Torakochirurgia
Cardiac cancer – is adenocarcinoma of the oesophagus or gastric adenocarcinoma?

During the last 4-5 decades there has been an alarming increase in the number of patients with carcinoma of the esophagogastric junction, but a fall in incidence of carcinomas of the distal part of the stomach can be noticed. The growth in incidence of gastroesophageal reflux (GERD) seems to be responsible for that phenomenon. Cardiac carcinoma becomes a serious therapeutic problem due to: symptomless onset, features intermediate between adenocarcinoma of the esophagus and stomach, tumor localization on the border between two cavities of the body, infiltration of adjacent tissues, high ratio of metastases, bad prognosis, necessity of performing a major surgical procedure in therapy process. The only efficacious method of cardiac carcinoma treatment is type RO resection (microscopic radical resection). In literature there is no international agreement about a definition of cardiac carcinoma which results in the huge amount of data concerning cardiac carcinoma being incomparable. Accordingly, there is a need to introduce a synonymous definition of cardiac carcinoma and its classification, which could allow the analysis of data relating to etiopathogenesis, etiology and optimal therapeutic approach. The aim of this article is an attempt to find such a synonymous definition of cardiac carcinoma and its classification, which could allow the analysis of data relating to etiopathogenesis, etiology and optimal therapeutic approach. A review of current literature has been performed, regarding directives of the 2nd International Congress of Stomach Carcinoma in 1997 (Munich), 7th International Congress of Esophageal Disease in Paris (2003), WHO Classification 2000, and presented by AJCC in 2002, TNM classification. Conclusions: Classification of adenocarcinomas of the esophagogastric junction proposed by Siewert et al. becomes an important step towards the systematization of the issue of cardiac cancer. This classification results in adenocarcinomas of the esophagogastric junction being treated as esophageal carcinoma, but type II tumors (cardiac carcinoma) with type III should be treated as stomach carcinoma with all implications regarding classification and method of treatment.