In the Siewert classification of gastroesophageal junction (GEJ) tumours, a Type II adenocarcinoma (true cardia tumour) originates from:

• A More than 5 cm above the anatomical GEJ (distal oesophageal origin)
• B 1 cm above to 2 cm below the anatomical GEJ (cardia epithelium at the Z-line) ✓
• C More than 3 cm below the anatomical GEJ (subcardial stomach)
• D 1 cm above to 5 cm above the anatomical GEJ

Explanation

Siewert classification divides GEJ adenocarcinomas based on the centre of the tumour's relationship to the anatomical GEJ (Z-line): Type I — centre 1–5 cm above GEJ (distal oesophagus/Barrett's origin); Type II — centre 1 cm above to 2 cm below GEJ (true cardia tumour); Type III — centre 2–5 cm below GEJ (subcardial gastric origin). This classification influences surgical approach: Type I typically requires oesophagectomy, Types II and III may require gastrectomy (or extended gastrectomy), and the approach affects lymphadenectomy template.

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

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Written and medically reviewed by the StethoPrep medical team.