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 |