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GIST (Gastrointestinal Stromal Tumor)

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  3. GIST (Gastrointestinal Stromal Tumor)

Overview of GIST (Gastrointestinal Stromal Tumor)

Gastrointestinal Stromal Tumour (GIST) develops anywhere in the gastrointestinal tract, at any age. The best way to prevent it is by adopting a healthy lifestyle.

A gastrointestinal stromal tumor (GIST) also known as (meday ka waram/ Ù…عدے کا ورم) is a soft tissue sarcoma located in the gastrointestinal tract, most commonly in the stomach (60%) or small intestine (35%). The interstitial cells of the gastrointestinal tract referred to Cajal (ICCs) or precursors of these cells start to replicate and cause GIST tumors. Moreover, the tumor can be malignant or benign, depending on the patient's condition.
Generally, it occurs in adults between the ages of 40 and 70; rarely exists in young adults.

Prevalence of Gastrointestinal Stromal Tumour (GIST)

The worldwide data on GIST is limited but the incidence rate is about 10-20% per million. Globally, 15-47% of cases were diagnosed with metastatic GIST.
Between 2009 to 2015 years, the average 5 years survival rate with different types and stages, after being diagnosed, are below:

Signs and Symptoms of GIST (Gastrointestinal Stromal Tumor)

The size and location of tumors represent the symptoms of GIST. In some cases, a small lump of GISTs does not cause any symptoms. But if the tumor is larger, the main sign of GIST is bleeding. It can also be possible that blood appears in vomit and stool.

Other signs and symptoms may include:

 

  • The feeling of fullness after a few bites
  • Loss of appetite
  • Stomach pain
  • Feeling a lump in my stomach
  • Bloody stool
  • Nausea
  • Difficulty in swallowing
  • Sudden weight loss

Types of GIST (Gastrointestinal Stromal Tumor)

  • Adult GIST: It develops anywhere in the gastrointestinal tract especially for older patients, due to the mutated gene (PDGFRA). Sometimes, medicine becomes resistant to genes such as PDGFRA D842V mutation that is completely resistant to Gleevec and Sutent.
  • Pediatric GIST: It affects children between the ages of 6 to 18 years old and results from mutated genes (such as the SDH gene). Carney’s triad is another name for pediatric GIST.
  • Wild-type GIST: People with wild-type GISTs are deficient in Succinate Dehydrogenase (SDH). Sometimes, this SDH may not be present in patients.
  • Familial GIST: This type causes germ-line mutation of specific genes. It means, people inherit it from their family and may pass it to their children.

Causes of GIST (Gastrointestinal Stromal Tumor)

GIST is mainly caused by genetic changes in one or several genes such as KIT and PDGFRA genes. About 80% of cases are reported with KIT gene mutations and 10% of cases are reported with PDGFRA cases. Mostly KIT and PDGFRA gene mutations result in both familial and sporadic GISTs. Only a small number of people are affected by mutations in other genes.

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Risk Factors of GIST (Gastrointestinal Stromal Tumor)

Several risk factors that increase the onset of the tumor are below:

 

  • Genetic Syndrome- Another syndrome can increase the risk of GIST such as:
  • Neurofibromatosis type 1 (NF1).
  • Carney triad
  • Chemical Exposure- If people are being exposed to some chemicals accidentally, such as herbicides, arsenic, and dioxin. This may increase the risk of GIST.
  • Radiation Exposure- Frequent exposure to radiation may trigger the risk of GIST like if a person had exposure to radiation for the treatment of other cancer or worked in a radiation-exposed area etc.

 

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Prevention

To prevent cancer, people should follow measures in their lifestyle:

  • Quit smoking
  • Avoid canned food
  • Add more vegetables to the diet
  • Take vitamin supplements such as vitC, vitD3, vitA, and others
  • Use fish oil or cod liver oil during cooking
  • Avoid artificial sweeteners
  • Do not drink carbonated beverages
  • Avoid conventional dairy products and beef as well.

Seek medical care if individuals are experiencing the following signs of GIST:

  • Bleeding
  • Stomach pain
  • Feeling a lump in my stomach
  • Bloody stool
  • Nausea
  • Weight loss

 

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Diagnosis

Doctors will ask questions regarding the symptoms and medical history, and after that, a complete physical examination test is conducted for the abdomen growth.  If doctors suspect that it may have GIST, then the following tests are performed for the determination of the tumor.

