Excel Hospital
  • What is GIST (Gastro Intestinal Stromal Tumor)?

    • Gastrointestinal stromal tumors (GISTs) are spindle cell tumors of the digestive tract that most often occur in the stomach or upper part of the small intestine.
    • GISTs also may be found in the esophagus, large intestine and anus.
    • GISTs occur most often in middle-aged and older adults.

  • Causes

    • Unknown

  • Pathophysiology

    • GISTs are tumors of connective tissue, i.e. sarcomas; unlike most gastrointestinal tumors, they are nonepithelial.
    • About 70% occur in the stomach, 20% in the small intestine and less than 10% in the esophagus.
    • Small tumors are generally benign, especially when cell division rate is slow, but large tumors disseminate to the liver, omentum and peritoneal cavity. They rarely occur in other abdominal organs.
    • GISTs are thought to arise from interstitial cells of Cajal (ICC), that are normally part of the autonomic nervous system of the intestine. They serve a pacemaker function in controlling motility.
    • Approximately 85% GISTs are associated with c-KIT mutations.

  • Signs and Symptoms

    - Up to 75% of GISTs are discovered when they are less than 4 cm in diameter and are either asymptomatic or associated with nonspecific symptoms.

    • Vague, nonspecific abdominal pain or discomfort (most common)
    • Early satiety or a sensation of abdominal fullness
    • Fatigue (with blood loss)
    • Signs of peritonitis (with perforation)

    - Obstructive signs and symptoms of GISTs can be site-specific, as follows:

    • Dysphagia with an esophageal GIST
    • Constipation and a distended, tender abdomen with a colorectal GIST
    • Obstructive jaundice with a duodenal GIST

  • Complications

    • Hemorrhage
    • Obstruction
    • Perforation

  • Diagnosis

    • Biochem
    • CT Scan
    • Endoscopy
    • EUS (Endoscopic Ultrasonography)
    • Biopsy with Immunohistochemistry

  • Treatment

    Surgery:Laparoscoy (preferable) / Open
    Adjuvant therapy: (Tyrosine kinase inhibitors : eg. Imatinib)
    - for high-risk tumors
    - for tumor shrinkage prior to surgical resection