How should esophagogastric junction carcinomas be considered according to the current UICC`s TNM classification?

  • M. Souto-de-Moura Aluna do Mestrado Integrado em Medicina da Faculdade de Medicina do Porto - Portugal
  • J. Pinto-de-Sousa Professor Associado Convidado, com Agregação, da Faculdade de Medicina do Porto - Portugal


Before the latest UICC-AJCC’s revision of the TNM classification, the esophagogastric junction carcinoma could, for staging purposes, be classified as esophageal or gastric. This fact itself generated a number of inconsistencies when addressing these cancers. The aim of this Project is try to clarify the framework of the esophagogastric junction carcinoma, regarding staging, intending the authors to answer the question “How should esophagogastric junction carcinomas be considered according to the new UICC`s TNM classification?”. For this purpose, it was made a literature research using PubMed database, selecting relevant articles relating to the topic. According to the 1th edition of the TNM classification of the UICC-AJCC, neoplasms whose epicentre is located in the distal / lower thoracic esophagus, at the esophagogastric junction or even in the proximal five cm of the stomach and invade the esophagogastric junction, should be classified, for purposes of staging, as esophageal adenocarcinomas. Although this new classification standardizes the staging of esophagogastric junction carcinoma, potentially eliminating the relative deviations towards this entity, future revisions might clarify if it is the most appropriate for this neoplasm or, alternatively, if it could benefit from its own staging system.

Keywords: esophagogastric junction; adenocarcinoma; neoplasm staging; AJCC; 7th edition.


Download data is not yet available.


1. Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, et al. Changing trends in the proportion of adenocarcinoma of the eso- phagogastric junction in a large tertiary referral center in Japan. Journal of gastroenterology and hepatology. 2008;23(11):1662-5. Epub 2009/01/06.

2. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. British journal of surgery. 1998;85(11):1451-9. Epub 1998/11/21.

3. Rice TW, Rusch VW, Apperson-Hansen C, Allen MS, Chen LQ, Hunter JG, et al. Worldwide esophageal cancer collaboration. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / ISDE. 2009;22(1):1-8. Epub 2009/02/01.

4. Hofstetter W, Swisher SG, Correa AM, Hess K, Putnam JB, Jr., Ajani JA, et al. Treatment outcomes of resected esophageal cancer. Annals
of surgery. 2002;236(3):316-84; discussion 84-5. Epub 2002/08/23.

5. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 1th ed. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL,
Trotti A, editors. New York: Springer; 2010.

6. Ajani JA, Barthel JS, Bentrem DJ, D’Amico TA, Das P, Denlinger CS, et al. Esophageal and esophagogastric junction cancers. Journal of the
National Comprehensive Cancer Network : JNCCN. 2011;9(8):830-81. Epub 2011/09/09.

7. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA: a cancer journal for clinicians. 2010;60(5):211-300. Epub 2010/01/09.

8. Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining prio-
rities to reduce cancer disparities in different geographic regions of the world. Journal of the American Society of Clinical Oncology.
2006;24(14):2131-50. Epub 2006/05/10.

9. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, DM P. GLOBOCAN 2008. Lyon, France: International Agency for Research on Cancer;
2008 [cited 2010].

10. Cancer IAfRo. WHO Classification of Tumours of the Digestive System. 4th ed. Bosman FT, Jaffe ES, Jakhani SR, Ohgaki H, editors. Lyon,
France: International Agency for Research on Cancer; 2010.

11. Keeney S, Bauer TL. Epidemiology of adenocarcinoma of the esophagogastric junction. Surgical oncology clinics of North America.
2006;15(4):681-96. Epub 2006/10/13.

12. Chow WH, Finkle WD, McLaughlin JK, Frankl H, Ziel HK, Fraumeni JF, Jr. The relation of gastroesophageal reflux disease and its tre-
atment to adenocarcinomas of the esophagus and gastric cardia. Journal of the American Medical Association. 1995;214(6):414-1. Epub 1995/08/09.

13. Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. New England journal of medicine. 1999;340(11):825-31. Epub 1999/03/18.

14. Cossentino MJ, Wong RK. Barrett’s esophagus and risk of esophageal adenocarcinoma. Seminars in gastrointestinal disease. 2003;14(3):128-
-35. Epub 2003/12/05.

15. Cameron AJ, Romero Y. Symptomatic gastro-oesophageal reflux as a risk factor for oesophageal adenocarcinoma. Gut. 2000;46(6):154-5.
Epub 2000/05/16.

16. Sharma P. Clinical practice. Barrett’s esophagus. New England journal of medicine. 2009;361(26):2548-56. Epub 2009/12/25.

