the GEJ
• C 1 cm above the GEJ to 2 cm below it (true cardia carcinoma) ✓
• D More than 2 cm below the GEJ extending into the proximal stomach

Explanation

The Siewert classification: Type I = tumor epicenter 1-5 cm above the anatomical cardia (distal esophageal adenocarcinoma, typically arising in Barrett's); Type II = tumor epicenter between 1 cm above and 2 cm below the cardia (true cardia carcinoma); Type III = tumor epicenter 2-5 cm below the cardia (subcardial gastric cancer). This classification determines the surgical approach—Type I typically requires esophagectomy, Type II is controversial (Ivor-Lewis or extended total gastrectomy), and Type III requires total gastrectomy with esophageal anastomosis.

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

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Written and medically reviewed by the StethoPrep medical team.