The cardia of the stomach is one of four parts where food and liquids pass through to enter the stomach. It also houses the lower esophageal sphincter that prevents stomach contents from backing up into the esophagus. Cancers that involve the cardia are rare, but they can be difficult to diagnose and treat. In this article, we’ll discuss what the cardia is, its function, and how it can be affected by various conditions. We’ll also cover some of the diagnostic features and treatment options for gastric cardia cancers.
Located in the center of the stomach, the cardia is where the pylorus, body, and fundus are found. It’s the first place food and liquids pass through as they move from the esophagus to the stomach. It’s the part of the stomach closest to the esophagus, so it’s not surprising that problems there can be hard to detect and diagnose.
In some patients, H pylori infection can cause localized inflammation in the cardia, or pericarditis. This chronic inflammation may result in intestinal metaplasia in the cardia. Intestinal metaplasia in the cardia is not believed to be as dangerous as that in other locations in the stomach or esophagus, but it can still progress to dysplasia and adenocarcinoma.
Some tumors involving the cardia can cause a smooth tapered narrowing of the distal esophagus that mimics the radiographic appearance of achalasia. These tumors can be differentiated from achalasia by the presence of an aperistaltic motion of the esophagus and by the fact that most patients with gastric cardia cancer have a recent onset of dysphagia, unlike most patients with primary achalasia who have a long history of dysphagia.
Cancers of the cardia can be diagnosed with endoscopy or esophagogastroduodenoscopy. When found early, they tend to be stage I and II tumors with favorable prognoses. A small number of patients with gastric cardia cancer develop advanced-stage disease that requires gastrectomy. In these cases, long-term survival rates are similar to those of other gastric cancers if a complete R0 resection is achieved.
In a study that examined the medical records of 251 patients with gastric cardia cancer, as well as 6568 controls who had undergone R0 resection for other types of gastric cancer, researchers found that tumors of the cardia are usually diagnosed at a later stage than other types of gastric cancer and that cytokeratin 7 and CA 19-9 immunoreactivity patterns are helpful in distinguishing them from esophageal squamous carcinoma. Furthermore, tumors of the cardia are more likely to recur, even after complete resection. Therefore, clinicians should focus on obtaining a negative resection margin in patients with gastric cardia cancer when considering their treatment options. This will help to reduce the risk of recurrence. Fortunately, this can be accomplished in most cases by using the latest techniques.
