The Siewert-Stein classification of esophageal adenocarcinoma classes these tumors according to their relationship to anatomical landmarks 1. It was initially proposed by Siewert et al in 1996, becoming widely used in predicting lymph node spread and directing optimal management. As of the 7th edition of the TNM classification system, gastro-esophageal junction (GEJ) tumors are a subset of esophageal tumors 2.
- type I: adenocarcinoma of the distal esophagus (epicenter of lesion 1-5 cm above GEJ)
- type II: adenocarcinoma of the cardia (epicenter of lesion up to 1 cm above and 2cm below GEJ)
- type III: sub-cardial type adenocarcinoma (epicenter of lesion 2-5 cm below GEJ)
Type III adenocarcinomas generally have a worse prognosis 3.
- 1. Siewert JR, Stein HJ. Carcinoma of the cardia: carcinoma of the gastroesophageal junction—classification, pathology and extent of resection. Dis Esophagus 1996;9:173-82.
- 2. Sobin L, Gospodarowicz M, Wittekind C: TNM classification of malignant tumors. 7th edition. Oxford: Wiley-Blackwell; 2009
- 3. Curtis NJ, Noble F, Bailey IS, Kelly JJ, Byrne JP, Underwood TJ. The relevance of the Siewert classification in the era of multimodal therapy for adenocarcinoma of the gastro-oesophageal junction. J Surg Oncol. 2013;109(3):202-7. doi 10.1002/jso.23484