Cardia carcinoma considered as a distinct clinical entity.

From 1 January 1969 until 31 December 1985, gastric resections were performed in 937 patients with carcinoma of the stomach and 422 patients with carcinoma of the cardia. During this period, the general frequency of cardia carcinoma increased continuously from 6.6 per cent (1969-71) to 37.5 per cent (1984-85) and a corresponding decrease of carcinomas in other sites was observed. Early carcinomas (pT1) of the oesophageal margin (n = 10, 2.4 per cent) were diagnosed less often than early carcinomas in other sites (n = 177, 18.9 per cent). Whereas 51.4 per cent of all resected carcinomas of the stomach showed no lymph node metastases (pN0), only 14.1 per cent of cardia carcinomas belonged to this category. With respect to operative treatment, Laurén's classification which defines the required margin of clearance according to diffuse type (frequency in cardia carcinoma 43 per cent, in other stomach sites 51 per cent), is of great significance. We believe that extensive oesophageal resection is necessary for patients with such difficult tumours. The pattern of metastasis in cardia carcinoma is similar to that of cancer in other stomach sites, the preferred area is the regional lymph nodes on the lesser curve (83 per cent). Histological classification and metastasis pattern show that cardia carcinoma is a type of carcinoma of the stomach which must be treated according to the criteria of stomach cancer surgery.