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The gastro-oesophageal junction (including the proximal cardia region of the stomach) is an anatomical site with a remarkably high and rapidly rising incidence of adenocarcinoma.1 Understanding the aetiology of cancer at this site and its relationship to adenocarcinoma of the oesophagus and of the stomach poses a challenge to surgeons, gastroenterologists and pathologists. Determining the origin of these cancers is of more than academic interest as their surgical management depends upon whether they are derived from the oesophagus or the stomach.2–4
In 1996, Siewert et al proposed a classification of gastro-oesophageal junction adenocarcinomas based upon their location relative to the gastro-oesophageal junction identified by the proximal margin of the gastric folds.4 5 Gastro-oesophageal junction cancers were considered to be those whose centre lay between 5 cm proximal to and 5 cm distal to the gastro-oesophageal junction. Siewert et al subdivided these gastro-oesophageal junction cancers into type I if the tumour centre lay 1–5 cm proximal to the gastro-oesophageal junction, type II if between 1 cm proximal and 1 cm distal to the junction and type III if 1–5 cm distal to the junction. This classification has been internationally recognised and is used by surgeons to plan management of the tumour.2 3
Siewert type 1 adenocarinomas have epidemiological and histological characteristics similar to oesophageal adenocarcinomas, including a marked male predominance, an association with a history of reflux symptoms and predominance of intestinal type Lauren histology.2 5 In contrast, Siewert type III adenocarcinomas resemble distal (non-cardia) gastric cancers with less marked male dominance, a similar proportion of intestinal and diffuse histological types and no association with reflux.5 Type I junctional adenocarcinomas are therefore considered to be oesophageal cancers which happen to be located in the distal oesophagus and type III junctional cancers to be gastric cancers which happen to be in the …
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