A Plea for Order in a Complex Disease—Answered

Abstract

Likely because of its relative rarity, our understanding of esophageal cancer has suffered from a lack of resolution related to the inappropriate grouping of the different types and locations of malignancy into one “grab bag.” Richard R. Grant said that “the value of identity of course is that so often with it comes purpose.” Adenocarcinoma of the Esophagogastric Junction provides today’s most comprehensive and tailored description of the pathogenesis, diagnosis, staging, and therapy of malignancy of a single region within the upper digestive tract. The definition of the esophagogastric junction is defined in this text as a 10-cm region of territory divided equally by the endoscopic cardia; while this purely anatomic description of tumor location (“Siewert Classification”) may blend somewhat different diseases (e.g., distal esophageal and proximal gastric adenocarcinoma) with separate pathophysiology, it has served as an integral component of our lexicon in this arena and heretofore enabled order to be established to this complex subject matter. Adenocarcinoma of the Esophagogastric Junction is a festschrift of sorts, honoring Dr. hc J. Rudiger Siewert who has been a primary thought leader in esophageal cancer over the past 30 years and served as mentor and/or inspiration to many of the authors in this book. The chapters are succinct and well written, and the topics follow a logical progression of thought. There are 15 chapters with each including multiple subsections that direct the reader through a distillation process of the most important concepts. Without being terse, the pertinent and clinically useful material is delivered in easy-to-understand and compressed form. Although there is a paucity of figures and images, and the ones that are present are of satisfactory quality, this fact likely contributes to the reasonable cost compared most other texts. Perhaps the most attractive aspect of Adenocarcinoma of the Esophagogastric Junction is that as one reads through, a sense of “order” is appreciated and this ultimately frames the barriers that exist in the care of these patients. I left this text with many new perspectives and a sense of “purpose.”