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Table 1 Tumour around the gastro-oesophageal junction: classification system and principal differences. (Information taken from [33, 42, 110])

From: Emerging aspects of oesophageal and gastro-oesophageal junction cancer histopathology – an update for the surgical oncologist

GOJ subtypes

Type I (Adenocarcinoma of distal oesophagus)

Type II (True cardia carcinoma)

Type III (Sub-cardial carcinoma)

Endoscopic criteria

Tumour mass arises 1 to 5 cm above the endoscopic cardia

Tumour mass arises 1 cm above to 2 cm below the endoscopic cardia

Tumour mass arises 2 to 5 cm below the area of the endoscopic cardia

Differing Characteristics

• Male predominance

• Arise in association with Barrett's oesophagus (80%)

• More likely to have hiatus hernia or history of GORD

• More similarities to Type III tumours than Type I

• Barrett's mucosa identified in 10%

• Barrett's mucosa identified in only 2%

• 60% have a diffuse growth pattern and 70% undifferentiated

Lymph node metastases

To mediastinal and abdominal lymph node stations

Mainly to abdominal lymph node stations

Mainly to abdominal lymph node stations

Precursor lesions

Barrett's oesophagus

Possible short segment Barrett's oesophagus or IM at the gastric cardia

Helicobacter pylori and IM of the subcardia region

Optimal surgical treatment

Transthoracic or transhiatal oesophagectomy

Controversial; may include either extended total gastrectomy or transthoracic or transhiatal oesophagogastrectomy

Extended total gastrectomy

  1. IM = intestinal metaplasia, GORD = gastro-esophageal reflux disease