There are also a number of rarer types of GIST:. Some GISTs are discovered through investigations for another medical condition or are diagnosed after surgery. A specialist doctor will diagnose GIST through a series of tests.
These may include:. A clear diagnosis will be made after a pathologist with experience in GIST has examined a tissue sample. Your doctor will use the results of your scans and tests to diagnose you with a GIST and advise you on treatment options. Unfortunately, some people are diagnosed with GIST when it has already spread to other parts of the body. The features that are currently used to determine the risk of the cancer coming back in patients with GIST or of the disease spreading to another part of the body are:.
Large tumours are more likely to behave aggressively than smaller tumours. A small GIST removed when it is less than 2cm in size may not cause problems in the future. Mitotic count is the number of actively dividing cells seen under a microscope within a certain area of the tumour. This tells the doctors the rate at which the cancer cells are multiplying and is an indicator to how aggressive the tumour is. Tumours in the small bowel and rectum appear to be more aggressive than those occurring in the stomach.
If the surface of the tumour was damaged during the operation to remove it, or if the tumour was not intact at the time of the surgery, there is a chance that tumour cells may have escaped into the abdomen. Sometimes this alone will define the tumour as high risk. Your tumour should be sent for mutational analysis. It is important to find out if your GIST is resistant to these drugs if drug treatment after surgery is being considered for you.
Some KIT mutant tumours exon 9 respond better to larger dose of imatinib but treating exon 9 mutations in this way has not been approved in England and Wales. Your MDT will include your key worker or sarcoma clinical nurse specialist, surgeon and other healthcare professionals involved in your care.
What Are Gastrointestinal Stromal Tumors?
They will support you throughout your treatment to ensure you get the right treatment as and when you need it. The type of treatment you receive depends on what part of the GI tract it is in and the risk category of recurrence.
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Your MDT will discuss your case and your doctor or nurse will talk you through your options so you are included in deciding what treatment is best for you. Surgery is usually the first treatment method used for GIST. The surgeon will remove the tumour and will aim to take out an area of normal tissue too; this is known as taking a margin. It allows cancer cells that are not visible to the naked eye to be removed along with the tumour.
This can reduce the risk of the cancer coming back. GIST in the small bowel You may have an operation to remove part of the small bowel. GIST in your stomach You may need to have part or most of your stomach removed. This will affect how you eat. Specialist dietitians can give you advice and support on making changes to your diet.
Some tumours cannot be removed surgically because of the dangers of the procedure or because of the damage removing them would do to vital structures. Other treatment options are considered if this is the case for you. Oral anticancer targeted drugs Patients with tumours that are too large to be removed safely, or those that have already spread to other parts of the body, can be treated using targeted drugs. This mutation tells the GIST cells to grow and multiply and is essential to their survival.
Targeted agents work by blocking the growth signals within the cancer cells generated by the mutation. Sometimes the tumour develops a resistance to Imatinib and hence over time it stops working. If this happens Sunitinib Sutent is used as a second treatment option. The drug Regorafenib Stivarga is used to treat people who have GIST that cannot be operated on or has spread to another part of the body. If you have had treatment with Imatinib and Sunitinib that has not worked or has caused bad side effects then Regorafenib is an alternative treatment.
Treatment before surgery If the tumour was too large to be removed at the time of diagnosis, it may be treated be treated initially with a targeted drug like imatinib.
If sufficient shrinkage has occurred after months, it may be possible to do an operation both more safely and without the need to remove so much of the organ, like the stomach. Some people who have had their tumour removed but are at a high risk of the cancer coming back may have a treatment called adjuvant therapy. Adjuvant therapy is an additional treatment after the first treatment which reduces the risk of the cancer returning. Clinical trials suggest that if it is to be used, giving it for three years is likely to give the best results. You may be offered the opportunity to take part in a study to investigate new diagnosis methods, drugs and treatments.
Some studies also look at the care and well-being of patients. Your doctor or nurse can give you more information on opportunities for you to take part in a clinical trial. A number of clinical trials are underway looking at new drugs that may overcome some of the limitations of the existing drugs used to treat GIST. Some clinical trials are trying to find better ways of using the drugs already available.
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Gastrointerstinal Stromal Tumor (GIST)
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