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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Oncology · Adenocarcinoma of the Esophagus and Esophagogastric Junction

Diagnosis & Staging: Mapping the Cancer

At a Glance

Staging esophageal and esophagogastric junction (EGJ) cancer uses tools like EUS and PET scans to map the tumor. Doctors use the Siewert Classification (Types I, II, or III) to find the tumor's exact location, which determines if you need an esophagectomy or gastrectomy.

Staging is the process of “mapping” your cancer to determine exactly where it is located and how far it has grown. This is the most critical step in your journey because it dictates every part of your treatment plan, from the type of surgery you might need to whether you should start with chemotherapy [1]. Because no single test is perfect, your team will use a combination of technologies to get the full picture [1].

The Diagnostic Toolkit

Your “map” is built using three primary tools:

  • Endoscopic Ultrasound (EUS): A thin tube with a tiny ultrasound probe is lowered into your esophagus. It is the best tool for seeing how deep the tumor has grown into the wall of the esophagus (the T-stage) [2]. However, EUS can sometimes be inaccurate in evaluating lymph nodes (the N-stage), so doctors often use it alongside other tests [3][4].
  • PET/CT Scan: This scan uses a radioactive sugar tracer to find “hot spots” of cancer activity. It is essential for checking if the cancer has spread to distant parts of the body, such as the liver or lungs (the M-stage) [5][6].
  • CT with Multiplanar Reconstruction (MPR): This is a specialized way of looking at CT images from multiple angles. It helps doctors precisely locate the center of the tumor, which is vital for surgical planning [7].

The Siewert Classification: Your Surgical Compass

For tumors located at the esophagogastric junction (EGJ), doctors use a specific system called the Siewert Classification [8]. This system categorizes tumors based on where their center (epicenter) sits relative to the junction of the esophagus and stomach:

Classification Location of Tumor Epicenter Usual Surgical Approach
Siewert Type I 1 cm to 5 cm above the junction Managed like esophageal cancer; usually requires an esophagectomy (removing part of the esophagus) [8][9].
Siewert Type II 1 cm above to 2 cm below the junction The “true” junction tumor. Surgery is individualized and may involve removing the lower esophagus and upper stomach [8][10].
Siewert Type III 2 cm to 5 cm below the junction Managed like gastric (stomach) cancer; usually requires a gastrectomy (removing the stomach) [8][11].

Why This Matters for You

The Siewert classification is “absolutely critical” because it determines where the surgeon will make incisions and which organs need to be partially or fully removed [12][13].

For example, if a tumor is classified as Type I, the surgeon needs to ensure they clear the lymph nodes in the chest (mediastinum) [14]. If it is Type III, the focus shifts to the lymph nodes in the abdomen [15]. Because the surgical recovery for an esophagectomy and a gastrectomy can be different, knowing your Siewert type helps you and your family prepare for the specific road ahead [16][17].

Clinical vs. Pathological Staging

Your current stage is your clinical stage, which is your doctor’s best estimate based on scans [1]. After surgery, a pathologist will look at the actual tissue under a microscope to provide your pathological stage. Sometimes these stages differ, but your clinical stage is what gets your treatment started today [1].

Common questions in this guide

What is the Siewert Classification for EGJ cancer?
The Siewert Classification is a system doctors use to categorize tumors located exactly where the esophagus meets the stomach. It classifies the tumor as Type I, II, or III based on its location, which helps your team decide the best surgical approach.
What is the difference between Siewert Type I and Type III tumors?
Siewert Type I tumors are located primarily in the lower esophagus and are usually treated with an esophagectomy. Siewert Type III tumors are located slightly lower in the upper stomach and are generally treated with a gastrectomy.
Why do I need an Endoscopic Ultrasound (EUS) for esophageal cancer?
An EUS uses a tiny ultrasound probe attached to a thin tube to see how deeply a tumor has grown into the wall of your esophagus. It is currently the most accurate tool available for determining this aspect of your clinical stage.
How does a PET/CT scan help in staging my cancer?
A PET/CT scan uses a specialized sugar tracer to highlight areas of active cancer in the body. This scan is essential for checking whether the cancer has spread from the esophagus to distant areas like the liver or lungs.
What is the difference between a clinical stage and a pathological stage?
Your clinical stage is the doctor's best estimate based on imaging scans before treatment begins. The pathological stage is confirmed later, after surgery, when a pathologist examines the actual tumor tissue under a microscope.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my scans, what is the 'Siewert Type' of my tumor (I, II, or III)?
  2. 2.Does the epicenter of the tumor favor an esophagectomy or a gastrectomy as the primary surgical plan?
  3. 3.What was the estimated length of esophageal invasion seen on the EUS or CT?
  4. 4.How did the PET/CT results change my clinical stage compared to the initial endoscopy?
  5. 5.If the EUS and CT show different things about my lymph nodes, which test are we relying on more for the treatment plan?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Update on Endoscopy-Based Imaging Techniques in the Diagnosis of Esophageal Cancer.

    Vasile MI, Mirea CS, Vîlcea ID, et al.

    Current health sciences journal 2017; (43(4)):295-300 doi:10.12865/CHSJ.43.04.01.

    PMID: 30595892
  2. 2

    Is endoscopic ultrasound examination necessary in the management of esophageal cancer?

    DaVee T, Ajani JA, Lee JH

    World journal of gastroenterology 2017; (23(5)):751-762 doi:10.3748/wjg.v23.i5.751.

    PMID: 28223720
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    Multiple staging investigations may not change management in patients with high-grade dysplasia or early esophageal adenocarcinoma.

    Reyhani A, Gimson E, Baker C, et al.

    Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 2023; (36(10)) doi:10.1093/dote/doad020.

    PMID: 37032121
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    Endoscopic ultrasonography compared with multidetector computed tomography for the preoperative staging of gastric cancer: a meta-analysis.

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    Efficacy of PET-CT in the Diagnosis and Treatment of Recurrence After Esophageal Cancer Surgery.

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    Four-step formula for the Siewert classification of adenocarcinomas of the esophagogastric junction: a computed tomography-based quantitative model.

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    Expert review of medical devices 2025; (22(7)):747-755 doi:10.1080/17434440.2025.2510534.

    PMID: 40439686
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    True esophagogastric junction adenocarcinoma: background of its definition and current surgical trends.

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    PMID: 31278583
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    [Treatment Strategy for Esophagogastric Junction Carcinoma;Highly Controversial Topic in the Upper Gastrointestinal Malignancy].

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    Esophagogastric junction adenocarcinomas: individualization of resection with special considerations for Siewert type II, and Nishi types EG, E=G and GE cancers.

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    Mediastinal Nodal Involvement After Neoadjuvant Chemoradiation for Siewert II/III Adenocarcinoma.

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    Priority of lymph node dissection for advanced esophagogastric junction adenocarcinoma with the tumor center located below the esophagogastric junction.

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This page explains staging and diagnostic tools for esophageal and EGJ adenocarcinoma for educational purposes only. Always consult your oncology team or thoracic surgeon to discuss your specific staging results and surgical treatment plan.

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