Understanding GIST:
A Gastro-Intestinal Stromal Tumour (GIST) is a rare growth that is found in the digestive
system. They account for only 2% of all types of tumour that occur in the digestive system.
GISTs occur more commonly in the stomach but can also be found in the gullet (oesophagus)
and the bowel (intestines). Most GISTs behave in a benign way (non- cancerous) but they can
be- come malignant (have the ability to spread to other places in the body) if not treated.
GISTs are also known as ‘sarcoma’ tumours. This means they occur within the tissues that hold
an organ in place. They are more common in people between the ages of 50 -70 years.
Entire, Gastrointestinal Stromal Tumors are scarce and ranks third in occurence overdue lymphomas and adenocarcinomas among the histological formes of gastrointestinal zone tumours.
These lesions are divided as leiomyosarcomas or leiomyomas since they controlled smooth muscle characteristics when tested under light microscopy.
Because the word GIST was presented by Clark and Mazur in 1983, lab study meant at the sub-cellular and molecular stages have proven that GISTs don’t possess the ultra structural and immunohistochemical characteristic of glossy muscle distinction, as are there in lleiomyosarcomas and eiomyomas.
Hence, the decision is fixed that Gastrointestinal Stromal Tumor don’t rise from glossy muscle cells, but also from mesenchymal differential such as the primogenitors of spindle.
These are GI pacesetter cells and are responsible for starting and aligning GI motion. This finding passed Kindblom to propose the term GI pacesetter cell tumours. Perhaps the critical growth that discerned GISTs as a exclusively medical entity is the invention of proto-oncogene variations in these tumours.
These improvements have conducted the sorting of GISTs like an object classify from glossy muscle tumours, served clarify their pathogenesis and etiology at a molecular stage leading to the growth of molecular-targeted medical aid for this malady. GISTs can form anyplace in the gastrointestinal parcel. They are submucosa wounds, which almost grow frequently endophytically in similar with the lm of the involved structure.
GISTs may apparent as exophytic extraluminal humps. These tumours have described placing in size from 1 to 40 cm diameter. About 50 to 70% of GISTs arise in the belly.
The smaller intestine is the next common place, with 20 to 30% of GISTs developing from the jejunoileum.
Small patronize sites of happening admit the rectum and colon and esophagus Primary mesenteric or omental GISTs are described but are rare. Around 10 to 20 people per million universe are named with GISTs every year.
Results in patients affected by GISTs are extremely besed on the medical performance and the istopathological attribute of the cysts. The overall 5-yr survival rate varies from 28 to 60%. This may be graded for patients with leading disease and those with recurrent or metastatic disease.
The average persistence rate in the earlier group is 5 yrs, when the average persistent rate in the final group is nearly 10 to 20 months. Bigger GISTs are linked with ramifications like GI hemorrhage, GI blockage, and bowel puncture.
Tumours can be confidential into high-risk and low-risk groups depend on mitotic and size pursuit. The suggestions of these tumour features are conferred in Histological findings and prognosis.
Gastrointestinal Stromal Tumor have no identified racial tendency. Vaguely more males are identified with GIST than females, even many reports have resulted in no sex enchant. GISTs are more commonly spotted in the final half of the 6th and the initial half of the 7th decades of life.
In some cases, they are uncovered in early adults. GISTs are really rare in kids.
Is a GIST a cancer?
A GIST is not strictly a cancer. However rarely they can behave like one and become
malignant i.e. spread to other parts of the body. Around in 20 of them can behave in a
cancerous/malignant way: usually the much larger ones. To prevent them becoming malignant
we usually try and remove them with an operation when they get larger than 2cm and if they
are causing bleeding or other symptoms. Larger GISTs are more likely to behave in a
cancerous way and can spread to other parts of the body such as lungs and the liver.
The vast majority do not and once removed they do not tend to cause any further trouble.
What are the symptoms of a GIST?
Small GISTs do not usually cause any symptoms. GISTs tend to bleed so the first sign is often
feeling tired and having a low blood count (anaemia) and/or vomiting blood or passing blood in
the stools. Other symptoms can include pain or discomfort in the stomach or bowels, feeling
bloated, indigestion and feeling sick.
What causes GISTs?
At present we do not know. They do not seem to be linked to any particular diet or lifestyle.
They do not run in families except very rarely.
How are GISTs treated?
Treatment for a GIST depends on the size of the tumour. Ones smaller than 2cm are left
alone: they will grow very slowly and if they get bigger or start bleeding then surgery will be
considered. If they are larger than 2cm the common treatment is surgery and this is often all
that is needed for the majority of these tumours.
Where possible the surgery is done through a keyhole technique (laparoscopic surgery) as most
of them are in the stomach. If the tumour is large or difficult to get to, an open operation may
have to be performed.
Can a GIST be cured?
Small GISTs and those that can be removed surgically are very likely to be cured. Larger
GISTs even if removed, may carry a risk of recurring. In these cases, regular check-ups with
your specialist will be required and sometimes drug treatment is advised.
