American Board of Internal Medicine (ABIM) Certification Practice Exam

What characterizes stage I gastroesophageal cancer?

1. A full-thickness lesion

2. A superficial lesion that has not spread

3. The presence of distant metastatic disease

4. Spread to locoregional lymph nodes

The correct answer is: A superficial lesion that has not spread

Stage I gastroesophageal cancer is characterized by superficial lesions that are confined to the epithelium and have not yet invaded deeper layers of the gastric wall or spread to adjacent tissues. This means that while the cancer is present, it is localized and has not metastasized to other organs or even to lymph nodes in the area surrounding the tumor. In this stage, the cancer remains treatable, often through surgical resection, because it has not spread beyond its initial site. As a result, early detection and staging are crucial, as they can significantly affect treatment outcomes. The other options describe characteristics that are not consistent with stage I cancer. For instance, the presence of a full-thickness lesion indicates a more advanced stage with deeper invasion into the gastric wall, which would not be categorized as stage I. The presence of distant metastatic disease suggests the cancer has progressed to stage IV, which is far more severe than stage I. Spread to locoregional lymph nodes would typically classify the cancer as at least stage II, where there is regional lymphatic involvement. Thus, the characteristics associated with stage I are specific to localized, superficial lesions that are treatable if caught early.