Gastrointestinal stromal tumor natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
If left untreated, patients with gastrointestinal stromal tumors (GIST) may progress to develop abdominal pain, abdominal distension and perforation. A benign GIST may remain unchanged for years before its progression into malignancy. A GIST may rupture and lead to intra-abdominal or gastrointestinal bleeding. Ultimately, the GIST may metastasize and turn fatal. Common complications of GIST include bowel obstruction, bowel perforation, and peritonitis. Depending on the extent of the tumor at the time of diagnosis, the prognosis of GIST may vary. Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor. A benign GIST treated with surgical resection has much more better outcome as compared to patients with malignant GIST.
Natural history
- Around 75% patients of gastrointestinal stromal tumors (GIST) are asymptomatic and are diagnosed as an incidental finding on imaging studies done for other reasons.
- If left untreated, patients with GIST may progress to develop abdominal pain, abdominal distension and perforation.
- Depending upon the type of GIST (benign or malignant), a benign GIST may remain unchanged for years before its progression into malignancy.[1]
- GIST are highly vascular and an untreated tumor may attain massive size leading to rupture and intra-abdominal or gastrointestinal bleeding.
- A ruptured GIST may lead to coffee ground emesis, black stools or even melena.
- Ultimately, the GIST may metastasize and turn fatal.
Complications
Common complications of GIST include:[2]
- Gastrointestinal bleeding
- Bowel obstruction
- Bowel perforation
- Peritonitis
- Volvulus
- Intussusception
- Surgical complications associated with resection include:
Prognosis
- Depending on the extent of the tumor at the time of diagnosis, the prognosis of GIST may vary.[3]
- Prognosis of GIST depends upon size, location, spread and mitotic rate of the tumor (mitoses per 50 high-power fields).[4][5][6][7][8]
- Patients with gastric GIST have been reported to have better outlook as compared to patients with extragastric GIST.
- Patients with localized primary disease have a average survival period of 5 years.
- Patients with malignant lesions and metastasis have an average survival period of 1-2 years.
- Patients with mitotic rate of >10 per 50 HPF have an average survival period of 1.5-2 years
- Patients with mitotic rate <10 per HPF have an average survival period of 8 years.
Refrences
- ↑ Antonopoulos P, Leonardou P, Barbagiannis N, Alexiou K, Demonakou M, Economou N (2014). "Gastrointestinal and extragastrointestinal stromal tumors: report of two cases and review of the literature". Case Rep Gastroenterol. 8 (1): 61–6. doi:10.1159/000354724. PMC 3975174. PMID 24707244.
- ↑ Sorour MA, Kassem MI, Ghazal A, El-Riwini MT, Abu Nasr A (2014). "Gastrointestinal stromal tumors (GIST) related emergencies". Int J Surg. 12 (4): 269–80. doi:10.1016/j.ijsu.2014.02.004. PMID 24530605. Vancouver style error: initials (help)
- ↑ "Risk Assessment and Prognosis".
- ↑ Dematteo RP, Heinrich MC, El-Rifai WM, Demetri G (2002). "Clinical management of gastrointestinal stromal tumors: before and after STI-571". Hum. Pathol. 33 (5): 466–77. PMID 12094371.
- ↑ Crosby JA, Catton CN, Davis A, Couture J, O'Sullivan B, Kandel R, Swallow CJ (2001). "Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database". Ann. Surg. Oncol. 8 (1): 50–9. PMID 11206225.
- ↑ Conlon KC, Casper ES, Brennan MF (1995). "Primary gastrointestinal sarcomas: analysis of prognostic variables". Ann. Surg. Oncol. 2 (1): 26–31. PMID 7834450.
- ↑ Güller U, Tarantino I, Cerny T, Schmied BM, Warschkow R (2015). "Population-based SEER trend analysis of overall and cancer-specific survival in 5138 patients with gastrointestinal stromal tumor". BMC Cancer. 15: 557. doi:10.1186/s12885-015-1554-9. PMC 4518595. PMID 26223313.
- ↑ Carney JA (1999). "Gastric stromal sarcoma, pulmonary chondroma, and extra-adrenal paraganglioma (Carney Triad): natural history, adrenocortical component, and possible familial occurrence". Mayo Clin. Proc. 74 (6): 543–52. doi:10.4065/74.6.543. PMID 10377927.