GASTROINTESTINAL STROMAL TUMOUR (GIST)

What is Gastrointestinal Stromal Tumour (GIST)?

Gastrointestinal Stromal Tumours (GIST) are a type of tumour that originate in the stroma, which is the supportive tissue of the gastrointestinal (GI) tract. It typically develops in the Interstitial Cells of Cajal, which help control the muscles in the GI tract. GISTs can form anywhere in the digestive system but are most commonly found in the stomach or small intestine, and less commonly, the oesophagus.

GISTs are rare, accounting for about 1-2% of all GI cancers. GISTs can be malignant (cancerous) and can spread (metastasize). Therefore, GISTs require proper diagnosis, staging and treatment options discussed in a cancer multi-disciplinary team (MDT).  

Diagnosis and Staging of GIST

Many GISTs do not cause symptoms in the early stages.

When symptoms do appear, they can vary and may include pain, bloating, nausea, vomiting, or a feeling of fullness. In some cases, GISTs may cause bleeding or obstruction, leading to the diagnosis.

To confirm the presence of a GIST, a combination of tests may be used, including:

  1. Imaging: CT scans (with IV contrast) or MRI are commonly used to detect the tumour and assess its size, location, and possible spread

  2. Endoscopy: Diagnostic endoscopy and/or Endoscopic Ultrasound (EUS)

  3. Biopsy: A small tissue sample may be taken from the tumour to examine under a microscope to confirm the diagnosis of GIST (most commonly taken at the time of an endoscopy)

Treatment Options

Treatment for GIST depends on the size, location, and whether the tumour has spread.

The management of GISTs involves a multidisciplinary approach including specialist surgeons, gastroenterologists, medical oncologists, radiologists & pathologists, and cancer nurse specialists.

The main treatment options include:

  1. Surgical Removal: Surgery is the most common treatment for localised GISTs (tumours that have not spread)

    The goal is to remove the tumour completely. In many cases, the tumour can be removed without having to remove an entire organ (e.g. stomach). In some cases however, due to the size or location, it may be necessary to perform a more extensive operation.

    Wherever possible, Dr. Stokes & Dr. Hammerschlag will utilise minimally invasive surgical techniques to resect GISTs, resulting in smaller incisions, less pain and a quicker recovery

  2. Targeted Therapy: For tumours that cannot be surgically removed or for advanced cases, medications that target the genetic mutations (e.g., Imatinib) can help slow tumour growth and control symptoms. This is typically coordinated by medical oncologists

  3. Radiation Therapy: This may be used in certain cases but is less common for GISTs

  4. Chemotherapy: GISTs do not typically respond well to traditional chemotherapy, but it may be used in some cases where other treatments are ineffective

Prognosis

The outlook for patients with GIST depends on various factors, including:

  • Tumour Size and Location

  • Mutational Status of the tumour

  • Spread of the Disease (metastasis)

  • Overall health of the patient and co-existing medical conditions

Follow-Up Care

After treatment, regular follow-up visits are necessary to monitor for any recurrence or metastasis. This typically includes:

  • Imaging tests to detect any new tumours (regular CT scans)

  • Sometimes blood tests to assess overall health and response to treatment

  • Ongoing support for managing side effects of treatment, if any

Personalised, Compassionate Surgical Care

South East Upper GI Surgical Group warmly welcomes both private and public patients for new consultations and can see urgent referrals quickly, including new cancer diagnoses.