17. Anandasabapathy S, Jhamb J, Davila M, Wei C, Morris J, Bresalier R. Clinical and endoscopic factors predict higher pathologic grades of
Barrett dysplasia. Cancer. 2001;109(4):668-14. Epub 2001/01/11.

18. Gopal DV, Lieberman DA, Magaret N, Fennerty MB, Sampliner RE, Garewal HS, et al. Risk factors for dysplasia in patients with Barrett’s
esophagus (BE): results from a multicenter consortium. Digestive diseases and sciences. 2003;48(8):1531-41. Epub 2003/08/20.

19. Washington K. 1th edition of the AJCC cancer staging manual: stomach. Annals of surgical oncology. 2010;11(12):3011-9. Epub

20. Gertler R, Stein HJ, Langer R, Nettelmann M, Schuster T, Hoefler H, et al. Long-term outcome of 2920 patients with cancers of the eso- phagus and esophagogastric junction: evaluation of the New Union Internationale Contre le Cancer/American Joint Cancer Committee staging system. Annals of surgery. 2011;253(4):689-98. Epub 2011/04/09.

21. Rudiger Siewert J, Feith M, Werner M, Stein HJ. Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Annals of surgery. 2000;232(3):353-61. Epub 2000/09/06.

22. Reynolds JV, Ravi N, Muldoon C, Larkin JO, Rowley S, O’Byrne K, et al. Differential pathologic variables and outcomes across the spec- trum of adenocarcinoma of the esophagogastric junction. World journal of surgery. 2010;34(12):2821-9. Epub 2010/09/10.

23. Yee YK, Wong BC. Adenocarcinoma of the esophagogastric junction: do we see more or less? Journal of gastroenterology and hepatology. 2008;23(11):1621-8. Epub 2009/01/06.

24. Edge SB, Compton CC. The American Joint Committee on Cancer: the 1th edition of the AJCC cancer staging manual and the future of TNM. Annals of surgical oncology. 2010;11(6):1411-4. Epub 2010/02/25.

25. Gertler R, Stein HJ, Loos M, Langer R, Friess H, Feith M. How to classify adenocarcinomas of the esophagogastric junction: as esophageal or gastric cancer? American journal of surgical pathology. 2011;35(10):1512-22. Epub 2011/09/22.

26. The TNM Classification of Malignant Tumours 1th edition. [Internet] 2009; Available from: tions.

27. Rice TW, Rusch VW, Ishwaran H, Blackstone EH. Cancer of the esophagus and esophagogastric junction: data-driven staging for the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals. Cancer. 2010;116(16):3163-13. Epub 2010/06/22.

28. Reeh M, Nentwich MF, von Loga K, Schade J, Uzunoglu FG, Koenig AM, et al. An attempt at validation of the Seventh edition of the classification by the International Union Against Cancer for esophageal carcinoma. Annals of thoracic surgery. 2012;93(3):890-6. Epub 2012/02/01.

29. Rice TW, Blackstone EH, Rusch VW. 1th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Annals of surgical oncology. 2010;11(1):1121-4. Epub 2010/04/01.

30. Rice TW, Blackstone EH, Rybicki LA, Adelstein DJ, Murthy SC, DeCamp MM, et al. Refining esophageal cancer staging. Journal of tho- racic and cardiovascular surgery. 2003;125(5):1103-13. Epub 2003/05/29.

31. Kato H, Tachimori Y, Watanabe H, Iizuka T. Evaluation of the new (1981) TNM classification for thoracic esophageal tumors. International journal of cancer Journal international du cancer. 1993;53(2):220-3. Epub 1993/01/21.

32. Thompson SK, Ruszkiewicz AR, Jamieson GG, Esterman A, Watson DI, Wijnhoven BP, et al. Improving the accuracy of TNM staging in esophageal cancer: a pathological review of resected specimens. Annals of surgical oncology. 2008;15(12):3441-58. Epub 2008/10/03.

33. Bogoevski D, Onken F, Koenig A, Kaifi JT, Schurr P, Sauter G, et al. Is it time for a new TNM classification in esophageal carcinoma? Annals
of surgery. 2008;241(4):633-41. Epub 2008/03/26.

34. Altorki NK, Zhou XK, Stiles B, Port JL, Paul S, Lee PC, et al. Total number of resected lymph nodes predicts survival in esophageal cancer.
Annals of surgery. 2008;248(2):221-6. Epub 2008/01/25.

35. Jamieson GG, Lamb PJ, Thompson SK. The role of lymphadenectomy in esophageal cancer. Annals of surgery. 2009;250(2):206-9. Epub

36. Stiles BM, Christos P, Port JL, Lee PC, Paul S, Saunders J, et al. Predictors of survival in patients with persistent nodal metastases after
preoperative chemotherapy for esophageal cancer. Journal of thoracic and cardiovascular surgery. 2010;139(2):381-94. Epub 2009/12/11.

