American Board of Internal Medicine (ABIM) Certification Practice Exam

Which stage of gastroesophageal cancer is defined by the presence of distant metastatic disease?

1. Stage I

2. Stage II

3. Stage III

4. Stage IV

The correct answer is: Stage IV

The stage of gastroesophageal cancer that is characterized by the presence of distant metastatic disease is indeed Stage IV. In cancer staging, the classification system often follows the principles set by the American Joint Committee on Cancer (AJCC), which utilizes the TNM (Tumor, Node, Metastasis) system. Stage IV indicates that the cancer has spread beyond the primary site in the stomach or esophagus to distant organs or tissues. Common sites for metastasis in gastroesophageal cancer include the liver, lungs, and peritoneal cavity. At this stage, the disease is often more difficult to treat with curative intent and may instead require palliative care focused on symptom management and quality of life. In contrast, the earlier stages (Stage I, II, and III) are defined by localized disease and regional lymph node involvement without distant metastasis. Stage I typically implies that the tumor is small and has not spread to lymph nodes; Stage II may involve a larger tumor or spread to nearby lymph nodes; and Stage III typically denotes more extensive local progression and lymphatic spread, but without the involvement of distant sites. Thus, the defining characteristic of Stage IV is the presence of metastases, which distinguishes it from the earlier stages.