  • Computerized Tomography (CT) Scan-This test is used for the detailed cross-sectional scan of abdominal organs, checking the size and position of the tumor.
  • Magnetic Resonance Imaging (MRI)- It also gives a detailed image of the abdomen but is more visible than a CT scan.
  • PET Scan (Positron Emission Tomography Scan)-This is applicable to a malignant tumor. A small amount of radioactive glucose is injected into the vein. The area where malignancy is present becomes brighter and more active because these cells have taken up a lot of injected glucose. It is easily determined.
  • Upper Endoscopy- From this test, doctors examine the inner lining of the esophagus, stomach, and the first part of the small intestine through a thin flexible, lighted tube (endoscope). This tube is inserted down through the mouth. IV sedatives are required for this procedure.
  • Endoscopic Ultrasound (EUS)- In this test, an endoscope is used with ultrasound probes that transmit sound waves through the affected area. In this way, a detailed image of the abdomen and the location of a tumor in it is. This gives a precise result of the metastasized tumors and the affected organs connected with them. It means a complete determination of the extent of a tumor.
  • Fine-needle Aspiration Biopsy- A small fragment of tissue from the tumor is removed by the fine needle for GIST analysis. This method is done with the EUS.

If cancer is diagnosed, the below tests may conduct to find the type and number of cancer cells:

  • Immunohistochemistry- A differential laboratory test is conducted to differentiate one type of cancer from another type of cancer. This method is conducted with the help of antibodies that recognize the antigen in the patient's tissue sample. These antibodies combine with an enzyme or fluorescent dye and then bind to the antigen. As an enzyme or dye becomes activated, this helps to mark antigens under a microscope.
  • Mitotic Rate- It measures the replication of cancer cells in affected tissue. It determines the number of dividing cells in cancer tissue.

After proper diagnosis, oncologists decide the appropriate line of treatment according to the patient’s condition.

Treatment of GIST (Gastrointestinal Stromal Tumor) | When to Consult a Doctor

There are many treatment options that the patients try to relieve the symptoms or stop the spread of tumors. Apart from medical treatment, the affected people also use herbal remedies.

  1. Herbal Remedies:

Following are the main herbs that are specifically used for the treatment of GIST.

  • Amla
  • Haritaki
  • Bahera
  • Kachnar bark
  • Guggul
  • Graviola
  • Curcumin
  • Tamarind bark

  1. Medical Treatment

Different types of treatment are available for GIST patients. Some are standard and some are being tested in clinical trials.

Following are the four main types of standard treatments are used:

  • Surgery

This method is suitable for benign GIST that is localized in one area of the organ. To treat it, a laparoscope (a thin lighted tube) device is inserted into the body through small incisions in the wall of an abdomen. This tube helps to see the affected tissue or organ which is removed through more incisions.

  • Targeted Therapy

Targeted therapy is an effective method that identifies and kills specific cancer cells through drugs or other substances such as:

  • Tyrosine kinase inhibitors (TKIs) 
  • Imatinib mesylate
  • Sunitinib

Targeted therapies are less harmful to healthy cells than chemotherapy or radiation therapy.

  • Watchful Waiting

Doctors usually monitor the patient’s condition without any further treatment. It is helpful to check the changes in signs and symptoms and whether they appear or not.

  • Supportive Care

The main aim of supportive care is to prevent the patients from symptoms of the disease, side effects, and psychological, social, and spiritual problems related to a disease or its treatment. Supportive care is beneficial for improving the quality of life of patients, especially people who have a serious or life-threatening disease. In some cases, radiation therapy is given for relieving pain in patients with a malignant tumors.

After the treatment, patients should attend follow-up sessions at the prescribed time. If the patients will delay it, then it might be possible for the recurrence of the GIST tumor.

Clinical Trials

Clinical trials are conducted for the introduction of treatments. Some patients are taking part in it by their own choice and implementing new treatment approaches to them.  Clinical trials are part of cancer research. 

Before undergoing the trials, researchers give the standard treatment to the patients. On the basis of the patient's condition after treatment, clinical trials are done to look for a better, safe and effective treatment.

 

Note: Discuss with doctors before being a part of clinical trials.

 

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