Gastrointestinal stromal tumor

The article is professionally consulted by Master, Doctor Duong Xuan Loc - Gastroenterologist - General Surgery Department - Vinmec Danang International General Hospital.

Gastrointestinal stromal tumor is a rare type of cancer that affects the digestive tract or nearby structures in the abdomen. From the onset, the disease sometimes silently shows no symptoms, but sometimes causes the patient's health to deteriorate, metastasize to adjacent organs quickly.

Gastrointestinal stromal tumors are soft tissue sarcomas in nature and can be located in any part of the digestive system. Among them, the most common sites of gastrointestinal stromal tumors are the stomach and small intestine. Occasionally, primary gastrointestinal stromal tumors can develop in other organs in the abdominal cavity such as the peritoneum, liver, pancreas, ovaries, uterus, and prostate.
Gastrointestinal stromal tumor can be acquired by anyone and at any age but is most common between the ages of 50 and 70 and almost never occurs before the age of 40. The disease begins in the cells. Specialized nerves are located in the wall of the gastrointestinal tract. These cells are a component of the autonomic nervous system. Any change in the genetic machinery of one of these cells increases the risk of gastrointestinal stromal tumors.

Small gastrointestinal stromal tumors may cause no symptoms, and the disease may progress very slowly without serious consequences throughout life. In contrast, people with larger gastrointestinal stromal tumors will seek medical attention early when they have symptoms of vomiting blood or melena, bloody stools due to rapid bleeding from the tumor.
In addition, other symptoms caused by gastrointestinal stromal tumors may include:
Anemia, due to the tumor bleeding protractedly Abdominal pain Feeling a growing mass in the abdomen Nausea – Vomiting Loss of appetite Losing weight Difficulty swallowing

To date, no environmental or behavioral risk factors have been shown to contribute to gastrointestinal stromal tumor formation. Therefore, the patient should not worry that his diet or lifestyle habits have caused this pathology.
On the other hand, random gene mutations are the obvious cause of gastrointestinal stromal tumors. Indeed, the majority of cases have shown mutations identified in the cell surface proteins isolated from this stromal tumor. However, there are rare cases of gastrointestinal stromal tumors in families due to inherited germline mutations. In addition, people with type 1 polyneuropathy are also at increased risk of developing gastrointestinal stromal tumors.

To diagnose gastrointestinal stromal tumor, your doctor will begin by taking your personal and family history. Next, the doctor performs physical examinations to check for the formation of malignant tumors in the abdomen. If you have signs and symptoms that suggest a gastrointestinal stromal tumor, your doctor will order tests to determine its location and determine the possibility of metastases to other areas. other agency. These tests may include:
3.1. Contrast-enhanced computed tomography For this test, you swallow a liquid that makes your stomach and small intestine more visible under X-rays because of the contrast. You may also get an injection of a similar substance into your bloodstream. The scanner then captures and processes detailed images, allowing for cross-sectional understanding of the abdominal organs as well as showing the size and location of the tumor.

3.2. Colonoscopy The doctor examines the inner lining of the esophagus, stomach, and first part of the small intestine with a flexible tube inserted into the mouth, which is both illuminated and imaged. Not only that, thanks to a colonoscopy, the doctor can take biopsy tissue samples from abnormal lesions on the intestinal wall.
3.3. Endoscopic ultrasound This test also uses an endoscope, but with an extra ultrasound probe at the tip of the tube. When the sound wave from the transducer generates a reverberation, it is received back to the transducer. A computer converts the echoes into images of structures in the abdomen, showing the exact location of the tumor. If the tumor has spread to the liver or peritoneum, these may also be seen on endoscopic ultrasound.

3.4. Fine-needle biopsy A tissue sample from the tumor is needed for the definitive diagnosis of gastrointestinal stromal tumor. The preferred method for biopsy specimens is endoscopic ultrasound combined with fine-needle aspiration. In the laboratory, cells from the tissue sample will be analyzed for the resulting protein product as well as the genetic machinery. Simultaneously, cells from gastrointestinal stromal tumors were examined under the microscope to observe the mitotic rate. The higher the mitotic rate, the higher the possibility of spreading to other organs, the more severe the malignancy.

Small, asymptomatic gastrointestinal stromal tumors found incidentally during testing for another condition are likely to be followed up without intervention. In contrast, large or symptomatic gastrointestinal stromal tumors should be surgically removed unless they are too large or they involve too many organs and tissues that surgery is not possible. Surgery will also be delayed or contraindicated in people with poor general health or distant metastatic small gastrointestinal stromal tumors.
In cases like the one above, drug treatment can be effective with focused targeting of specific abnormalities present in cancer cells. By blocking these abnormalities, the drug can cause cancer cells to die off gradually. For gastrointestinal stromal tumors, the target of these drugs is an enzyme called tyrosine kinase that helps cancer cells grow. Accordingly, Imatinib (Gleevec) is the first targeted therapy used both to shrink tumors before surgery and to prevent recurrence after surgery as well as improve patients' symptoms better.

In summary, gastrointestinal stromal tumor is a rare malignancy in the gastrointestinal tract with any location. Symptoms and long-term prognosis are as severe as other intra-abdominal cancers. However, the most effective way to prevent this is when patients are regularly examined for health, screened and actively treated from the very beginning.

References: liferaftgroup.org, gistsupport.org, webmd.com