The goal of the most recent 7th edition of the AJCC Cancer Staging Manual for gastric and esophageal cancer is to harmonize tumors arising from the distal esophagus to gastric cardia, including management of gastroesophageal junction (GEJ)-type tumors. The treatment of complex tumor types is best guided by a staging classification that reliably groups patients according to prognosis and therapy. The development of effective staging classifications is based on the analysis of large databases, ideally composed of patients that are consistently and accurately staged and treated, to derive accurate staging groups. Many challenges exist to developing a solid staging system for this area, because improved understanding of gastric, esophageal, and GEJ tumors has shown that this is a heterogeneous disease with varying outcomes depending on tumor location and type. Developing a system to adequately address these issues is an evolving target that will continue to require refinement and reconsideration as further data and analysis emerge. Therefore, this article elucidates the key features of this most recent staging system and outlines the changes and how they impact the NCCN Clinical Practice Guidelines for Oncology (NCCN Guidelines) for Gastric and Esophageal Cancer.
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