GISTs that cannot be removed are not curable but drug treatment is available which can help
to control and slow down the growth of the tumour. (See section below on Glivec).
Surgery
Surgery to remove part or all of the stomach is called a ‘gastrectomy’. The type of gastrectomy
depends on the location of the GIST within the stomach. Most GISTs of the stomach require a
local excision; that is removal of the tumour and a small cuff of normal stomach around it.
This type of excision involves less disruption to the normal function of the stomach.
If the tumour is big or located near the exit of the stomach, then a partial gastrectomy is performed, this involves removing about 50% of the stomach. The type of operation you need will be discussed with you by your surgeon.
Positions of wounds
If you would like to know where your operation incisions will be, please ask your surgeon or nurse to draw on the following diagram.
How long will I stay in hospital?
Most people are in hospital for between 2 - 5 days following a laparoscopic removal of a gastric
GIST. If you need an open operation, your stay may be longer (7 days).
Laparoscopic removal of a GIST
Most operations to remove a GIST in the stomach can be performed via a ‘keyhole’ (laparoscopic)
operation
Laparoscopic surgery is always performed under general anaesthetic.
A telescope the width of a small finger is placed into the abdomen through a small cut by the navel. The surgeon can see the inside of the abdomen on a video screen. In order to create space around the organs within the abdomen and provide the surgeon with a clear view it is necessary to introduce carbon dioxide gas to ‘blow up’ the abdomen.
Special instruments are passed through two or three other separate 5-12 mm incisions in the
abdomen as well; these enable the surgeon to retract and manipulate the structures within the
abdomen and remove part of the stomach.
The small incisions will be closed using steri-strips (paper strips), dissolvable sutures or skin glue
and covered with a dressing. The wounds will be sealed within 48 hours after which time you may
remove the dressing and have a bath or shower.
What are the risks/complications of laparoscopic gastric surgery?
Bleeding from the edges of the stomach is a rare complication - this can result in
vomiting blood or passing blood in stools and may need further surgery to stop the
bleeding
Occasionally it may prove impossible to proceed with the laparoscopic approach so
an open procedure would be carried out
Wound infection – minor wound infections do not need any specific treatment.
Occasionally a more serious infection may need antibiotic treatment
Chest problems
Any operation near the diaphragm will affect breathing afterwards; chest infection is a common
occurrence after gastric surgery. About a quarter of patients will require antibiotics for this.
If you
have chest problems to start with (asthma, COPD or smoking-related chest problems) then a
chest infection after the operation can be severe and very occasionally life-threatening.
Pain Control
After a major operation, you may experience some dis- comfort. This is usually controlled by
either regular pain killers or sometimes the epidural method of pain relief.
This involves inserting
a thin plastic tube in your back just before the operation. It is attached to a pump to give you
continuous pain relieving medication until you are ready to take tablets.
The anaesthetist will
Discuss this with you before the operation. It is important to make sure you have adequate pain
relief so you can move around and cough to prevent complications.
The physiotherapists will
work closely with you to help your lungs recover and prevent breathing complications. This is the
most important part of your recovery process.
Eating after surgery
Once you are allowed to start eating after the surgery (usually two or three days post operatively),
a dietitian may see you to advise you about your diet and give you advice about meals.
Having
part of the stomach removed will mean you may need to eat smaller and more frequent meals.
Please do not hesitate to ask the dietician any questions as it is important that you know what
type of food you should be eating and when.
You will be able to eat normal solid foods and with
time you will probably manage to eat larger portions.
Will I need further follow up and treatment after surgery?
Following surgery your surgeon will speak to you about whether you need any further follow up or
any further treatment and this will depend on the pathology report and the size of the tumour.
Small tumours require no further follow up but for medium sized tumours (around 5cm) we like to
see you on a yearly basis and arrange a CT scan intermittently.
Some people will benefit from having drug treatment after surgery. See Glivec section for further
information.
Non – surgical treatment
When a GIST tumour is too large to remove or has spread to other parts of the body, drug
treatment is commonly used to shrink and control it.
The drug commonly used is called Glivec
(Imatinib). Glivec can work effectively at controlling and stopping the growth of GIST tumours for
an average of 2 years.
In some cases the drug treatment shrinks the tumour enough to allow an
operation to be performed.
Glivec drug treatment
Glivec is a drug that is extremely good at treating large malignant GIST tumours. It is a type of
biological therapy called a tyrosine kinase inhibitor and the National Institute of Clinical
Excellence (NICE) has recommended that it should be the first choice of treatment for people
with GISTs that cannot be removed.
Glivec is a tablet and you can have the treatment at home.
Side effects can include:
Tiredness
Feeling sick
Fluid retention – causing puffiness around the eyes, swollen hands and feet
Skin rash
Useful contacts for further information
www.gistsupport.co.uk