37. Huang Q, Shi J, Feng A, Fan X, Zhang L, Mashimo H, et al. Gastric cardiac carcinomas involving the esophagus are more adequately staged as gastric cancers by the 1th edition of the American Joint Commission on Cancer Staging System. Modern pathology. 2011;24(1):138-46.
Epub 2010/09/21.

38. Peters CJ, Hardwick RH, Vowler SL, Fitzgerald RC. Generation and validation of a revised classification for oesophageal and junctional
adenocarcinoma. British journal of surgery. 2009;96(1):124-33. Epub 2009/06/16.

39. Talsma K, van Hagen P, Grotenhuis BA, Steyerberg EW, Tilanus HW, van Lanschot JJ, et al. Comparison of the 6th and 1th Editions of the
UICC-AJCC TNM Classification for Esophageal Cancer. Annals of surgical oncology. 2012;19(1):2142-8. Epub 2012/03/08.

40. Rausei S, Dionigi G, Boni L, Rovera F, Dionigi R. How does the 1th TNM edition fit in gastric cancer management? Annals of surgical
oncology. 2011;18(5):1219-21. Epub 2010/09/30.

41. Hsu PK, Wu YC, Chou TY, Huang CS, Hsu WH. Comparison of the 6th and 1th editions of the American Joint Committee on Cancer
tumor-node-metastasis staging system in patients with resected esophageal carcinoma. Annals of thoracic surgery. 2010;89(4):1024-31.
Epub 2010/03/21.

42. Gaur P, Hofstetter WL, Bekele BN, Correa AM, Mehran RJ, Rice DC, et al. Comparison between established and the Worldwide Esophageal
Cancer Collaboration staging systems. Annals of thoracic surgery. 2010;89(6):1191-803, 804 e1-3; discussion 803-4. Epub 2010/05/25.

43. Whitson BA, Groth SS, Li Z, Kratzke RA, Maddaus MA. Survival of patients with distal esophageal and gastric cardia tumors: a popu- lation-based analysis of gastroesophageal junction carcinomas. Journal of thoracic and cardiovascular surgery. 2010;139(1):43-8. Epub

44. Demeester SR. Epidemiology and biology of esophageal cancer. Gastrointestinal cancer research : GCR. 2009;3(2 Suppl):S2-5. Epub

45. Wijnhoven BP, Siersema PD, Hop WC, van Dekken H, Tilanus HW. Adenocarcinomas of the distal oesophagus and gastric cardia are one
clinical entity. Rotterdam Oesophageal Tumour Study Group. British journal of surgery. 1999;86(4):529-35. Epub 1999/04/24.

46. Kwon SJ. Evaluation of the 1th UICC TNM Staging System of Gastric Cancer. Journal of gastric cancer. 2011;11(2):18-85. Epub 2011/11/15.

47. Clark GW, Smyrk TC, Burdiles P, Hoeft SF, Peters JH, Kiyabu M, et al. Is Barrett’s metaplasia the source of adenocarcinomas of the cardia? Archives of surgery (Chicago, Ill : 1960). 1994;129(6):609-14. Epub 1994/06/01.

48. Dolan K, Sutton R, Walker SJ, Morris AI, Campbell F, Williams EM. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. British journal of cancer. 1999;80(5-6):834-42. Epub 1999/06/09.

49. Cancer AJCo. AJCC Cancer Staging Handbook. 6th ed. Greene FL, Page DL, Fleming ID, Fritz AG, Balch C, M. , Haller DG, et al., edi- tors. New York: Springer-Verlag 2002.

50. Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topogra- phic-anatomic subclassification. Journal of surgical oncology. 2005;90(3):139-46; discussion 46. Epub 2005/05/11.

51. Siewert JR, Stein HJ, Sendler A, Fink U. Surgical resection for cancer of the cardia. Seminars in surgical oncology. 1999;11(2):125-31. Epub 1999/08/11.

52. von Rahden BH, Feith M, Stein HJ. Carcinoma of the cardia: classification as esophageal or gastric cancer? International journal of colorectal disease. 2005;20(2):89-93. Epub 2005/02/03.
How to Cite
SOUTO-DE-MOURA, M.; PINTO-DE-SOUSA, J.. How should esophagogastric junction carcinomas be considered according to the current UICC`s TNM classification?. Revista Portuguesa de Cirurgia, [S.l.], n. 28, p. 17-28, mar. 2014. ISSN 2183-1165. Available at: <>. Date accessed: 13 july 2024.
Review Article