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5. The definition of the esophagogastric junction is controversial
   [ 11 ]; however, a standard definition used for the pathological
   assessment of an esophagogastrectomy specimen is the point
   where the tubular esophagus meets the upper limit of the gas-
   tric rugal folds. If this landmark is obscured by tumor, the
   junction may be identified by highest point of the peritoneal
   reflection on the serosal surface of the stomach.


6. The size of the tumor correlates with survival [ 5 , 7 ] and its
   measurements and location directs how the tumor is to be
   staged. Tumors centered in the proximal stomach but having
   their midpoint within 2 cm distal to gastro-esophageal junc-
   tion while still extending into the esophagus (macroscopically
   or microscopically) will be staged as esophageal cancer [ 12 ].


7. The macroscopic involvement of margins by the carcinoma is
   classified as R2 residual disease, whereas microscopic presence
   of cancer only is R1 [ 12 ].


8. The involvement of adjacent structures such as pleura, pericar-
   dium, diaphragm, or gastric serosa is a feature that defines T4
   stage disease.

Fig. 4 Esophagogastrectomy specimen after neoadjuvant chemotherapy and

radiotherapy where a tumor cannot be appreciated at gross examination. Arrow

indicated the likely fibrotic area

Benjamin M. Allanson and M. Priyanthi Kumarasinghe